copyright © 2015 cengage learning ®. chapter 17 reproductive system diseases and disorders

Copyright © 2015 Cengage Learning®.

Chapter 17

Reproductive System Diseases and Disorders


Anatomy and Physiology

• Female external structures:– Vulva– Labia majora and minora– Clitoris– Vestibule and vestibular glands– Hymen– Vaginal orifice



• Female internal structures:– Ovaries– Fallopian tubes– Uterus– Cervix– Vagina

• Female hormones:– Estrogen– Progesterone



• Male external structures:– Scrotum– Penis

• Male internal structures:– Testes– Epididymis– Vas deferens– Urethra– Seminal vesicles– Bulbourethral and prostate glands


Common Signs and Symptoms for Female Reproductive

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


Common Signs and Symptoms for Male Reproductive Disorders• Urinary disorders

– E.g., frequency, dysuria, nocturia, incontinence

• Pain in pelvis, groin, or reproductive organs

• Lesions on external genitals• Swelling of reproductive organs• Abnormal penile drainage• Burning, itching of the genitals


Diagnostic Tests for Females• Bimanual examination

• Hysterosalpingogram

• Pap smear of cervix

• Cervical biopsy

• Cone biopsy


Hysterosalpingogramis an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time becoming pregnant (infertile).During a hysterosalpingogram, a dye (contrast material)is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.


In a cervical punch biopsy, the cervix may be stained with iodine solution in order to see abnormalities better. These areas of tissue are then sampled and examined.


A cone biopsy is used to determine how deeply cancer cells have spread into tissue beneath the surface of the cervix. It is also used to treat very early and very small tumours. If the cancer is large, you may have a cone biopsy followed by further treatment. The biopsy is done under a general anaesthetic and involves a day or overnight stay in hospital. Results are usually available in a week.


Diagnostic Tests for Females

• Dilatation and curettage

• Laparoscopy

• Mammography

• Blood tests


A D&C is usually done to determine what condition is causing abnormal bleeding. Some conditions that may cause abnormal bleeding are: MiscarriageHormone imbalancesEndometrial polypsAbnormal endometrial thickeningEndometrial cancerSometimes a D&C is done to stop the bleeding, rather than to diagnose why you are bleeding. For example, this procedure may be done to remove products of conception (eg, tissue from the fetus or placenta) or to treat bleeding that has not responded to other methods.A D&C is not done if you have an infection (eg, affecting the uterus or fallopian tubes).


Laparoscopy


Diagnostic Tests for Males

• Digital rectal examination

• Cystoscopy

• Biopsy

• Laboratory tests– Including prostate-specific antigen (PSA)


cystoscopy lets your doctor see inside the bladder with a slender lighted tube with a camera on the end. The cystoscope can be used to remove small tissue samples (a biopsy) to be examined under a microscope


The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced in the prostate, a small gland that sits below a man's bladder. PSA is mostly found in semen, which also is produced in the prostate. Small amounts of PSA ordinarily circulate in the blood.There is some disagreement about the use of PSA in young men with no symptoms. Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of white men. (Ex: see following slide) Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group


Female Reproductive System Diseases

• Premenstrual syndrome (PMS)– Symptoms prior to menses

– Symptoms begin mid-cycle:• Headache• Nausea• Back and joint pain• Edema and bloating• Weight gain



• PMS– Symptoms begin mid-cycle:

• Breast tenderness• Sleep disturbances• Irritability• Mood swings• Depression

– Individualized treatment:• Dietary changes

– Avoid caffeine, chocolate, nicotine, salt, sugar, and alcohol


Female Reproductive System Diseases• Menstrual abnormalities:

– Amenorrhea-----absence of menses– Dysmenorrhea-----painful difficult menses– Menorrhagia--- is the medical term for menstrual periods with

abnormally heavy or prolonged bleeding

– Metrorrhagia--Uterine bleeding at irregular intervals, particularly between the expected menstrual periods. May be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids or, less commonly, cancer of the uterus.-----



• Menopause– Natural halting of menstruation

– NOT a disease, is normal physical change related to aging

– Usually takes place between age 40 and 50

– Can be surgically induced at any age by removal of both ovaries


Female Reproductive System Diseases• Menopause

– Symptoms:• Hot flashes, night sweats, and vaginal dryness• For some women – psychological symptoms of

depression, sleep disorders, and decreased libido

– Diagnosis:• Blood tests for presence of FSH

– Treatment:• MHT (menopausal hormone therapy) on an individual

basis by the individual and their physician


Female Reproductive System Diseases• Vaginitis--http://www.mayoclinic.org/diseasesconditions/vaginitis/basics/

symptoms/com20022645

– Inflammation of the vagina– Causes:

• Bacteria• Yeast

– Symptoms:• Vaginal burning, itching, swelling of the vagina and external

genitalia• A white cottage cheese–appearing discharge with Candida

– Diagnosis:• Testing vaginal fluid pH• Culture; antigen detection


Female Reproductive System Diseases• Vaginitis:

– Treatment:• Identify and treat cause• Abstain from sexual intercourse until condition has

healed

– Common types of vaginitis include• Candida

– Fungus or yeast

• Trichomonas– Parasite

• Atrophic– Postmenopausal


Female Reproductive System Diseases• Endometriosis

– Abnormal growth of endometrial tissue outside of uterus

– Common implantation sites:• Ovaries• Fallopian tubes• Abdominal wall• Intestines

– Implanted endometrial tissue continues to act under the influence of hormones producing chocolate cysts, scar tissue, and adhesions


Actually the chocolate cyst is the cyst of the ovary with intracavitary hemorrhage and formation of a hematoma containing old brown blood. The term chocolate cysts come from the physical appearance as these growths are usually comprised of dried blood making them brown in appearance.


Female Reproductive System Diseases• Endometriosis

– Symptoms:• Dysmenorrhea• Low back, vaginal, and pelvic cramping• Heavy menses• Dyspareunia• Primary complication is infertility

– Treatment:• Hormones• Remission with pregnancy, nursing, and

menopause• Panhysterectomy


Female Reproductive System Diseases• Pelvic inflammatory disease (PID)

– Inflammation of some or all pelvic reproductive organs•May include cervicitis, endometritis,

salpingitis, and oophoritis– Causes:

• Most commonly STDs

– Symptoms:• Fever• Chills• Pelvic pain• Leukorrhea


Female Reproductive System Diseases• Pelvic inflammatory disease can be caused by a

number of bacteria but are most often caused by gonorrhea or chlamydia infections. These bacteria

are usually acquired during unprotected sex.– PID– Treatment:

• Antibiotics• Analgesics• Rest

– Prevention:• Practicing safe sex with proper use of condoms


Female Reproductive System Diseases• Ovarian cyst

– Commonly benign fluid-filled sac(s) on or near ovary

– Two types: • Physiologic• Neoplastic

– Symptoms:• Low back pain• Pelvic pain• Dyspareunia-painful intercourse -• Nausea and vomiting

– Treatment depends on type and size– May resolve by itself or require laparoscopy


Ovarian cyst


Ovarian neoplasms may be primarily cystic, solid, or mixed. Some are benign, some are malignant. Some produce enough hormone to cause symptoms for the patient. Some examples of these shown below

Ovarian cysts can be broadly categorized as having two origins: physiologic cysts as a consequence of ovulation(or atttempted ovulation), and neoplastic cysts. Of the two, ovulation-related cysts are by far the more



• Fibroid tumor– Also known as leiomyomas– Benign tumors of smooth uterine muscle– Most common tumor of female reproductive

system– Symptoms:

• Abnormal uterine bleeding• Excessive menstrual bleeding and pain

– Treatment depends on woman’s age and desire for children:

• Surgical removal • Hysterectomy


Fibroids are classified according to their location in three types:(1) subserosal - when the fibroid grows under the outer layer or serosa of the uterus; (2) intramural - when the fibroid grows within the muscular wall of the uterus (myometrium), and (3) submucosal or intracavitary - when the fibroid grows just under the lining of the uterine cavity (mucosa) or it occupies the inside of the uterine cavity. Submucosal or intracavitary fibroids can change the shape of the uterine cavity


Female Reproductive System Diseases• Toxic shock syndrome

– A severe, life-threatening illness– Found almost exclusively in menstruating

females using tampons

– Cause:• Organism called Staphylococcus aureus

– Symptoms:• Sudden onset of high fever• Vomiting



Toxic shock syndrome Toxic shock syndrome historically has been associated primarily with the use of superabsorbent tampons. However, since manufacturers pulled certain types of tampons off the market, the incidence of toxic shock syndrome in menstruating women has declined.•Toxic shock syndrome can affect men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds and surgery.

– Symptoms: (continued) • Diarrhea• Decreasing blood pressure

– Treatment:• IV fluids• Antibiotics


Symptoms of Toxic ShockBy Mayo Clinic StaffPossible signs and symptoms of toxic shock syndrome include: A sudden high feverLow blood pressure (hypotension)Vomiting or diarrheaA rash resembling a sunburn, particularly on your palms and solesConfusionMuscle achesRedness of your eyes, mouth and throatSeizuresHeadaches


Female Reproductive System DiseasesUterine prolapse

•Uterus protrudes into vagina caused by:•Damage to supportive tissues during pregnancy and childbirth

•Effects of gravity

•Loss of estrogen

•Repeated straining over the years

– Symptoms:• Heaviness in pelvis• Urinary stress• Dysuria• Low back pain

– Treatment:• Hysterectomy


Female Reproductive System Diseases• Cystocele

– Herniation of urinary bladder through anterior vaginal wall• Possible causes of anterior prolapse include:• Pregnancy and vaginal childbirth• Being overweight or obese• Repeated heavy lifting• Straining with bowel movements• A chronic cough or bronchitis

– Symptoms:• Pelvic pressure• Urinary urgency, frequency, and incontinence

– Treatment depends on degree of herniation• Kegel exercise• Surgery


Female Reproductive System DiseasesRectocele

– Herniation of rectum through posterior vaginal wall

•Other conditions and activities that increase the pressure already on the pelvic floor and can cause or contribute to posterior prolapse include: Chronic constipation or straining with bowel movements

•Chronic cough or bronchitis

•Repeated heavy lifting

•Being overweight or obese•Pregnancy and childbirth

Symptoms:• Discomfort• Constipation• Fecal incontinence

Treatment:• Surgical repair


Female Reproductive System Diseases• Cervical cancer

– Fifth leading cause of cancer-related death in females

– Most common cause:• Human papillomavirus (HPV)

– Symptoms:• Abnormal cervical bleeding

– Treatment:• Surgical removal of tumor


Female Reproductive System Diseases• Cervical cancer

– Risk factors:• Beginning sex at an early age• Multiple sex partners• Smoking • Sex with males who smoke• Sex with males who have a spouse diagnosed with

cervical cancer• Obesity• Excessive alcohol consumption

– Prevention: Reduce risk factors AND• Have yearly pap smear tests – follow up on results• Get HPV vaccine


Cervical cancer is a progressive neoplastic syndrome of the cells of the cervix. Although most invasive cancer arises from squamous cells, about 20% of cervical cancer is associated with dysplastic glandular cells (adenocarcinomas).Over time, these cells can develop changes resulting in precancerous or cancerous forms. The progression can range from cervical intraepithelial neoplasia (CIN) to squamous intraepithelial lesions (SIL) to carcinoma in situ and eventually to invasive cancer. Because there is usually a long preinvasive period, during which the risk of metastasis is low and good treatment can be curative, cervical cancer is well suited for screening



• Uterine cancer

– Develops in endometrium and spreads to uterine wall

– Symptoms:• Abnormal bleeding in postmenopausal females

– Treatment:• Surgical removal of uterus and ovaries• Radiation therapy


Female Reproductive System Diseases• Ovarian cancer

– Quite common and often fatal– Symptoms:

• Pressure on bladder• Abdominal or pelvic pain• General feeling of ill health

– Treatment:• Complete hysterectomy• Radiation• Chemotherapy


Ovarian cancer


Diseases of the Breast

• Fibrocystic disease– Most common breast disorder of

premenopausal females between age 30 and 55

– Cause: Cysts linked to estrogen levels

– Treatment: To decrease breast pain:• Reduce caffeine and salt• Use mild diuretics• Use mild analgesics week before menstruation


Diseases of the Breast • Mastitis

– Inflammation of breast tissue– Symptoms:

• Redness, heat, swelling• Pain• Bloody nipple discharge

– Treatment:• Antibiotics• Application of heat• Analgesics• Firm, supporting bra to decrease discomfort


The common signs and symptoms include:Decreases in milk volume due to diminished lactose levels Breast refusal due to increased sodium and chloride levels in the milk A break in the skin i.e. nipple damageStinging pain in the nipple when feeding and afterwardsA nipple wound that won’t heal with crusting yellow to red exudateThe breast will appear swollen, red, warm and soreFlu-like symptoms including chills, headache and a rapid pulseFever above 38 degreesRed streaks extending towards the axilla The causes include:Milk stasis due to severe, prolonged engorgementInfrequent or inadequate emptying of breasts


Diseases of the Breast• Breast cancer

– Adenocarcinoma of breast ducts

– Most common breast neoplasm• Affects one in eight females

– Risk factors:• Age 40 and over• Family member affected with breast cancer• Onset of menses before age 13


Signs of breast cancer


The American Joint Committee on Cancer (AJCC) staging system provides a strategy for grouping patients with respect to prognosis. Therapeutic decisions are formulated in part according to staging categories but primarily according to the following:Tumor size.Lymph node status.Estrogen-receptor and progesterone-receptor levels in the tumor tissue.Human epidermal growth factor receptor 2 (HER2/neu) status.Menopausal status.General health of the patient.


TX Primary tumor cannot be assessed.

T0 No evidence of primary tumor.

Tis Carcinoma in situ.

Tis (DCIS) DCIS.

Tis (LCIS) LCIS.*

Tis (Paget) Paget disease of the nipple NOT associated with invasive carcinoma and/or carcinoma in situ (DCIS and/or LCIS) in the underlying breast parenchyma. Carcinomas in the breast parenchyma associated with Paget disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disease should still be noted.

T1 Tumor ≤20 mm in greatest dimension.

T1mi Tumor ≤1 mm in greatest dimension.

T1a Tumor >1 mm but ≤5 mm in greatest dimension.

T1b Tumor >5 mm but ≤10 mm in greatest dimension.

T1c Tumor >10 mm but ≤20 mm in greatest dimension.

T2 Tumor >20 mm but ≤50 mm in greatest dimension.

T3 Tumor >50 mm in greatest dimension.

T4 Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules).c

T4a Extension to the chest wall, not including only pectoralis muscle adherence/invasion.

T4b Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d'orange) of the skin, which do not meet the criteria for inflammatory carcinoma.

T4c Both T4a and T4b.

T4d Inflammatory carcinoma.


Diseases of the Breast

• Breast cancer

– Risk factors: (continued)• Menses continuing after age 50• Nullipara• First child after age 30• Obesity• Chronic breast disease• Brassiere wear time


Diseases of the Breast• Breast cancer

– Symptoms:• Nontender lump of varying size• Occurs most often in upper-outer quadrant of breast

– Often with dimpling

– Treatment:• Lumpectomy• Mastectomy• Chemotherapy• Radiation


Disorders of Pregnancy• Ectopic pregnancy

– Fertilized ovum attaches to tissue outside uterus

• Usually in fallopian tubes

– Symptoms:• Acute pelvic pain• Vaginal bleeding• Positive pregnancy test

– Treatment:• Prompt surgery to terminate pregnancy

– Every effort taken to preserve ovary and tube if future pregnancy desired


Ectopic Pregnancy


Disorders of Pregnancy• Spontaneous abortion

– Natural termination of pregnancy before fetus is viable

– Also known as miscarriage

– Symptoms:• Vaginal bleeding• Cramping and pelvic pain

– Treatment:• Bed rest• Once spontaneous abortion begins, it is difficult to

stop• D&C


Disorders of Pregnancy• Morning sickness

– Associated with first trimester of pregnancy

– Symptoms:• Nausea and vomiting

– Treatment:• Not necessary unless excessive vomiting• Light meals several times per day• Dry food before drinking• Avoidance of fatty foods• Rest after meals


Disorders of Pregnancy• Hyperemesis gravidarum

– Excessive vomiting during pregnancy– Symptoms:

• Excessive vomiting– Leading to dehydration, weight loss, and possible

electrolyte imbalance

– Treatment:• IV fluids• Withholding all foods and oral fluids

– Usually subsides by second pregnancy


Disorders of Pregnancy• Toxemia-----Pre-eclampsia

– Usually appears during third trimester– Symptoms:

• Hypertension• Sudden weight gain• Proteinuria• Edema in face, hands, and feet

– Treatment:• Frequent monitoring of blood pressure, weight, and

urine protein


PRECLAMPSIA / TOXEMIA IN PREGNACYPreclampsia / toxemia is also known as chronic hypertension. Is when the pregnancy may develop high blood pressure. And some other reasons are due to:1) Obese during pregnancy2) suffer from diabetes, rheumatiod arthirits or kidney diease3) pregnancy below 20 years of age or above 40 yeas of age4) Hereditary


Disorders of Pregnancy• Abruptio placentae

– Separation of placenta from uterus– Symptoms: Determined by degree of

separation• Partial separation may be asymptomatic• Complete separation may cause severe abdominal

pain and vaginal bleeding– Hemorrhage, shock, and decrease in fetal heart tones

– Treatment:• Prompt delivery either vaginally or by cesarean

section (C-section)

• Blood replacement may also be necessary


Disorders of Pregnancy

• Placenta previa– Abnormal positioning of placenta in lower uterus

often near or over cervical os

– Symptoms:• Painless, bright red vaginal bleeding during third trimester

– Treatment:• Vaginal delivery if asymptomatic or bleeding not severe• Emergency C-section if maternal bleeding or fetal anoxia


Male Reproductive System Diseases• Prostatitis

– Inflammation of prostate gland

– Symptoms:• Dysuria Pyuria• Fever Low back pain

– Treatment:• Antibiotics• Warm sitz baths• Increased fluid intake• Analgesics


Male Reproductive System Diseases

• Benign prostatic hyperplasia (BPH)– Enlargement of prostate gland due to normal

cells overgrowing and enlarging– Common in males over age 60– Symptoms:

• Nocturia• Inability to start urination• Weak urinary stream• Inability to empty bladder


Benign prostatic hyperplasia

Classification and external resources

Diagram illustrating normal prostate (left) and benign prostatic hyperplasia (right).

ICD-10 N40

ICD-9 600

DiseasesDB 10797

MedlinePlus 000381

eMedicine med/1919

Patient UK Benign prostatic hyperplasia

MeSH D011470

Jump to: navigation, search



• BPH

– Treatment:• Prostatic massage• Sitz bath• Catheterizations• Regular sexual intercourse• Surgery


Transurethral Resection of Prostate (TURP)


The surgeon reaches the prostate by inserting an instrument through the urethra (the narrow channel through which urine passes from the bladder out of the body). This instrument, called a resectoscope, is about 12 inches long and one-half inch in diameter. It contains a light, valves that control irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. It's inserted through the penis and the wire loop is guided by the surgeon so it can remove the obstructing tissue one piece at a time. The pieces of tissue are carried by fluid into the bladder and flushed out at the end of the procedure.



• Prostatic carcinoma– Neoplasm of prostate gland affecting males

over age 50

– Second most common cause of cancer-related deaths in males

– Symptoms: • Similar to BPH

– Treatment:• Depends on age, physical condition of individual, and

degree of metastasis



• Epididymitis– Inflammation of epididymis– Symptoms:

• Swollen, hard, and painful epididymis• Severe scrotal pain and swelling

– Treatment:• Rest• Analgesics• Use of scrotal support• Avoidance of alcohol, spicy foods, and sexual

stimulation



• Orchitis

– Inflammation of one or both testes due to viral or bacterial infection

– Symptoms:• Swelling, pain, and tenderness of one or both testes• Fever• Malaise

– Treatment depends on cause• Antibiotic if bacterial• Bed rest, analgesic, antipyretic, scrotal support


Male Reproductive System Diseases• Testicular tumor

– Commonly affects young males between age 20 and 35

• Most common type of cancer in this age group

– Symptoms:• Painless mass felt in testicle

– Treatment:• Orchiectomy• Chemotherapy• Radiation



• Cryptorchidism– Undescended testicle

– Common cause:• Premature birth

– Treatment:• Surgery


In cryptorchidism, the testis is not in the scrotum, but may be found in the inguinal canal or in the abdominal cavity. From Damjanov, 2000.


Cryptorchidism


Sexually Transmitted Diseases (STDs)

• STDs– Formerly called venereal diseases– A group of many diseases that are spread by

intimate or sexual contact– Treatment commonly consist of identifying sex

partners and treating the infected individuals concurrently

– Prevention of STDs is best achieved by avoiding intimate contact with infected individuals


STDs

• Genital herpes– Viral infection– One in six individuals in United States infected

– Periods of remission and exacerbation

– Symptoms:• Blister-like lesions causing dysuria• Severe itching


Genital Herpes


STDs• Acquired immunodeficiency syndrome

– AIDS– Blood-borne viral infection– Discussed in detail in Chapter 5

• Hepatitis– Viral infection of the liver– Hepatitis B and C can be spread by sexual

intercourse– Discussed in detail in Chapter 12


STDs• Genital herpes

– Viral infection of the mucous membranes

– Cause: • Herpes simplex virus

– Symptoms:• Blisters• Extreme pain• Severe itching• Painful urination


STDs

• Genital herpes

–Symptomatic treatment:• Antiviral medications• Sitz baths• Ice therapy• Analgesics

–No cure


STDs• Gonorrhea

– One of the most common STDs in the United States– Causes inflammation in mucous membranes of

genital and urinary system

– Cause: • Neisseria gonorrhoeae bacterium

– Symptoms:• Purulent discharge from penis and vagina• Dysuria


Also called the "clap" or "drip," gonorrhea is a contagious disease transmitted most often through sexual contact with an infected person. Gonorrhea may also be spread by contact with infected bodily fluids, so that a mother could pass on the infection to her newborn during childbirth. Both men and women can get gonorrhea.

Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in mucus membranes of the body.


← Previous Next →


STDs

• Gonorrhea– Symptoms: (continued)

• Urinary frequency in males and females• Cervicitis in females• Genital itching and burning pain

– Treatment:• Antibiotics

– Penicillin– Tetracycline– Ceftriaxone


STDs• Syphilis

– Chronic, life-threatening STD

– Cause:• Treponema pallidum bacterium

– Symptoms: Three stages• Primary

– Painless chancre appears

• Secondary– Chancre heals– Rash appears


STDs• Syphilis

– Three stages:• Tertiary

– Period of rest lasting 6 weeks to 1 year– Bacteria invade organs throughout body leading to gumma– Curable with antibiotics but outcome best if treated as

early as possible– effects of lesions can be irreversible

– Treatment:• Penicillin• Tetracycline


STDs• Chlamydia

– Very common, one of the most damaging STDs– Also known as silent STD– Cause:

• Bacterial

– Symptoms:• Drainage from penis and vagina• Burning and itching of genital area or with urination• Abdominal pain and dyspareunia in the infected



STDs• Trichomoniasis-Trichomoniasis is a

sexually transmitted infection caused by the parasite Trichomonas vaginalis.– Common STD affecting approximately 10% of

all sexually active individuals– Cause:

• Protozoan – Trichomonas vaginalis

– Symptoms:• Usually asymptomatic • When symptoms occur they include:• Male

– Urethritis


http://www.medicinenet.com/image-collection/chancroid_picture/picture.htm


STDs

• Trichomoniasis– Symptoms:

• Male (continued)– Epididymitis– Prostatitis

• Female– Itching and burning of genital area– Green, frothy vaginal discharge

– Treatment• Antiparasitic medications


STDs• Genital warts

– One of the most common STDs– Warts that affect the warm, moist tissue of the

genital area– Cause:

• HPV (virus)

– Symptoms:• Tenderness, discomfort related to size, location, and

number of warts

– Treatment:• Chemical or surgical removal

*Cervical cancer more common in females with genital warts


Of genital warts, 90% are caused by HPV 6 or 11. HPV types 6 or 11

Although genital warts are painless and not a threat to health, they can be a cause for concern and can be passed to sex partners.


Sexual Dysfunction

• Dyspareunia

– Pain or discomfort with sexual intercourse– May affect males and females

– Cause: physical or psychological conditions

– Treatment:• Dependent on cause


Sexual Dysfunction• Female arousal–orgasmic dysfunction

– Also known as frigidity– Lack of sexual desire or responsiveness– Cause: Often due to neurologic and

psychological conditions– Symptom: Inability to reach orgasm– Treatment:

• Education on healthy sex attitudes and sexual stimulation techniques


Sexual Dysfunction

• Impotence/erectile dysfunction (ED)– Now most commonly known as ED

– Symptoms:• Inability of male to achieve or maintain erection

sufficient to complete sexual intercourse• Does not affect fertility

– Cause:• Vascular insufficiency and psychological factors


Sexual Dysfunction

• Impotence/ED– Treatment varies:

• Change in medications• Psychological counseling• Surgery• Internal and external devices

– Prevention:• May not be preventable• Activities related to healthy lifestyle may aid in

prevention


Sexual Dysfunction• Premature ejaculation

– Expulsion of seminal fluid during foreplay, prior to complete erection, or immediately after beginning sexual intercourse

– Most common sexual problem in males• Especially young males

– Cause:• Usually psychological rather than physical

– Treatment • Based on cause• Can include sex therapy and education


Sexual Dysfunction

• Infertility– Inability of couple to achieve pregnancy

– Female causes:• Presence of STD• Hormonal disorders• Abnormality of reproductive organs• Endometriosis• Scarring or blockage of fallopian tubes• Vaginal antibodies that kill sperm


Sexual Dysfunction• Infertility

– Male causes:• Presence of STD or other infection in tract• Structural abnormalities• Hormonal disorders

– Treatment:• Surgery• Medications to correct hormone imbalance• Fertility drugs• Inseminations


Trauma• Rape

– Sexual intercourse (vaginal or anal) without consent or against will of individual

– May be any age and against either sex

– High incidence

– Date rape drugs

– Difficult recovery


Rare Diseases

• Vaginal cancer– Rare form of cancer that occurs in daughters of

mothers who used diethylstilbestrol (DES) hormone

– Treatment:• Surgery• Chemotherapy• Radiation


Rare Diseases

• Puerperal sepsis– Infection of endometrium following childbirth


– Prevention:• Asepsis during and after childbirth


Rare Diseases

• Hydatidiform mole

– Grape-like cysts in uterus that mimic pregnancy

– Treatment:• D&C

– At higher risk to develop choriocarcinoma• Requiring frequent follow-up examinations


Hydatidiform mole is a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy. It is a type of gestational trophoblastic disease ...


Effects of Aging on Females

• Thinning and graying of pubic hair• Decreased elasticity and atrophy• Shrinking of internal organs• Decreased vaginal lubrication• Greater stimulation and lubricants

required for sexual pleasure• Breast atrophy


Effects of Aging on Males

• Decreases in testosterone and sperm• Decrease in size of testes• Decreased elasticity of penis and scrotum• Thinning and graying of pubic hair• Greater stimulation required for erection• Diminished ejaculation amount• Enlarged prostate–problem with urination

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