HUMAN

REPRODUCTIVE
DISORDERS
(Male and
Female)
Submitted by:
Khristen Anne M. Rafols
II - Mendel

Submitted to:
Mrs. Jennet Mañalac
Science II Teacher
 A reproductive disorder, also known as a reproductive system disease, is an abnormality in the reproductive system of males or females that prevents reproduction. These can be
genetic or congenital abnormalities or be transmitted sexually. Reproductive diseases or disorders can affect both men and women and are sometimes caused by infections or tumors. Testing and
treatment may be available for various types of diseases or disorders, however, medical science hasn't found the solution to all problems yet.
Some Reproductive Disorders:

Endometriosis
* occurs when the endometrium--which normally lines a woman's uterus--grows in other places. The most common incursions are the fallopian tubes, ovaries or the tissue lining a
woman's pelvis. The problem occurs because the lining acts just as it normally would during a woman's menstrual cycle--it thickens, then breaks down every month. The blood normally
passed during menstruation is trapped from this displaced lining and irritates surrounding tissue.

Prostate Cancer
* affects the small walnut-shaped gland in men and can hinder the production of seminal fluid--the fluid vital to sperm's nourishment and transportation. This cancer occurs when
cells in the prostate multiply or mutate very quickly, sometimes spreading to other areas of the body. Despite the rapid growth of the cells, the cancer usually grows slowly, remaining
confined to the prostate gland. If detected early, there is a better chance of successful treatment.

Vaginitis
* The most common disease of the reproductive system affecting women is vaginitis, which is an inflammation of the vagina. This disease can be caused by a change in the normal
balance of vaginal bacteria, an infection or reduced estrogen levels after menopause. Symptoms of this disease vary, with some women experiencing vaginal discharge, itching or pain, and
some experiencing no symptoms whatsoever. Vaginitis can be treated successfully with antibiotics.

Syphilis
* A sexually transmitted bacterial infection, syphilis starts as a painless sore on your genitals, mouth or other body part. The disease progresses in stages, each more serious than the
last. Syphilis can lead to serious complications if left untreated, such as blindness, seizures and dementia. Treatment for syphilis is a simple matter of antibiotics, but it must be diagnosed and
caught in the early stages for the cure to be effective.

Polycystic Ovary Syndrome

* refers to the condition of the ovaries in affected women--enlarged and covered in numerous small cysts. PCOS is one of the most common hormonal disorders in women of
reproductive age and can display symptoms such as abnormal menstrual periods and excess hair growth. Long-term complications and risks can occur in undiagnosed cases, such as type 2
diabetes, heart disease and stroke.

Reproductive Infertility
* failure to achieve pregnancy after one year of regular, unprotected intercourse. Most frequent cause of infertility in males is low sperm count and/or a large proportion of abnormal
sperm, which can be due to environmental influences. Body weight is most significant factor in causing female infertility. In women of normal weight, fat cells produce a hormone called
leptin that stimulates hypothalamus to release GnRH. In overweight women, ovaries often contain many small follicles, and woman fails to ovulate. Other causes of infertility in females are
blocked uterine tubes due to pelvic inflammatory disease and endometriosis. 

Genital warts
* caused by human papillomaviruses (HPVs) and are seen on penis, foreskin of men, near vaginal opening in women. A newborn can become infected while passing through birth
canal.

Genital herpes
* caused by herpes simplex virus. Type 1 usually causes cold sores and fever blisters, while type 2 more often causes genital herpes. Persons usually get infected with herpes simplex
virus type 2 when they are adults. Symptoms includes itching sensation, painful ulcers, fever, pain on urination, swollen lymph nodes in groin, and in women, a copious discharge. At this
time, individual has an increased risk of acquiring an HIV infection.

Chlamydia
* named for tiny bacterium that causes it (Chlamydia trachomatis). Chlamydia infections of lower reproductive tract are usually mild or asymptomatic, especially in women.
Women may have a vaginal discharge along with symptoms of a urinary tract infection. Chlamydia also causes cervical ulcerations, which increase risk of acquiring HIV. If infection is
misdiagnosed or if a woman does not seek medical help, there is a particular risk of infection spreading from cervix to uterine tubes so that pelvic inflammatory disease (PID) results.

Gonorrhea
* caused by bacterium Neisseria gonorrhoeae. Typical symptoms are pain upon urination and a thick, greenish-yellow urethral discharge. In males and females, a latent infection
leads to pelvic inflammatory disease (PID), which can also cause sterility in males. Gonorrhea proctitis, an infection of anus characterized by anal pain and blood or pus in feces, also occurs
in patients. Oral/genital contact can cause infection of mouth, throat, and tonsils. Gonorrhea can spread to internal parts of body, causing heart damage or arthritis.

©Rafols
 PREMENSTRUAL SYNDROME

Premenstrual Syndrome:  Also called PMS   -The effects of this disorder ranges from minimal discomfort to severe, disruptive behavioral and somatic changes.  Symptoms usually appear 7 to 14 days before menses and usually subside with its onset.

Cause:  Direct cause unknown, PMS may result from a progesterone deficiency in the luteal phase ot the menstrual cycle or from an increased estrogen-progesterone ratio.  Approximately 10% of patients with PMS have elevated prolactin levels

Symptoms:

Behavioral changes:  Mild to severe personality changes

Nervousness
Hostility
Irritability
Agitation
Sleep disturbance
Fatigue
Lethargy
Depression
Somatic changes :
Breast tenderness or swelling
Abdominal tenderness or bloating
Joint pain
Headache
Edema
Diarrhea or constipation
Patient may also experience exacerbations of skin problems such as; ache - respiratory problems such as asthma, and neurologic problems such as seizures.

Treatment:

Treated symptomatically:  treatment may include;

Antidepressants, NSAID's (nonsteroidal anti-inflammatory drugs),
Vitamins
Tranquilizers
Sedatives
Progestins
Treatment may require; a diet that is low in simple sugars, caffeine, and salt, with adequate amounts of protein, high amounts of complex carbohydrates, and possibly, vitamin supplements formulated for PMS
There is also a self - help groups that exist for women with PMS check in your local area.
 

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 OVARIAN CYSTS

Ovarian Cysts:  Usually, these cysts are nonneoplastic sacs that contain fluid or semisolid material.  Ovarian cysts are usually small and produce no symptoms, ovarian cysts should be thoroughly investigated as possible sites of malignant change.  
Common types ;include follicular, cysts, which are usually very small, semitransparent, and fluid-filled; and lutein cysts, including corpus luteum cysts, which are functional, nonneoplastic enlargements of the ovaries; and theca-lutein cysts, which are
commonly bilateral and filled with clear, straw-colored fluid.  Polycystic (or sclerocystic) ovary disease is part of the Stein-Leventhal syndrome.
Ovarian cysts can develop any time between puberty and menopause, including during pregnancy.  Corpus luteum cysts occur infrequently, usually during early pregnancy.

Cause: Follicular cysts arise from follicles that over distend instead of going through the atretic stage of the menstrual cycle.   Corpus luteum cysts are caused by excessive accumulation of blood during the hemorrhagic phase of the menstrual cycle.  
Theca-lutein cysts are commonly associated with hydatidiform mole, choriocarcinoma, or hormone therapy.  Polycystic ovary disease results from endocrine abnormalities.

Symptoms:
Usually small cysts produces no symptoms, unless torsion or rupture causes signs of acute abdomen.
Low back pain
Mild pelvic discomfort
Dyspareunia ( difficult and or painful intercourse)
Abnormal uterine bleeding
Acute abdominal pain (similar to that of appendicitis) -in ovarian cysts with torsion
In corpus luteum cysts appearing early in pregnancy, the patient may develop unilateral pelvic discomfort and (with rupture) massive intraperitoneal hemorrhage.
In polycystic ovary disease, the patient may develop amenorrhea ( abnormal absence or stoppage of menses), Oligomenorrhea (abnormally infrequent menstruation), or infertility secondary to the disorder as well as bilaterally enlarged ovaries.

Treatment:
Follicular cysts usually don't require treatment because they tend to disappear spontaneously within 60 days.   If they interfere with daily activities, Clomiphene citrate P.O. for 5 days or progesterone I.M. for 5 days, reestablishes the ovarian hormonal
cycle and induces ovulation.
Oral contraceptives may also accelerate involution of functional cysts (including both types of lutein cysts and follicular cysts).
Treatment for corpus luteum cysts that occur during pregnancy is symptomatic because these cysts diminish during the third trimester and rarely require surgery.
Theca-lutein cysts disappear spontaneously after elimination of hydatidiform mole or choriocarcinoma, or discontinuation of HCG or clomiphene citrate therapy.
Polycystic ovary disease treatment may include; drugs, such as clomiphene citrate to induce ovulation or if drug therapy fails to induce ovulation, surgical wedge resection of one-half to one-third of the ovary.
Surgery may become necessary for both diagnosis and treatment.  For example, a cyst that remains after one menstrual period should be removed.  Pathologic studies confirm the diagnosis.
 

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 ENDOMETRIOSIS

Endometriosis:  Endometrial tissue appears outside the lining of the uterine cavity.   This ectopic tissue usually remains in the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and the cul-de-sac, but it
can appear anywhere in the body. Active endometriosis usually occurs between ages 30 and 40, more so in women who postpone child-bearing.   It is uncommon before age 20.  Severe symptoms of endometriosis may occur abruptly ore develop slowly
over many years.  Endometriosis usually becomes progressively severe during the menstrual years, and subsides after menopause.  Infertility is the primary complication.  Spontaneous abortion may also occur.

Cause:  Direct cause is unknown, but familial susceptibility or recent surgery that required opening the uterus may predispose a woman to edometriosis.  Researcher shows the possible cause of endometriosis are: 
1.) trasportation---during menstruation, the fallopian tubes expel endometrial fragments that implant of the ovaries or pelvic peritoneum  
2.) formation in situ--inflammation or a hormonal change triggers metaplasia (differentiation of coelomic epithelium to endometrial epithelium)  
3.) induction--this is a combination  of transportation and formation in situ and is the most likely cause.  The endometrium chemically induces undifferentiated mesenchyma to form endometrial epithelium

Symptoms:
Dysmenorrhea (painful menstruation)--  Pain usually begins 5 to 7 days before menses reaches its peak and last for 2 to 3 days.  It is less cramping and less concentrated in the abdominal midline than primary dysmenorrheal pain.
Lower abdominal pain and in the vagina --
Pain to posterior pelvis and back
Multiple tender nodules on uterosacral ligaments or in the rectovaginal system.  They enlarge and become more tender during menses.  Ovarian enlargement may also be evident.
Other symptoms depend on the location of the ectopic tissue:
Ovaries and oviducts--infertility and profuse menses
Ovaries or cul-de-sac--deep-thrust dyspareunia (painful intercourse)
Bladder--suprapubic pain, dysuria (painful or difficulty urinating), hematuria (Presence of blood in the urine)
Rectovaginal septum and colon--painful defecation, rectal bleeding with menses, pain in the coccyx or sacrum
Small bowel and appendix--nausea and vomiting, which worsen before menses, and abdominal cramps
Cervix, vagina, and perineum--bleeding from endometrial deposits in these areas during menses

Treatment:
Treatment varies according to the stage of the disease and t he patient's age and the desire t have children.
For young women who want to have children includes:  androgens, such as danazol, which produce a temporary remission in Stages I and II.  Oral contraceptives and progestins also relieve symptoms.
Stage III and IV (when ovarian masses are present), they should be removed to rule out cancer.   The patient may undergo conservative surgery, but the treatment of choice for women who don't want to bear children or who have extensive disease
(StageIII and IV) is a total abdominal hysterectomy performed with bilateral salpingo-oophorectomy.
 

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 UTERINE LEIOMYOMAS/MYOMAS/FIBROMYOMAS/FIBROIDS

Uterine leiomyomas:  Known also as Myomas, Fibromyomas, and Fibroids, these neoplasms (tumor; any new and abnormal growth) art the most common benign tumors in women.   They usually occur in the uterine corpus, although they may appear
on the cervix or on the round or broad ligament. Uterine Leiomyomas are usually multiple and usually occur in women over age 35; they affect blacks three times more often than whites.

Cause:  The cause is unknown, but excessive levels of estrogen and human growth hormone (HGH) probably influence tumor formation by stimulating susceptible fibromuscular elements.   Large doses of estrogen and the later stages of pregnancy
increase both tumor size and HGH levels.  When estrogen production decreases, uterine leiomyomas usually shrink or disappear (usually after menopause)

Symptoms:
Pain
Submucosal hypermenorrhea (excessive menstrual bleeding, but occurring at regular intervals and being of usual duration)
Possibly other forms of abnormal endometrial bleeding
Dysmenorrhea (abnormally painful menses)
If tumor is large, the patient may develop a feeling of heaviness in the abdomen;
Increasing pain
Intestinal obstruction
Constipation
Urinary frequency or urgency
Irregular uterine enlargement

Diagnostic tests:
Blood studies/ anemia will support the diagnosis
D&C (dilatation and curettage)
Submucosal hysterosalpingoraphy - detects submucosal leiomyomas
Laparoscopy - visualizes subserous leiomyomas on the uterine surface

Treatment:
Treatment of choice for women who desire to have children - A surgeon may remove small leiomyomas that have caused problems in the past or that appear likely to threaten a future pregnancy
Tumors that twist or grow large enough to cause intestinal obstruction require a hysterectomy, with preservation of the ovaries if possible
Pregnant patient:  If a patient uterus no larger than a 6 month normal uterus by the 16th week of pregnancy, the outcome for the pregnancy remains favorable, and surgery is usually unnecessary.   However if a pregnant woman has a leiomyomatous
uterus the size of a 5 to 6 month normal uterus by the 9th week of pregnancy, spontaneous abortion will probably occur, especially with a cervical leiomyoma.   If surgery is necessary, a hysterectomy is usually performed 5 to 6 months after delivery
(when involution is complete), with preservation of the ovaries if possible
Appropriate intervention depends on the severity of symptoms, the size and location of the tumors, and the patient's age, parity, pregnancy status, desire to have children, and general health.

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 PELVIC INFLAMMATORY DISEASE

Pelvic Inflammatory Disease:  Or PID -  recurrent, acute, subacute, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement.  PID may refer to inflammation of the cervix, uterus, fallopian tubes, and ovaries, which can extend
to the connective tissue lying between the broad ligaments (parmetritis).   Early diagnosis and treatment prevent damage to the reproductive system.   Complications of PID may include potentially fatal septicemia, pulmonary emboli, shock and
infertility.  Untreated PID may be fatal.

Symptoms:
Clinical features vary with the affected area.
They may include profuse, purulent vaginal discharge
Low-grade fever
Malaise
Lower abdominal pain

Three types of PID:

Salpingo-oophoritis (fallopian tubes, and ovaries):  Acute:  sudden onset of lower abdominal and pelvic pain, usually after menses, increased vaginal discharge; fever; malaise; lower abdominal pressure and tenderness; tachycardia; pelvic peritonitis  
Chronic: recurring acute episodes
Cervicitis (inflammation of the cervix):  Acute- purulent, foul-smelling vaginal discharge; vulvovaginitis, with itching or burning; red, edematous cervix; pelvic discomfort; sexual dysfunction; metrorrhagia; infertility; spontaneous abortion  
Chronic- cervical dystocia, laceration or eversion of the cervix, ulcerative vesicular lesion (when cervicitis results from herpes simplex virus type II)
Endometritis (inflammation of the uterus):  Acute- mucoopurulent or purulent vaginal discharge oozing from cervix; edematous, hyperemic endometrium, possible leading to ulceration and necrosis; lower abdominal pain and tenderness; fever;
rebound pain; abdominal muscle spasm; thrombophlebitis of uterine and pelvic vessels 
Chronic- recurring acute episodes (more common from multiple sexual partners and sexually transmitted infections)

Cause: PID can result from infection with aerobic or anaerobic organisms.

Risk factors: Any sexually transmitted infection 
More than one sex partner 
Conditions or procedures, such as cauterization of the cervix, that alter or destroy cervical mucus, allowing bacteria to ascend into the uterine cavity 
Any procedure that risks transfer of contaminated cervical mucus into the endometrial cavity by instrumentation such as use of a biopsy curet 
Infection during or after pregnancy 
Infectious foci within the body, such as drainage from a chronically infected fallopian tube

Treatment:
Effective management eradicates the infection, relieves symptoms, and avoids damaging the reproductive system.
Aggressive therapy with multiple antibiotics begins immediately after culture specimens are obtained.
Infection may become chronic if treated inadequately
Supplemental treatment of PID may include bed rest, analgesics, and I.V. therapy
Narcotics may be needed, NSAID's are preferred for pain relief.
Development of a pelvic abscess requires adequate drainage.  A ruptured pelvic abscess is a life-threatening condition.  If this complication develops, the patient may need a total abdominal hysterectomy, with bilateral salpingo-oophorectomy

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 MENOPAUSE

Menopause:  The mechanisms of menstruation cease to function.  Menopause results from a complex, long term syndrome of physiologic changes, the climacteric-cause by declining ovarian function.

Cause:  Physiologic menopause, the normal decline in ovarian function caused by aging, begins in most women between ages 40 and 50 and results in infrequent ovulation, decreased menstruation, and eventually, cessation of menstruation ( usually
ages 45 - 55)
Pathologic menopause (premature menopause), the gradual or abrupt cessation of menstruation before age 40, cause unknown, however certain disorders, especially severe infections and reproductive tract tumors, may cause pathologic menopause by
seriously impairing ovarian function.  Other factors that may incur pathologic menopause include malnutrition, debilitation, extreme emotional stress, excessive radiation exposure, and surgical procedures that impair ovarian blood supply.
Artificial menopause is the cessation of ovarian function following radiation therapy or surgical procedures.

Symptoms:

Changes in the body's systems usually don't occur until after the permanent cessation of menstruation
Reproductive system:  changes may include; shrinkage of vulval structures and loss of subcutaneous fat, possible leading to atrophic vulvitis; atrophy of vaginal mucosa and flattening of vaginal rugae, possibly causing bleeding after coitus or
douching; vaginal itching and discharge from bacterial invasion; and loss of capillaries in the atrophying vaginal wall, causing the pink, rugose lining to become smooth and white.   Menopause may also produce excessive vaginal dryness and
dyspareunia due to decreased lubrication from the vaginal walls, and decreased secretion from Bartholin's glands; a reduction in the size of the ovaries and oviducts; and progressive pelvic relaxation as the supporting structures of the reproductive tract
lose their tone from the absence of estrogen
Urinary system:  Atrophic cystitis, resulting from the effects of decreased estrogen levels on bladder mucosa and related structures, may produce pus in the urine (pyuria), painful or difficulty urinating (dysuria), and urgency, and incontinence.   May
have on occasion have blood in the urine (hematuria)
Breasts:  Menopause may cause reduced breast size
Integumentary system:  Estrogen deprivation may lead to loss of skin elasticity and turgor.  The patient may have slight alopecia (balding), and may experience loss of pubic and axillary hair.
Autonomic nervous system:  Hot flashes and night sweats. Patient may experience vertigo, syncope, tachycardia, dyspnea, tinnitus, emotional disturbances such as irritability, nervousness, crying spells, and fits of anger.   Patients may also experience
and exacerbation of preexisting neurotic disorders such as; depression, anxiety, and compulsive, manic, or schizoid behavior
Vascular and musculoskeletal systems:  Menopause may also induce atherosclerosis and osteoporosis. 
Artificial menopause, without estrogen replacement, produces symptoms within 2 to 5 years in 96% of women.   Since menstruation in both pathologic and artificial menopause often ceases abruptly, severe vasomotor and emotional disturbances may
result.

Treatment:
Since physiologic menopause is a normal process, it may not require intervention.
Atypical or adenomatous hyperplasia requires drug therapy
Cystic endometrial hyperplasia doesn't require treatment
If osteoporosis occurs, calcium is given
Estrogen therapy 
Women who take estrogen must be monitored regularly to detect possible cancer early.  If the uterus remains progestin is recommended in addition to estrogen.
 

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 FEMALE INFERTILITY

Female Infertility:  Infertility may be caused by any defect or malfunction of the hypothalamic - pituitary - ovarian axis, such as certain neurologic diseases. 

Cause:
Cervical factors, such as infection and possibly cervical antibodies that immobilize sperm
Psychological problems
Ovarian factors
Tubal and peritoneal factors, such as tubal loss or impairment secondary to ectopic pregnancy
Uterine abnormalities, such as; congenitally absent, double uterus; leiomyomas or Asherman's syndrome, in which the anterior and posterior uterine walls adhere because of scar tissue formation
Approximately 15% of all couples in the US cannot conceive after regular intercourse for at least 1 year without contraception.  45 to 50% of all infertility is attributed to the female.

Symptoms:
Diagnosis requires a complete examination and health history.  Questions includes patient's reproductive and sexual function, past diseases, mental state, previous surgery, types of contraception used in the past, and family history

Treatment:
Intervention aims to correct the underlying abnormality or dysfunction within the hypothalamic-pituitary-ovarian complex.
Hormone therapy may be necessary in hyperactivity ;or hypoactivity of the adrenal or thyroid gland
Progesterone replacement for progesterone deficiency
Anovulation requires treatment with clomiphene citrate
If mucus production decreases (an adverse effect of clomiphene citrate), small doses of estrogen may be given concomitantly to improve the quality of cervical mucus
Surgical restoration may correct certain anatomic causes of infertility, such as fallopian tube obstruction
Artificial insemination has proven to be an effective alternative strategy for dealing with infertility problems
In vitro (test tube) fertilization has also been successful

KALLMAN SYNDROME

Kallmann Syndrome: A rare inherited condition characterized by hypogonadism, eunuchoidism and impaired or absent sense of smell. The condition occurs as a result of failure of a part of the hypothalamus which results in hormonal imbalance.

Symptoms:
Reduced sense of smell Progressive loss of vision Delayed growth
Absent sense of smell Cleft palate Infertility
Reduced hormone production by testes Delayed puberty
Reduced hormone production by ovaries Small genitalia

Medications:

Some of the different medications used in the treatment of Kallmann Syndrome include:

Novarel Humegon Pergonal

Pregnyl Profasi HP Menotropins

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 ANDROGEN INSENSTIVITY SYNDROME

Androgen Insensitivity Syndrome: Females with male XY genetics but inability to respond to testosterone

Symptoms:

Female body type Normal female voice Female sexual characteristics

Tallness Normal female breast enlargement Absent uterus
Female infertility Normal female hip pattern Short vagina
Lack of periods Normal female body hair pattern Sparse axillary hair
Delayed menarche Misplaced testes hidden in abdomen Sparse pubic hair
Primary amenorrhea Lack of uterus, fallopian tubes, and ovaries Undescended testes - sometimes present in the labia
Genetic male XY chromosomes Short internal vagina Infertility
Normal appearing female external genitals Low estrogen levels Female genitalia
Normal female body shape - except for some degree of tallness Development of female breasts in males Coexisting female and male genitalia

Cause:

Androgen insensitivity syndrome is caused by a mutation in the androgen receptor, or AR gene. The affected individual is genetically male, with one X and one Y chromosome, but their body cannot respond appropriately to the male
hormone, androgen. As such, they will have external female genitalia, but no uterus. They are generally raised as females.

Treatment:

Surgical testes removal - to prevent later testicular cancer

Estrogen replacement therapy

Vaginal cosmetic surgery - to create a normal length vagina if required.

CRYPTORCHIDISM

Cryptorchidism: Misplaced testes hidden in the abdomen at birth.

Symptoms:

Misplaced testes hidden in the abdomen

Missing testicle in male newborn

Cause:

Cryptorchidism does not have a specific cause. It is possible that genetics and maternal health and hormones are responsible for the abnormal testicular development.

Treatment:

Always seek professional medical advice about any treatment or change in treatment plans.

Surgery

Orchidoplexy

Surgical removal of testes - if they cannot be corrected; to avoid risk of later testicular cancer

©Rafols