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Patho Reproductive System

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The structure and function of both male and female reproductive systemes depend on interactions among the

  • central nervous system (hypothalamus)
  • endocrine system (anterior pituitary)
  • gonads (ovaries, testes)
  • hypothalamic-pituitary-gonadal (H-P-G) axis

A set of complex neurological and hormonal interaction accelerate at puberty and lead to sexual maturation and reproductive capability


At puberty, extrahypothalamic factors cause the hypothalamus to secrete..... Finish the cycle

GnRH (gonadotropin-releasing hormone) --->stimulates anterior pituitary---> which secretes the FSH and LH---->that stimulate the gonads (ovaries and testes)---> which then secrete (estrogen and progesterone) female or male (testosterone) sex hormones.


When is puberty complete in females and males?

Female= with the first ovulatory menstrual period completed

Males= with the first ejaculation that contains mature sperm


What is the uterus?

What are its three layers?

is the hollow, muscular organ in which a fertilized ovum develops until birth.

  • endometrium= lining
  • myometrium= muscular layer
  • perimetrium= outer covering, which is continuous with the pelvic peritoneum.

What is happening in the uterus when a female is going to menstruate?

The enodmetrium proliferates (thickens) and is shed in response to cyclic changes in levels of female sex hormones, The cervix is the narrow, lower portion of the uterus that opens into the vagina.


Fallopian tubes

extend from the uterus to the ovaries. Their function is to conduct ova from the spaces around the ovaries to the uterus. Fertilization normally occurs in the distal third of the Fallopian tubes.


Ovaries are the site of

  • ovum maturation and release
  • production of female sex hormones (estogen, progesteron)
  • production of androgens

The female sex hormones are involved in

  • sexual differentiation and development
  • menstrual cycle
  • pregnancy
  • lactation

Although they are primarly male sex hormones, androgens in women are recursors of female

sex hormones and contribute to the prepubertal growth spurt, pubic and axillary hair growth, and activation of sebaceous glands


Estrogen (primarily estradiol) is produced by cells in the developing

ovarian follicle (structure that encloses the ovum)


Progesterone is produced by cells of the

corpus luteum, the structure that develops from the ruptured ovarian follicle after ovulation (ovum release)


Androgens in females are produced within the

ovarian follicle, adrenal glands, and adipose tissue


Menstrual cycle 3 phases

  • follicular/proliferation phase
  • the luteal/secretory phase
  • and menstruation

average cycle is 27-30 days


Ovarian events of the menstrual cycle---> gonadotropins and follicular secretion of inhibin

High FSH----> stimulate follicle of ovum maturation (follicular phase) ----> then surge of LH causes ovulation----> which is followed by development of the corpus lutem (luteal phase)


Cyclic changes in hormones levels also cause

thinning and thickening of the vaginal epithelium, thinning and thickening of cervical secretions, and changes in basal body temperature


Milk production occurs in response to

prolactin, a hormone that is secreted in larger amounts after childbirth. Milk ejection is under the control of Oxycontin, another hormone of pregnancy and lactation


The male hormones are produced

steadily rather than cyclically


Describe the hormonal stimulation of the reproductive systems; note characteristics of puberty

Review pages 774-777; figures 31-1 through 31-3 and Table 31-1


Describe the phases of the menstrual cycle, noting its differential hormonal effects

Review pages 784-787; refer to Figure 31-9 and Tables 31-2 and 31-3


Precocious puberty

can be defined as sexual maturation before age 6 years in age in black girls, or age 7 years in white girls and before 9 years in boys.


In 95% of cases of delayed puberty,

hormonal levels are normal and the hypothalamic -pituitary -gonadal axis is intact, but maturation occurs slowly


Sexual maturation, or puberty, should begin

girls= 8-13

boys= 9-14


Polycystic ovary syndrome (PCOS)

is a condition in which excessive androgen production is triggered by inappropriate secretion of gonadal androgen production is triggered by inappropriate secretion of gonadotropins. This hormonal imbalance prevents ovulation and causes enlargement and cyst formation in the ovaries, excessive endometrial proliferation, and often hirsutism.


what plays a key role in androgen excess in women?



Premenstrual syndrome (PMS)

is the cyclic recurrence of physical, psychological, or behavioral changes distressing enough to disrupt normal activities or interpersonal relationships. Emotional symptoms, particularly depression, anger, irritability, and fatigue, are reported as the most distressing symptoms; physical symptoms tend to less problematic. Treatment is symptomatic and includes self-help techniques, lifestyle changes, counseling, and medication.


Pelvic inflammatory disease (PID)

is and acute ascending infection of the upper genital tract caused by sexually transmitted pathogen, Untreated PID can lead to infertility


Benign ovarian cysts develop from

mature ovarian follicles that do not release their ova (follicular cysts) or from a corpus luteum that persists abnormally instead of degenerating (corpus luteum cysts).

Cysts usually regress spontaneously.


Leiomyomas, also called uterine fibroids

are benign tumors arising form the smooth muscle layer of the uterus, the myometrium.


Endometriosis is the presence of functional endometrial tissue

tissue that responds to hormonal stimulation

at sites outside the uterus. Endometriosis causes and inflammatory reaction at the site of implantation and is cause of infertility


Most cancers of the female genitalia involve the

uterus (endometrium is most common), the cervix, and the ovaries. Cancer of the vagina is rare.


Cervical cancer arises from the cervical epithelium and is triggered by


The progressively serious neoplastic alterations are vertical intraepithelial neoplasia (cervical dysplasia), cervical carcinoma in situ, and invasive cervical carcinoma, Smoking is a cofactor.


Risk factors for endometrial cancer include exposure to

  • unopposed estrogen
  • obesity
  • high fat diet
  • infertility
  • no pregnancies
  • late menopause
  • diabetes
  • hypertension
  • Hormonal contraception protects against endometrial and ovarian cancers. The incidence of endometrial caner is greatest among women in their 50-60 's

risk factors for ovarian cancer include

  • family history
  • residence in an industrialized country
  • prior breast or endometrial caner
  • infertility
  • early menopause
  • obesity
  • high fat diet
  • exposure to asbestos or talc

ovarian cancer causes more deaths that any other genital cancer in women


Urethritis causes urinary symptoms

including a burning sensation during urination (dysuria), frequency, urgency, urethral tingling or itching, and clear or purulent discharge


Phimosis and paraphimosis are

penile disorders involving the foreskin, In phimosis, the foreskin cannot be retracted over the glans, in paraphimosis the foreskin is retracted and cannot be reduced (returned to its normal anatomic position overall the galns). Phimosis is causes by poor hygiene and chronic infection and can lead to paraphimosis. Paraphimosis can constrict to penile blood vessels, preventing virulation to the glans


Peyronie diseaase consits of

fibrosis affecting the corpora cavernosa, which causes penile curvature during erection. Fibrosis prevents engorgement on the affected side, causing a lateral curvature that can prevent intercourse.


Priapism is a prolonged q

painful erection that is not stimulated by sexual arousal. Th corpora cavernous (nut not the corpus spongisum) fill with blood will not drain from the area, probably because of venous obstruction.


Priapism is associated with

spinal cord trauma, sickle cell disease, leukemia, and pelvic tumors. It can also be idiopathic


A varicocele is an abnormal dilation

of the veins within the spermatic cord caused either by congenital absence of valves in the internal spermatic vein or by acquired valvular incompetence


Cryptorchidism is a congenital condition in which

one or both testes fail descend into the scrotum. Uncorrected crypotorchidism is associated with infertility and significantly increased risk of testicular cancer


Testicular torsion is the rotation of the a

TESTIS, WHICH TWISTS BLOOD VESSELS IN THE SPERMATIC CORD. This interrupts the blood supply to the testis, resulting in edema and, if not corrected within 6 hours, necrosis and atrophy of testicular tissues.


Testicular cancer

the most common malignancy in males 15-35 years of age. Although its cause is unknown, high androgen levels, geneticpredisposition, and history of cyrptorchidism, trauma, or infection may contribute to tumorigenesis



and inflammation of the epididymis, is usually caused by a sexually transmitted pathogen that ascends through cas deferentia from an already infected urethra or bladder.


Benign prostatic hyperlasia (BPH)

also called benign prostatic hypertrophy

is the enlargement of the prostate gland. This condition becomes symptomatic as the enlarging prostate compresses the urethra, causing symptoms of bladder outlet obstruction and urine retention


Prostatitis is

inflammation of the prostate.

Prostatitis syndromes have been classified by the Nation Institues of Health as

  1. acute bacterial prostatitis (ABP)
  2. chronic bacterial prostatitis (CBP)
  3. chronic pelvic pain sysndrome (CPPS)
  4. asymptomatic inflammatory prostatitis

Prostate cancer is the

the most common cancer in American males, and the incidence varies greatly worldwide. Possible causes include genetic predispositon, environmental and dietary factors, inflammation, and alterations in levels of hormones (testosterone, dihydotertosterone, and estradiol)

and growth factors. Incidence is greatest among northwestern European and North American men (particularly black) older than 65 years



or inappropriate lactation, is the persistent secretion of a milky substance by the breast of a woman who is not in the postpartum state or nursing an infant. Its most common cause is nonpureperal hyperprolactinemia, a rise in serum prolactin levels


Non proliferatic lesions include

fibrocystic changes (FCC). In addition to FCC, many women experience several other types of beign breat tumors


Ductal carcinoma in situ (DCIS)

refers to a heterogeneous group of lesions, presumably malignant epithelial cells, within the ductual system. Because presumably malignant epithelial cells, within the ductal system. Because not all DCIS lesions progress to invasion or become clinically significant, the main concern is which DCIS lesions become invasive. Lobular carcinnoma in situ (LCIS) originates form the duc-lobular unit.


Brest cancer is the most

common form of cancer in women and second to lung cancer as the most common cause of caner death. It is a heterogeneous disease with diverse molecular, phenotype, and pathologic changes


The major risk factors for breast cancer are

  • reproductive factors
  • hormonal factors
  • growth factors

such as excessive estradiol and IGF-1; familial factors, such as a family history of breast cancer; and environmental factors, such as ionizing radiation, Physical activity and lack of postmenopausal weight gain may be risk-reducing factors


The exact molecular events leading to breast invasion are complex and not completely understood.

These events include genetic and epigenetic alterations and cancer cell and stomal interactions. Approximately one third of breast cancers are hormone dependent (progesterone receptor positive or estrogen receptor positive)


Most breast cancers arise from

the ductal epithelium and then my metastasize to the lymphatics, opposite breast, abdominal cavity, lungs, bones, kidneys, liver, adrenal glands, ovaries, and pituitary glands


The first clinical manifestation of breast cancer is

usually a small, painless lump in the breast. Other include palpable lymph nodes in the axilla, dimpling of the skin, nipple and skin reaction, nipple discharge, ulceration, reddened skin, and pone pain associated with bony metastases



is the over development (hyperplasia) of breast tissue in a male. It is first seen as a firm, palpable mass at least 2cm in diameter and is located in the subareolar area


Effects of estrogen and progesterone

card image

Luteinizing hormone (LH) from the anterior pituitary stimulates the corpus
luteum to secrete

progesterone, which initiates the secretory phase of endometrial development. If conception
occurs, the nutrient-laden endometrium is ready for implantation. If conception and implantation do not occur,
the corpus luteum degenerates and ceases its production of progesterone and estrogen.


PMS is the

cyclic recurrence in the luteal phase of the
menstrual cycle of physical, psychologic,
or behavioral changes distressing enough to impair interpersonal relationships
or usual activities.


exaggerated feelings of depression with psychosocial
impairment known as

premenstrual dysphoric disorder
(PMDD). PMS/PMDD is believed to be the end result of
abnormal tissue response to the normal hormone changes
of the menstrual cycle. Fluctuating estrogen and progesterone
levels may trigger this biologic response.


Primary dysmenorrhea

Excessive endometrial prostaglandin F (PGF) production causes painful
menstruation, increases myometrial contractions, and constricts blood


Secondary dysmenorrheal

Results from endometriosis, pelvic adhesions, uterine fibroids, and


Amenorrhea Primary

Menarche failure; no menstruation by 14 years of age with no secondary
sex characteristics or the absence of menstruation by 16 years of age
regardless of the presence of secondary sex characteristics


Amenorrhea Secondary

Menstruation ceases following menarche; anovulation


Dysfunctional uterine bleeding (DUB)

Progesterone deficiency or estrogen excess; an imbalance between
progesterone and estrogen


Heavy or irregular bleeding caused by
disturbance of menstrual cycle

Estrogen proliferates endometrium, whereas progesterone limits it; large
mass of tissue is available for heavy, irregular bleeding


Polycystic ovarian syndrome (PCOS)
DUB and amenorrhea

Related to hypertension, hyperinsulinemia, and dyslipidemia; leads to
infertility, hirsutism, acne, endometrial hyperplasia, cardiovascular
disease, and diabetes mellitus


Causes of amenorrhea include

altered gonadotropin levels, altered ovarian hormone secretion, Turner syndrome,
congenital and acquired central nervous system (CNS) defects, and anatomic malformations of the reproductive


PID is an acute inflammatory process caused by

PID involves organs of the upper genital tract, uterus, fallopian
tubes or uterine tubes, or ovaries. In its most severe form, the
entire peritoneal cavity may be involved.


Infection of the fallopian
tubes is



infection of the ovaries is



Most cases of PID are caused by

sexually transmitted microorganisms
that ascend from the vagina to the uterus, fallopian
tubes, and ovaries.
PID is considered a polymicrobial infection with the
majority of cases being caused by gonorrheal or chlamydial
microbes, such as anaerobes and facultative organisms.
These organisms may induce a response that causes
necrosis with repeated infections and may predispose a
woman to PID. After one episode of pelvic infection,
15% to 25% of women experience long-term sequelae
such as infertility, ectopic pregnancy, chronic pelvic pain,
and pelvic adhesions. The incidence of complications
increases markedly with repeated infections.


Leiomyomas (smooth

  • Unknown; hormonal fluctuations
    alter size
  • Abnormal or increased
    uterine bleeding, pain,
  • treatment: Gonadotropinreleasing
    (GnRH) agonist,
    oral contraceptives

Urethritis is an

inflammatory process usually caused
by sexually transmitted microorganisms

`Symptoms of urethritis include urethral tingling
or itching or a burning sensation during urination.
Frequency, urgency, and purulent or clear mucus-like
discharge from the urethra may occur. Treatment is
appropriate antibiotic therapy for infectious urethritis and
avoidance of mechanical irritation.


Phimosis and paraphimosis are both disorders in
which the

penile foreskin, or prepuce, is “too tight”
to be moved easily over the glans penis. In phimosis,
the foreskin cannot be retracted back over the glans;
in paraphimosis, the foreskin is retracted and cannot
be moved forward to cover the glans. Phimosis can
occur at any age and is most commonly caused by
poor hygiene and chronic infection.


Peyronie disease is a fibrotic condition that causes

lateral curvature of the penis during erection. The
problem usually affects middle-aged men and is associated
with painful erection, painful intercourse for both
partners, and poor erection distal to the involved area.
There is no definitive treatment for Peyronie disease.


Varicocele, hydrocele, and spermatocele are common

intrascrotal disorders


Varicocele is an

abnormal dilation
of a vein within the spermatic cord

is incompetence or congenital absence of
valves in the spermatic veins that normally prevent backflow
of blood. Thus, blood pools in the veins rather than
flowing into the venous system. Decreased blood flow
through the testis interferes with spermatogenesis and
can cause infertility.


Cryptorchidism is a condition in which one or both

testes fail to descend into the scrotum

is associated with lowered
sperm count and impaired fertility. Undescended testes
are susceptible to neoplastic processes. Treatment often
begins with administration of human chorionic gonadotropin.
If hormonal therapy is not successful, the testis is
located and moved into the scrotum surgically.


Torsion of the testis is a condition

wherein the testis
rotates on its vascular pedicle; this position interrupts its
blood supply. Onset may be spontaneous, or torsion may
follow physical exertion or trauma. If the torsion cannot
be reduced manually, surgery must be performed within
6 hours after the onset of symptoms to preserve normal
testicular function



or inflammation of the epididymis,generally occurs in sexually active young males. In young men, the usual cause is a sexually transmitted microorganism.

Acute and severe scrotal or inguinal pain is caused by
inflammation of the epididymis and surrounding tissues.
The individual may have pyuria and bacteriuria and a
history of urinary symptoms, including urethral discharge.
Complications of epididymitis include abscess
formation, infarction of the testis, recurrent infection,
scarring of epididymal endothelium, and infertility.


BPH, formerly called benign prostatic hypertrophy,
causes problems as

enlarged prostatic tissue compresses
the prostatic urethra. More than half of all men between
60 and 69 years of age have prostatic enlargement.


Prostatitis is an

inflammation of the prostate usually
limited to a few of the gland’s excretory ducts. Prostatitis
is categorized as acute bacterial prostatitis, chronic bacterial
prostatitis, or nonbacterial prostatitis.



or inappropriate lactation, is the persistent
and sometimes excessive secretion of a milky
fluid from the breast of a woman who is not pregnant or
nursing an infant.

excessive prolactin in the blood unrelated
to pregnancy or childbirth. This excess prolactin can be
caused by any factor that stimulates prolactin secretion
from the pituitary gland, that interferes with prolactininhibiting
factor (PIF), which inhibits prolactin secretion
(probable dopamine), or that interferes with pituitary
receptors for PIF.


Gynecomastia is the

overdevelopment of breast tissue
in a male.

Gynecomastia usually involves an imbalance of the
estrogen-testosterone ratio. The ratio can be altered by
tumor- and drug-induced hyperestrogenism, which raises
the estrogen levels while testosterone levels remain normal.
Gynecomastia also can be caused by increased breast
tissue responsiveness to estrogen or decreased responsiveness
to androgen.

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