So this is chapter 19 that we're starting on. It's on page 517 in your textbook. Just review some of the anatomy and physiology there on the first couple of pages. Just re-familiarize yourself with that.
Look over spermatogenesis as we're reviewing the male reproductive system. This is a continuous process. It is the production of spermatozoa and takes about 60 to 70 days to complete this. this process. The testes is the sperm, quote-unquote, sperm factory of the body.
The epididymis is where the sperm mature. Vas deferens is what helps transfer the sperm to the urethra. The seminal vesicles help to secrete, to nourish the sperm.
Prostate gland also provides secretions that help balance pH. The calprs glands, bulbulurethral secretes alkaline mucus, and then finally to the penis where the ejaculation of semen occurs. Again, just an anatomical view that's on page 518 in your textbook. So when we look at male hormones, Follicle stimulating hormone or FSH.
This is what initiates the whole process of spermatogenesis. Also, luteinizing hormone or LH. This stimulates testosterone production in the interstitial cells or the lydic cells in the testes. So testosterone is going to be essential for the maturation of sperm. Serum levels of testosterone provide a negative feedback system for the continuous control of gonadotropin secretions because there is no cyclic hormones in males.
Other functions of testosterone are going to be development and maintenance of secondary sexual characteristics such as male hair distribution, deeper voice, Okay, so congenital abnormalities of the penis. Epispadias, this refers to the urethral opening being on the dorsum or the upper surface of the penis proximal to the glands. So if the defect extends proximally, it can affect the urinary sphincter. So they may have incontinence and sometimes infections occur because there's a stricture at the opening.
Peyronie's disease. This is a bend in the penis that's caused by scar tissue on the penis. This can result in painful sex and erectile dysfunction. Not really sure what the cause of this disease is. It's not fully understood, but thought to be repeated injury to the penis is the primary cause.
hypospadias, the urethral opening on the dorsum of the underside of the penis. And treatment for these are going to be surgical resection, reconstruction. Disorders of the testes and scrotum is what we'll look at next. First one, cryptocortism. This is when one or both of the testes fail to descend into the normal position of the scrotum and this occurs during the latter part of pregnancy.
So the testes will remain in the abdominal cavity. or discontinue the descent at some point in the inguinal canal or above the scrotum. Ectopic testes, the testes are positioned outside of the scrotum.
This can cause a degeneration of the seminiferous tubules and the spermatogenesis is impaired and also increases the risk of testes. testicular cancer, especially if treatment is not done by five years of age. And there's a picture there of cryptocortism.
Hydrocele. So this occurs when an excessive amount of fluid collects in the potential space between the layers of the tunica vaginalis and it occurs around one or both of the testes. This is usually distinguished by transillumination. It can occur as a congenital defect in a newborn when peritoneal fluid accumulates in the scrotum. And this fluid is usually reabsorbed in time.
So if the fluid continues to escape from the peritoneal cavity in the proximal portion of the processus vaginalis, a section of the peritoneal membrane, this does not close off as expected after the descent of the testes. This can... be acquired as a result of an injury or infection, a tumor, and may compromise blood supply or cause lymph drainage in the testes.
There's a picture there of a hydrosil. It's on page 520 in your textbook. A spermatosil. So this is a cyst.
that contains fluid and sperm. It develops between the testes and the epididymis outside the tunica vaginalis and it can be related to an abnormality of the tubules. If the cyst is large, it may be surgically removed.
Baricocel is a dilated vein in the spermatic cord. Usually it's on the left side. It frequently develops after puberty and results from a lack of valves in the veins. And this permits a backflow of blood and increased pressure in the veins. So it may be mild and scrotal support minimizes the heavy feeling.
If it is extensive, painful, tender, it can lead to infertility because of the impaired blood flow. So that usually requires surgery. There's a picture of the varicocele there.
That's again on page 520. Torsion of the testes. This occurs when the testes rotate on the spermatic cord, compressing the arteries and vein. Schemia develops. The scrotum swells.
This requires immediate attention and usually surgery to restore blood flow to the testes. This frequently occurs during puberty, both spontaneously and after trauma. So that's one of the distinguishing factors there between torsion, varicocele, and a hydroseal.
So remember the hydroseal can be transilluminated, and that's usually how that is distinguished. So inflammation and infections. Prostatitis is an infection or inflammation of the prostate gland, and there are four categories of that. Category one is acute bacterial, two is chronic bacterial, three is non-bacterial, and then four is asymptomatic inflammatory.
Prostatitis is going to cause a tender, you're going to see a tender, swollen gland. It's typically soft and boggy on palpation. The urine will contain large quantities of microorganisms, pus, and leukocytes. And some patients have chronic prostatitis. This is where the prostate is only slightly enlarged, irregular, and firm.
Fibrosis is more extensive and in most cases the urinary tract is infected. So with chronic you'll see dysuria, frequency, and urgency. Ballinitis is a fungal infection of the glands penis. It's usually transmitted with sexual activity and caused by the fungus Candida albicans.
Usually the infection is in uncircumcised males. Epididymitis is an inflammation of the epididymis. It's the coiled tube at the back of the testicle. Orchitis is an infection of the testicle.
Epididymo orchitis is an inflammation of both the epididymis and the testicle. These can be both bacterial or viral infections. Acute bacterial, these are just differentiating.
the different types of prostatitis the gland is tender and swollen urine and secretions do contain bacteria non-bacterial the urine and secretions will have large amounts of leukocytes and then chronic bacterial the gland is only slightly enlarged you see dysuria frequency and urgency Acute bacterial infections are primarily caused by E. coli and sometimes Pseudomonas, Proteus, or Streptococcus infections. Chronic bacterial infection is related to repeated infections by E. coli. These are opportunistic bacteria from just the normal flora that we have in our gut.
So the cause of this is going to be from an ascending infection as it progresses up the urethra and is caused primarily by what we mentioned, E. coli, Pseudomonas. In young men, it is associated with UTIs. And in older men, with benign prosthetic hypertrophy. Also through catheterization, bacteremia, and with STDs.
So the signs and symptoms, these are both acute and chronic forms that have dysuria, urinary frequency, and urgency. There's decreased urinary stream. The acute form includes fever and chills, low back pain, leukocytosis, abdominal discomfort.
Systemic signs, including fever, malaise, anorexia, muscle aches. The treatment is going to be for acute. chronic bacterial infection antibacterial drugs such as ciprofloxacin and a non bacterial infection anti-inflammatory drugs and prophylactic antibacterial agents. Balanitis this is a fungal infection of the glands penis it's an STD it's caused by the fungus Candida albicans, and usually in uncircumcised males. The vesicles develop into patches, and usually the treatment is with a topical antifungal medication like miconazole, and then epididymitis, an infection of the epididymis.
Orchiditis, infection of the testicle. And these causative organisms can vary before puberty. Most of them are caused by intestinal bacteria like E.
coli. And in sexually active men, gonorrhea, chlamydia are typically responsible for these conditions. Also, men with a medical history of urinary tract infections or prostatitis, as well as those who've had surgery of the bladder or urethra or catheterization have a higher risk of developing these conditions. And antibiotics are going to be the primary treatment.
Tumors, we have benign, prosthetic, hypertrophy, cancer of the prostate and the testes. Benign... Prosthetic hypertrophy is common in older men.
About 50% of men over age 65 experience some form varying from mild to severe. The change is hyperplasia of the prosthetic tissue, and there's nodule formation surrounding the urethra. So with these changes, this leads to a compression of the urethra and variable degrees of urinary obstruction.
So the hyperplasia is related to an imbalance between estrogen and testosterone, and this usually results from the hormonal changes associated with aging. There is no connection between BPH and prosthetic carcinoma. So what you will see for initial signs and obstruction of the urinary flow, hesitancy, dribbling, decreased force of the urinary stream, this is because there's narrowing of the urethra, and also incomplete bladder emptying leads to frequency, nocturamia, and increased urinary tract infections.
The treatment, usually only a small percentage of cases require any intervention. Sometimes drugs that reduce the androgenic effects and slow nodular growth like Avidart. Surgery is not desirable.
Alpha adrenergic blockers like Tamsulosin or Flomax relax that smooth muscle in the prostate and bladder. And this results in an increased flow of urine. Sometimes a combination of finasteride, ProScar, and doxazosin, Cardura, has shown to reduce the progression of hypertrophy and possible obstruction.
And then if the obstruction is severe, surgery may be required. Prostate cancer is going to be common in men older than 50 years and ranks high as a cause of cancer-related deaths in men. Most tumors are adenocarcinomas arising from the tissue near the surface of the gland rather than the central area as we would see in BPH.
There's more than one focus of neoplastic cells. They vary, tumors vary in the degree of cellular differentiation. Some can be more aggressive, growing and spreading at a faster rate, and most of the tumors are androgen dependent.
Five to ten percent of the prosthetic cancers are caused by an inherited mutation of the HBC1 gene, and others can be either intrinsic or extrinsic. factors, high androgen levels, increased insulin-like growth factor, or a history of recurrent prostatitis. So signs and symptoms are going to be a hard nodule in the periphery of the gland.
It's often located in the posterior lobe, and it's detected whenever you perform a digital rectal examination. The tumor tends not to cause early urethral obstruction because of its location, but as the tumor develops, some obstruction can occur and you'll start to see signs of hesitancy, decreased stream, urinary frequency, or bladder infection or cystitis. Diagnosis is made by PSA, prostatic acid.
Acid phosphatase and PSA prostate specific antigen. Ultrasonography is useful. Biopsy and bone scans to detect any metastasis.
Treatments can include surgery, radical prostatectomy, radiation, this might be implanted pellets. If it's androgen, sensitive, then orchiectomy is effective as well as antitestosterone drugs. Most testicular tumors are malignant.
About 1 in 300 are affected, and it's the most common solid tumor cancer in younger men. The number of cases is increasing, and this is why we encourage men to do testicular self-examinations for early detection. So this is one that, you know, in the younger, young adult males that you really want to check for, for cancer of the testes.
So, they may originate from one type of cell or mixed cells from various sources, like a teratoma or seminoma. Just different germ cells are involved and sometimes mixed tumors are involved. Some malignant tumors. will secrete HCG, human chorionic gonadotropin, or alpha-fetoprotein AFP. So these are useful serum markers for diagnosis and follow-up monitoring.
Some testicular neoplasms can spread at an early stage, whereas others can remain localized for prolonged periods of time. So a typical spreading pattern, first they appear in the common iliac and para-aortic lymph nodes, and then in the mediastinal and supraclavicular lymph nodes, and then through the metastasis will spread through the blood to the lungs, liver, bone, and brain at a later stage. There are several staging systems that are used and this is based on the extent of the primary tumor, the degree of lymph node involvement, and the present of distant metastases. And there is that figure 19.7 on page 524 in your textbook. Causes are going to be hereditary.
It's a change in chromosome number 12 in some families. and also a possible relationship with infection or trauma. An established predisposing factor is cryptocortism or Maldacen of the testes.
And exposure to herbicides and other environmental agents can also be predisposing factors. So some signs and symptoms to secular tumors present as a hard, usually painless, and unilateral mass. So keep that in mind for testicular cancer.
It's going to be hard, painless, and unilateral mass. The testes may be enlarged or may feel heavy. Eventually there's some dull, aching pain in the lower abdomen. And in some cases, a hydrosil or epididymitis may occur because of the inflammation. Or sometimes gynecomastia in large breasts become evident if hormones are being secreted by the tumor.
So diagnostic tests, ultrasound, CT, lymphangiography, the presence of tumor markers like AFP and HCG are useful for diagnosis. If a solid mass is seen during diagnostic imaging, surgical removal of the entire testes is done rather than a local biopsy of the mass. And this helps reduce the spread of the tumor cells.
Okay, so review of the female reproductive system. This starts on page 525. So review the structure function of the female anatomy. That's on the first couple of pages there.
The vulva, clitoris, vagina, just a few of those structures. Page 526 are where those are listed. And this is a figure on page 526. The female reproductive system, uterus, cervix, includes the internal, external os, and fallopian tubes, ovaries, and breast.
So, hormones and the menstrual cycle. The hormonal secretions or release of ova and associated endometrial changes occur in a cyclical pattern in women during the reproductive years. Average cycles are 28 days, but can range of 21 to 45 days is considered normal. Some women experience irregular menstrual cycles.
The cycle consists first of menstruation or menses. This occurs with the sloughing of the endometrial tissue when the implantation of the ovum has not occurred. Then the endometrial proliferation stage follows.
This is where follicle stimulating hormone is secreted. by the anterior pituitary gland and this results in maturation of the ovarian follicle. Next is the maturation follicle secretes estrogen. This causes proliferation or thickening of the functional layer of the intermedium and then at midpoint as luteinizing or LH levels greatly increased ovulation takes place with the release of mature ovum.
The ovarian follicle is now converted by luteinizing hormone into the corpus luteum, which increases the production of progesterone. And progesterone enhances the development of the endometrial blood vessels and glycogen secreting glands. preparation for a fertilized implantation of a fertilized ovum and if fertilization does not occur estrogen and progesterone levels drop the corpus luteum and the intrametrium degenerate resulting in menstruation and beginning of another cycle so just cut that is all on page 528 just familiarize yourself with the cycle, what is happening at what point. So some structural abnormalities.
The normal position of the uterus is slightly anteverted, tipped forward that is, and anti-flexed, bent forward over the bladder with the cervix downward and back. Position of the uterus can vary because of minor congenital alterations, childbirth, or pathologic conditions such as scar tissue or tumors. Sometimes there is a retroversion and this can cause back pain. painful menstruation or dysmenorrhea and dyspiremia painful intercourse and then with aging or excessive stretching or trauma the supporting ligaments fascia and muscles of the uterus bladder and rectum become weakened what's known as pelvic relaxation and sometimes the organs can shift out of their normal position in the pelvis this happens a lot with with women that have had multiple births, large babies, repeated pregnancies separated by short intervals.
And then also a genetic component also appears to be a factor. Uterine displacement, or also known as prolapse, is the descent of the cervix or uterus into the vagina. A prolapse is classified as first, second, and third degree. First degree is when the cervix drops into the vagina.
Second is if the cervix lies at the opening to the vagina and the body of the uterus is in the vagina. And then third degree is if the uterus and cervix protrude through the vaginal orifice. Early stages of prolapse may be asymptomatic and more. advanced stages cause discomfort and a feeling of heaviness in the vagina and with protrusion the cervix can become irritated and infected pro-ep is treated with surgery or by using a pessary like a supporting device to maintain the uterus in position. Rectoceles, this is a protrusion of the rectum in the posterior vagina and this can cause constipation and pain.
Cysticel is a protrusion of the urinary bladder into the interior wall of the vagina. So with this the bladder cannot be empty completely and they often develop recurrent cystitis. These both, if severe enough, can require surgical repair.
Menstrual disorders. Amenorrhea is the absence of menstruation. This can be primary or secondary. primary is when menarche has never occurred and this is usually from a genetic disorder like Turner syndrome or chromosome abnormality where the ovaries are not functioning a congenital defects affect the hypothalamus central nervous system pituitary or the congenital absence of the uterus and congenital uterine hypoplasia can also interfere with the normal process Secondary amenorrhea is the cessation of menstruation in an individual who previously experienced menstrual cycles. So it frequently results from an impediment in the hypothalamic pituitary axis where the hypothalamus may be suppressed by such things as tumors, stress, sudden weight loss, eating disorders, or participating in competitive sports.
Dysmenorrhea refers to painful menstruation. It can be primary or secondary. Primary has no organic foundation and just develops when ovulation commences. Sometimes women experience some discomfort, but for many the pain is sufficient to interrupt normal activities. In many cases, dysmenorrhea is relieved after childbirth.
So this is caused by severe cramping pain and related to the excessive release of prostaglandin during the endometrial shedding phase. And this prostaglandin causes strong uterine muscle contractions and ischemia, and so therefore pain develops. usually about 24 to 48 hours before or at the onset of menses and can last for 24 to 48 hours. Sometimes women can develop nausea, vomiting, headaches, dizziness, and they also accompany these cramps. So usually things like heating pads, non-steroidal, anti-inflammatory drugs, exercise.
This can inhibit prostaglandin synthesis. And another alternate treatment would be oral contraceptives, and this leads to an anovulatory cycles that are not painful. And then we have secondary dysmenorrhea, and this usually results from pelvic disorders like endometriosis, uterine polyps or tumors, or pelvic inflammatory disease.
Pre-menstrual syndrome, PMS, that is a condition that begins usually about a week before the onset of menses and ends with the onset of menses. The cause of this is not completely understood, but research on hormonal factors continues and most women, these are nuisance symptoms, breast tenderness, weight gain, abdominal distension or bloating. irritability, emotional lability, sleep disturbance, depression, headaches, fatigue. And in some women mental concentration is affected, lethargy can be experienced.
And they're so severe in some women about three to eight percent of the population reports such severe symptoms that it has been termed as premenstrual dysphoric. syndrome. So treatment is tailored to the individual. It may include hormonal therapy like oral contraceptives, diuretics, and even sometimes antidepressants are useful with treating this. So abnormal menstrual bleeding, the usual cause of this is a lack of ovulation, but also can be because of hormonal imbalances.
and the pituitary-ovarian axis. Menorrhagia, that's an increased amount in duration of flow. Menorrhagia, bleeding between cycles. Polymenorrhea, short cycles of less than three weeks.
And oligomenorrhea is long cycles of more than six weeks. So endometriosis affects about 5 million women in the United States. It's defined as the presence of endometrial tissue outside the uterus and it's on structures such as the ovaries, ligaments, or colon. These ectopic endometrium responds to cyclical hormone changes and bleeding leads to inflammation and pain. Fibrous tissue can cause adhesions and obstructions of the involved structures.
The cause has not been established. It's thought to be congenital in some cases. And then treatment is with hormonal suppression and even surgical removal of tissue. On to infections. And, um...
Candida aces. So this is one form of vaginitis and vaginitis refers to an inflammation of the vagina. And this is usually the result of an infection or some type of imbalance in the normal bacterial flora, but can also be caused by yeast infections, which is what Candida aces is. It's caused by Candida albicans. which is an opportunistic superficial infection of the mucous membranes or the skin.
If this can follow antibiotic therapy or another bacterial treating another bacterial infection somewhere else in the body and with pregnancy someone who's diabetic or someone with reduced host resistance and not not having a good immune system. So, candidiasis causes red, swollen, intensely pruritic mucous membranes and a thick, white, curd-like discharge. It can extend to vulvar tissues.
It is treated with antifungals, medications such as gonazole, gonolotrimine, monistat. And for long course treatment, the azole medications are effective and to prevent a reoccurrence. Some of those factors need to be addressed, the causative factors.
Infections, pelvic inflammatory disease, or PID, this refers to an infection of the reproductive tract, the uterus, fallopian tubes, and or ovaries. This can be acute or chronic. The infection usually originates as an ascending infection from the lower reproductive tract and may occur because of bacteremia.
Most infections arise from STDs and non-sterile abortions or childbirth. And there you have a picture of that on page 533. PID can cause scarring of tubes and increases the risk of infertility and ectopic pregnancy. There's potential acute complications like peritonitis, pelvic abscesses, and septic shock.
Pelvic pain is usually going to be the first symptom or sign. Lower abdominal pain is what you usually see with PID. increased temperature, guarding, nausea, vomiting, leukocytosis, and purulent discharge can also be present. Treatment usually requires aggressive antibiotic therapy in the hospital, usually with cefoxitin and doxycycline, and usually recurrent infections are common, so it's recommended treating the other sexual partners. Benign tumors, leiomyomas or fibroids, ovarian cysts, polycystic ovarian syndrome, and fibrocystic breast disease.
Leomyomas or fibroids, these are benign tumors of the myometrium. They're common during the reproductive years and usually classified by where they're located. They're usually multiple, well-defined, unencapsulated masses. Abnormal bleeding may occur because of these, and they may interfere with implantation, making it difficult for pregnancy to occur.
and they're often asymptomatic until large growths appear and require hormonal therapy or surgery ovarian cyst you can see follicular corpus luteal cysts common and they're usually unilateral in both ruptured and unruptured follicles their physiological type lasts about 8 to 12 weeks and disappear without complications And there are multiple small fluid filled sacs. And if bleeding occurs, more serious inflammation can occur. It can require surgical intervention.
And there's diagnosed ultrasound or laparoscopy for identification. Polycystic ovarian syndrome or Stein-Levin-Fall syndrome. These are large ovaries containing cysts and covered with a thick capsule that develop. Associated hormonal abnormalities include elevated androgen, estrogen, luteinizing hormone levels, and decreased follicle stimulating hormone levels.
So you have usually fluctuations and and peaks in the FSH and LH hormones are missing. Ovulation does not occur. So the problem is a dysfunction in the hypothalamic pituitary control system and the cause is really unknown.
It's thought to be inherited. Young women oftentimes developed hirsutism or abnormal hairiness, amenorrhea, and infertility. Sometimes they need to be on medications to help stimulate ovulation and oral contraceptives are used to reduce the androgen secretions and the masculinizing masculinization effects.
Some women have insulin resistance and so treatment with an anti-hyperglycemic drug like metformin can result in ovulation. Fibrocystic breast disease is also known as benign breast disease or fibrocystic change and this can include a broad range of breast lesions. It is sometimes confused between the physiologic changes that occur in the breast during the menstrual cycle with abnormal or pathologic changes.
So with fibrocystic disease This refers to the presence of nodules or masses in the breast tissue that change during the menstrual cycle. And this is in response to those fluctuating hormones. This makes this increased density makes it really hard for a breast self-examination to be done. And why it's really important for women to to do these monthly breast self-exams so that they get the idea or the feeling of what. what is normal versus abnormal for them.
There's an increased risk of breast cancer with fibrocystic breast disease if atypical cells are present. There's also increased cystic masses with caffeine intake. Malignant tumors.
So these are going to be carcinoma of the breast, cervix, uterus, and ovarian cancer. Carcinoma of the breast is a common malignancy and a major cause of death in women. Breast cancer does occur in males although it is rare. Breast carcinoma increases after 20 years of age but we're seeing more and more malignancy at younger ages. So these malignant tumors develop in the upper outer quadrants of the breast in approximately half of the cases.
Most of the tumors are unilateral. Earlier onset is associated with more aggressive growth, and most of these arise from ductal epithelial cells, and metastasis occurs via lymph nodes early in the course of the disease. The presence of estrogen or progesterone receptors on tumor cells also influences the treatment.
Some predisposing factors are going to be first-degree relatives with the disease. There's a strong genetic predisposition, BRCA1 and BRCA2. There's longer and higher exposures to estrogen, nulliparous, or their first pregnancy was later in life, lack of exercise. smoking, high-fat diet, radiation therapy to the chest, or cancer to the uterus, ovaries, or pancreas are going to be some predisposing factors to breast cancer in women. So signs and symptoms.
The initial sign is going to be a single, small, hard, painless nodule. So this is usually picked up on by a change in their mammogram. Initially, that is what you see. Later, you might see distortion of breast tissue, dimpled skin, or discharge from the nipple.
So an ultrasound or needle biopsy does confirm this diagnosis. So the course of breast, courses of breast cancer. Metastasis. occurs by the time the tumor is about one to two centimeters in diameter.
There's usually axillary lymph node involvement and secondary tumors occur in the bone, lung, brain, and liver. Treatment. So surgery usually and combined with radiation and chemotherapy does provide an effective treatment in many cases. Surgical removal of the tumor.
involves minimal tissue loss, like a lumpectomy. That's the preferred method for stage 1 and 2. But sometimes a more radical approach, like a mastectomy, may be necessary for more advanced cases. And sometimes a surgical approach combined with radiation after surgery. Some women opt for mastectomies and breast reconstructive surgery, in particular if there is a strong genetic risk for a recurrence of the cancer.
And in some cases, hormone therapy can be used as well. Lymph nodes may have to be removed. And the number usually depends on the spread of the tumor cells.
So the treatment with drugs are going to be hormone blocking agents, tamoxifen, raloxifen, levista, and toment tomerafin estrogen receptor blockers and drugs that inhibit estrogen production like aromidex femera aromasin Some other targeted drug therapies, you can look over those. Carcinoma of the cervix. So a number of cases of invasive cancer and a number of deaths from cervical cancer have declined by about 74% since women started doing the pap smears for screening.
This is... a very good early screening and diagnostic tool while the cancer is still inside you. So by about the age of 20 is when really pap smears are recommended checking those cervical cells for any early treatable stages of the disease.
If not by age 20, then when sexual intercourse has began and at intervals advised by you as the provider. You might want them more frequently if they do have a family history of a first degree relative. The pathophysiology, you see early changes in the cervical epithelial tissue.
It consists of. dysplasia. These are abnormal cells showing less differentiation. An in situ tumor is located on the mucosal surface.
You might see invasion to the submucosa and spread to adjacent organs. And this can occur with late metastasis. So this is a common.
chart that's on 19 point figure 19.8 on page 538 if you want to look just glance over that about what you're seeing at the different stages there for cervical cancer so risk factors are going to be over age of 40 it's strongly linked to the hpv virus or an std that's common if they have multiple sexual partners sexual intercourse that begins early teenage years, smoking, and a history of prior STDs. Carcinoma of the uterus is more common in postmenopausal women. Early indicators is going to be painless vaginal bleeding or spotting. in someone over 50 years of age.
If they're on high dose estrogen hormone treatment without progesterone, this is a more common risk factor. Also obesity and diabetes. Pap smear does not detect this cancer. So, or it's not a very dependable assessment tool.
So usually direct aspiration of uterine cells provides a more accurate cell sample, and a biopsy is required to confirm the diagnosis. Late signs of malignancy include palpable masses or discomfort or pressure in the lower abdomen and bleeding after intercourse. Treatment is surgery and radiation. and chemotherapy if it's at a later stage. Ovarian cancer, only about 25% of these cases are diagnosed in the early stage when it has a good prognosis.
So that has long been considered a silent tumor. It's of increasing concern because of this. There's not really a reliable screening that's available.
Large masses, though, are detected by pelvic examinations and by transvaginal ultrasounds. There are very few that are diagnosed in the early stage, and there are different types of ovarian cancer, and they vary in their degree of aggressiveness. Treatment does involve surgery and chemotherapy. Some of their risk factors are gonna be obesity, the BRCA1 gene, early menarche, their nulliparous or have a late first pregnancy. Use of fertility drugs or talcum powder that's contaminated with asbestos.
So oral contraceptives containing progesterone are somewhat protective for ovarian cancer. Infertility or sterility. This results in affecting a couple's reproductive capacity.
It can be caused by female or male conditions or combined. The couple is considered infertile after a year of unprotective intercourse fails to produce a pregnancy. So it can be associated with hormonal imbalances, increasing age of parents at the time of their first conception attempt. Structural abnormalities may prevent pregnancies like uterine fibroids. Fallopian tubes, epididymis, or vas deferens may be obstructed by scar tissue, and this can be a result of infection or endometriosis.
Infection of the testes may burn out the sperm-producing cells. Chemotherapy reduces the viability of sperm or ova. Workplace toxins and environmental pollutants can also reduce viable sperm.
And also, access to viable sperm may be reduced by changes in vaginal pH caused by infection or the use of douches or excessively thick cervical mucus or Cigarette smoking by either the male or female partner and even secondhand smoke has been found to be a deterrent for pregnancy. Sexually transmitted diseases. So this is a just kind of an overview to get you started on these. You will go over and see a lot of these whenever you start your FMP2 women's health rotation. So sexually transmitted diseases are classified as bacterial infections.
That's chlamydia, gonorrhea, syphilis. Viral infections are genital herpes, condylomida, acuminata, or genital warts. And protozoan infections are trichomoniasis.
So your bacterial infections are chlamydia. This is considered to be one of the most common STDs and a leading cause of pelvic inflammatory disease. Males, you see urethritis and epididymitis.
Symptoms include dysuria, itching. There might be a white discharge from the penis, painful swollen scrotum, usually unilateral, fever from epididymitis. inguinal lymph nodes might be swollen and females are often asymptomatic or until PID or infertility develops so this is why it is it is such a common STD newborns may also be affected during birth gonorrhea this is caused by in gonorrhea a gram-negative aerobic, dipalococcus, and many strains have become resistant to penicillin and tetracycline.
Males, the most common site is the urethra, which is inflamed, and some males are even asymptomatic. Females are frequently asymptomatic, and PID, pelvic inflammatory disease, and infertility are serious complications. Gonorrhea can affect the eyes of a newborn. This can cause irreversible damage and blindness, and it can also spread systemically to cause septic arthritis.
Current treatment is a dual approach using multiple antibiotics to avoid development of resistance. So this is a really good table. 19.1 on page 543 that lists all the sexually transmitted diseases.
So review over those and be able to differentiate what your signs and symptoms, how you would diagnose or what kind of signs would you see with each different one of these infections. So syphilis. Syphilis has did decrease for a while but it is beginning to show an increase and also it has been shown to have antibiotic resistant strains of the pathogen.
It is caused by trypanemia palladium spirosheet. In the primary stage, you see presence of a change at the site of infection, genital region, anus, oral cavity. It can be painless, firm, ulcerated nodule, and it occurs about three weeks after exposure. The lesion heals spontaneously, but they're still contagious.
So that's a picture there of it. That's on page 544. You can see there. that kind of white, whitish area. That's what they're talking about there. Secondary stage, if it's untreated, then they develop a flu-like illness and a widespread symmetrical rash that's self-limited, but they still remain contagious.
And then the latent stage may persist for years and transmission may occur. And then there's tertiary syphilis, and this causes irreversible changes. This can set up in organs and major blood vessels, can cause dementia, blindness, motor disabilities. The organism can be transmitted to the fetus in utero. And so the baby born with tertiary syphilis changes are not reversible, and treatment is using multiple antimicrobial drugs.
And so just with this antibiotic resistance, that is what is causing such an outbreak. Mycoplasm, genitalium. is an STD. The CDC identified this as an STD in 2015 and noting that the cases have been on the rise with this.
Viral infections, we have genital herpes caused by herpes simplex. It can be HSV2 or HSV1. HSV1 is possible with oral sex and lesions are similar to HSV1.
Recurrent outbreaks of blister-like vesicles on the genitalia. It's usually preceded by a tingling or itching sensation, and the lesions are extremely painful. After the acute stage, virus migrates back to the dorsal root ganglion, and infectivity is greater when symptoms are present. There's a picture there of genital herpes. You can see these are the vesicles right here, this white area, and right here on the tip of the penis there are those clear fluid-filled sacs.
Reactivation is common and can be associated with stress, illness, menstruation. Antiviral drugs are used for the treatment and prevention of transmission, and the infection is considered to be lifelong. Viral infections, genital warts, this is also increasing in frequency. HPV is a circular, double-stranded DNA virus. And there are many types of HPV, several affect the genital tract.
And some of these are thought to be causes for cervical cancer. The incubation period can be up to six months. The disease can be asymptomatic and the warts vary in appearance. They can appear wherever there was contact with the virus has occurred.
They can be removed. by different methods and made predisposed to cervical or vulvar cancers. So some of the new or emerging viral STDs, trichomoniasis, that is an anaerobic flagellated protozoan. It's an extracellular parasite, usually asymptomatic in men. The organism resides primarily in the urethra and the infection in women can be subclinical and then flare up when the microbial balance of the vagina shifts.
Ebola and Zika viruses. Ebola virus has been found to to survive up to 565 days in the semen of infected men. And the protozoan infections, we talked about this, discussed trichomoniasis.
Systemic treatment is going to be necessary in treating both partners. And so this concludes Chapter... 19 in your textbook.
It is at the top of the chapter, Respiratory System Disorders, although it is not. It is Reproductive System Disorders. I think that was misprint there.
So we are in chapter 19, and that concludes chapter 19.