7/31/2009

Chapter
p 17
Reproductive System
Diseases and Disorders

Anatomy and Physiology Anatomy and Physiology

• Female external structures • Female internal structures

• Vulva – Ovaries
• Labia majora and labia minora – Fallopian tubes
• Clitoris
– Uterus
• Vestibule and vestibular glands
• Hymen
– Cervix
• Vaginal orifice – Vagina
• Hormones: estrogen and progesterone

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4

Anatomy and Physiology Anatomy and Physiology

• Male external organs • Male internal organs

– Scrotum and penis – Testes
– Epididymis
– Vas deferens
– Urethra
– Seminal vesicles
– Bulbouretheral and prostate glands

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

1
 7/31/2009

Common Signs and Symptoms Common Signs and Symptoms

• Female • Female
– Abdominal and pelvic pain – Pain during sexual intercourse
– Fever and malaise – Any change in breast tissue
– Abnormal vaginal discharge – Abnormal discharge from the nipple
– Burning and/or itching of the genitals

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

Common Signs and Symptoms Common Signs and Symptoms

• Male • Male
– Urinary disorders including frequency, – Swelling or abnormal enlargement of the
dysuria,
y nocturia, and incontinence reproductive
p organs
g
– Pain in the pelvis, groin, or reproductive – Abnormal penile discharge
organs – Burning and/or itching of the genitals
– Lesions on external genitals

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Diagnostic Tests Diagnostic Tests

• Female • Female
– Bimanual examination – Dilatation and Curettage
– Hysterosalpingogram – Laparoscopy
– Papanicolaou smear of cervix – Mammography
– Cervical biopsy – Blood tests
– Cone biopsy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

2
 7/31/2009

Diagnostic Tests Premenstrual Syndrome

• Male • Symotoms prior to menses

– Digital rectal examination • Symptoms begin mid-cycle
– Cystoscopy – Headache and nausea
– Biopsy – Back and joint pain
– Laboratory tests including PSA – Edema and bloating
– Weight gain

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14

Premenstrual Syndrome Premenstrual Syndrome

• Symptoms begin mid-cycle • Treatment

– Breast tenderness – Individualized
– Sleep disturbances – Dietary changes
– Irritability – Avoid caffeine, chocolate, nicotine, salt,
– Mood swings sugar, and alcohol
– Depression

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16

Menstrual Abnormalities Endometriosis

• Amenorrhea • Abnormal growth of endometrial tissue

• Dysmenorrhea outside of the uterus
• Menorrhagia • Common sites of implantation include
• Metrorrhagia ovaries, fallopian tubes, abdominal wall,
and intestines

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18

3
 7/31/2009

Endometriosis Endometriosis

• Symptoms • Treatment
– Dysmenorrhea – Hormones
– Low back, vaginal, and pelvic cramping – Remission with pregnancy, nursing, and
– Heavy menses and dyspareunia menopause
– Panhysterectomy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20

Pelvic Inflammatory Disease Pelvic Inflammatory Disease

• Inflammation of some or all of the pelvic • Symptoms

reproductive organs – Fever
• May include cervicitis
cervicitis, salpingitis
salpingitis, – Chills
endometritis, oophoritis – Pain in pelvic area
• Most commonly caused by STDs – Leukorrhea
• Treatment: antibiotics, analgesics, and
rest

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 21 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 22

Ovarian Cyst Ovarian Cyst

• Commonly benign fluid-filled sacs on or • Symptoms

near the ovary – Low back pain
• Two types – Pelvic pain
– Dyspareunia
– Physiologic
– Nausea and vomiting
– Neoplastic
• Treatment depends on type and size
• May resolve by itself or require
laparoscopy
Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 23 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 24

4
 7/31/2009

Fibroid Tumor Fibroid Tumor

• Also known as leiomyomas • Treatment depends on woman’s age

• Benign tumors of smooth uterine and desire for children
muscle • Surgical removal of fibroids or
• Symptoms hysterectomy
– Abnormal uterine bleeding • Uterine embolization
– Excessive menstrual bleeding and pain • Hormone therapy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26

Vaginitis Vaginitis

• Inflammation of vagina • Common type of vaginitis

• Symptoms – Candida: fungus or yeast
– Burning and itching – Trichomonas: parasite
– Swelling of vagina and external genitalia – Atrophic: post-menopausal

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 27 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 28

Toxic Shock Syndrome Toxic Shock Syndrome

• Found almost exclusively in • Symptoms

menstruating women using tampons – High fever
• Organism: staphylococcus aureus – Vomiting
• Symptoms: high fever, vomiting, – Diarrhea
diarrhea, and dropping blood pressure – Decreasing blood pressure
• Treatment: IV fluids, antibiotics • Treatment: IV fluids, antibiotics

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 29 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 30

5
 7/31/2009

Menopause Menopause

• Natural halting of menstruation • Common symptoms

• Occurs between ages 45 and 55 – Hot flashes and night sweats
– Vaginal dryness
– Depression
– Sleep disorders
– Decreased libido
• Treatment: hormone therapy, exercise

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 31 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 32

Uterine Prolapse Cystocele

• Uterus protrudes into vagina • Herniation of urinary bladder through

• Symptoms anterior vaginal wall
– Heaviness in pelvis • Symptoms: pelvic pressure,
pressure urinary
– Urinary stress urgency, frequency, and incontinence
– Dysuria • Treatment: depends on degree of
– Low back pain herniation
• Treatment: hysterectomy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 33 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 34

Rectocele Cervical Cancer

• Herniation of rectum through posterior • Fifth leading cause of cancer-related

vaginal wall death in females
• Symptoms: discomfort
discomfort, constipation
constipation, • Symptoms: abnormal cervical bleeding
fecal incontinence • Treatment: surgical removal of tumor
• Treatment: surgical repair

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 35 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 36

6
 7/31/2009

Uterine Cancer Ovarian Cancer

• Develops in endometrium and spreads • Quite common and often fatal

to uterine wall • Symptoms: pressure on the bladder,
• Symptoms: abnormal bleeding in abdominal or pelvic pain
pain, general
menopausal women feeling of ill health
• Treatment: surgical removal of uterus • Treatment: complete hysterectomy,
and ovaries with radiation radiation, and chemotherapy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 37 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 38

Fibrocystic Disease Fibrocystic Disease

• Most common breast disorder of • To decrease breast pain:

premenopausal females between the – Reduce caffeine and salt
ages
g of 30 and 55 – Use of mild diuretics
• Cysts are linked to estrogen levels – Use of mild analgesics the week prior to
menstruation is recommended

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 39 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 40

Mastitis Mastitis

• Inflammation of breast tissue • Treatment

• Symptoms – Antibiotics
– Redness – Application of heat
– Heat – Analgesics
– Swelling – Firm supporting bra to decrease discomfort
– Pain and often bloody nipple discharge

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 41 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 42

7
 7/31/2009

Breast Cancer Breast Cancer

• Adenocarcinoma of the breast ducts • Risk factors

• Most common breast neoplasm (affects – Onset of menses before age 13
one out of nine females) – Menses continuing after age 50
• Risk factors – Nullipara
– Age 40 and over – First child after age 30
– Family member affected with breast cancer – Obesity
– Chronic breast disease

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 43 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 44

Breast Cancer Ectopic Pregnancy

• Symptoms • Fertilized ovum attaches to tissue

– Non-tender lump of varying size outside the uterus, usually in fallopian
– Occurs most often in upper outer quadrant tubes
of breast often with dimpling • Symptoms
• Treatment – Acute pelvic pain
– Mastectomy, chemotherapy, and/or – Vaginal bleeding
radiation – Positive pregnancy test

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 45 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 46

Ectopic Pregnancy Spontaneous Abortion

• Treatment • “Miscarriage”
– Prompt surgery to terminate pregnancy • Natural termination of pregnancy before
– Every effort is taken to preserve ovary and fetus is viable
tube if future pregnancy is desired
• Symptoms
– Vaginal bleeding
– Cramping and pelvic pain

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 47 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 48

8
 7/31/2009

Spontaneous Abortion Morning Sickness

• Once it starts, progression is difficult to • Associated with first trimester of

stop pregnancy
• D & C may be necessary to remove any • Symptoms: nausea and vomiting
tissue remaining in the uterus • Treatment
– Not necessary unless vomiting
– Light meals several times a day

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 49 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 50

Morning Sickness Hyperemesis Gravidarum

• Treatment • Excessive vomiting during pregnancy

– Dry food before drinking • Treatment includes IV fluids and
– Avoid fatty foods withholding all foods and oral fluids
– Rest after meals • Usually subsides by second pregnancy

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 51 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 52

Toxemia Toxemia

• Usually appears during 3rd trimester • Treatment

• Symptoms – Frequent monitoring of blood pressure
– Hypertension – Weight and urine protein
– Sudden weight gain
– Proteinuria
– Edema in face, hands, and feet

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 53 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 54

9
 7/31/2009

Abruptio Placentae Abruptio Placentae

• Separation of placenta from uterus • Treatment

• Degrees of symptoms – Prompt delivery either vaginally or by c-
– Partial separation may be asymptomatic section
– Complete separation may cause severe – Blood replacement may also be necessary
abdominal pain and vaginal bleeding
– Shock and decrease in fetal heart tones

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 55 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 56

Placenta Previa Placenta Previa

• Abnormal positioning of placenta in • Treatment-vaginal delivery is

lower uterus near or over cervical os asymptomatic or if bleeding is not
• Symptoms: painless
painless, bright red vaginal severe;; emergency
g y c-section if maternal
bleeding during third trimester bleeding or fetal anoxia

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 57 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 58

Placenta Previa Prostatitis

• Treatment • Inflammation of prostate gland

– Vaginal delivery is asymptomatic if • Symptoms
bleeding g is not severe – Dysuria
– Emergency c-section if maternal bleeding – Pyuria
or fetal anoxia
– Fever and low back pain
• Treatment: antibiotics, warm sitz baths,
increased fluid intake, analgesics

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 59 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 60

10
 7/31/2009

Benign Prostatic Hyperplasia Benign Prostatic Hyperplasia

• Enlargement of prostate gland due to • Symptoms

normal cells overgrowing and enlarging – Nocturia
• Common in men over age 60 – Inability to start urination
– Weak urinary stream
– Inability to empty stream

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 61 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 62

Benign Prostatic Hyperplasia Prostatic Carcinoma

• Treatment • Neoplasm of prostate gland affecting

– Prostatic massage men over 50
– Sitz bath • Second most common cause of cancer-
cancer
– Catheterizations related deaths in men
– Regular sexual intercourse
– Surgery

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 63 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 64

Prostatic Carcinoma Epididymitis

• Symptoms are similar to BPH • Inflammation of epididymis

• Treatment • Symptoms
– Depends on age and physical condition of – Swollen,
Swollen hard
hard, and painful epididymis
individual – Often accompanied by severe scrotal pain
– Degree of metastasis and swelling

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 65 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 66

11
 7/31/2009

Epididymitis Orchitis

• Treatment • Inflammation of one or both testes due

– Rest to viral or bacterial infection
– Analgesics • Symptoms: swelling
swelling, pain
pain, tenderness
– Use of a scrotal support of one or both testes, fever, malaise
– Avoidance of alcohol, spicy foods, and • Treatment: dependent on cause
sexual stimulation

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 67 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 68

Testicular Tumor Cryptorchidism

• Commonly affect young men age 20-35 • Undescended testicle

• Most common type of cancer in this • Premature birth is common cause
group • Treatment: surgery
• Symptoms: painless mass felt in testicle
• Treatment: orchiectomy, chemotherapy,
and radiation

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 69 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 70

Genital Herpes Genital Herpes

• Viral infection • Symptoms

• 1 in 6 individuals in United States is – Blister-like lesions causing dysuria
infected – Severe itching
• Not curable • Treatment is symptomatic
• Periods of remission and exacerbation – Antiviral medications
– Sitz baths
– Ice therapy and analgesics

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 71 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 72

12
 7/31/2009

Gonorrhea Gonorrhea

• “Clap” • Treatment
• Symptoms – Antibiotics including Penicillin
– Purulent discharge from penis and vagina – Tetracycline
– Dysuria – Ceftiaxone
– Urinary frequency in males and females
– Female - cervicitis
– Genital itching and burning pain

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 73 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 74

Syphilis Syphilis

• Treatment: Penicillin or Tetracycline is • Secondary - rash appears

very effective • Tertiary
• Three stages – Bacteria invade organs throughout body
– Primary - appearance of painless chancre causing gumma
– Secondary - chancre heals – Curable with antibiotics during this stage
– Period of rest lasting 6 weeks to 1 year but effects of lesions are irreversible

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 75 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 76

Chlamydia Trichomoniasis

• Known as “silent” STD - Bacterial • Caused by protozoan

• Symptoms • Symptoms
– Drainage with burning and itching – Male - urethritis,
urethritis epididymitis
epididymitis, and
– Urination due to urethritis and epididymitis prostatitis
• Treatment: antibiotics – Female - green frothy vaginal discharge,
itching and burning of genital area

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 77 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 78

13
 7/31/2009

Trichomoniasis Genital Warts

• Treatment • Viral infection

– Antiparasitic medications such as Flagyl • Symptoms
– Possible tenderness in affected area
• Treatment
– Chemical or surgical removal
• Cervical cancer related to genital warts

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 79 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 80

Dyspareunia Premature Ejaculation

• Pain or discomfort with sexual • Expulsion of seminal fluid during

intercourse foreplay, prior to complete erection, or
• May affect men and women immediatelyy after sexual intercourse
• Treatment is dependent on cause • Common in young males
• Treatment is based on cause

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 81 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 82

Infertility Infertility

• Inability of couple to achieve pregnancy • Causes

after one year of unprotected sex – Presence of STD
– Hormonal disorders
– Abnormality of reproductive organs
– Endometriosis
– Scarring or blockage of fallopian tubes
– Vaginal antibodies that kill sperm

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 83 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 84

14
 7/31/2009

Infertility Hydiatidiform Mole

• Treatment • Grape-like cysts in uterus that mimic

– Based on cause pregnancy
– Surgery • Treatment: D & C
– Medication therapy • At higher risk to develop
– Hormone imbalance choriocarcinoma requiring frequent
follow-up examinations

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 85 Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 86

15