Reproductive Disorders



Reproductive Disorders





AMENORRHEA

Amenorrhea is the abnormal absence of menstruation. Absence of menstruation is normal before puberty, after menopause, or during pregnancy and lactation; it’s pathologic at any other time. Primary amenorrhea is the absence of menarche in an adolescent by age 14 without the development of secondary sex characteristics or by age 16 with normal development of secondary sex characteristics. Secondary amenorrhea is the absence of menstruation for at least 6 months after the normal onset of menarche. Primary amenorrhea occurs in 0.3% of women; secondary amenorrhea occurs in about 4% of women. Prognosis is variable, depending on the specific cause. In the case of obstructive causes, surgical correction of outflow tract obstruction is usually curative.


Causes



  • Anovulation due to deficient secretion of:



    • estrogen


    • gonadotropins


    • luteinizing hormone (LH)


    • follicle-stimulating hormone (FSH).


  • Lack of ovarian response to gonadotropins


  • Constant presence of progesterone or other endocrine abnormalities


  • Endometrial adhesions (Asherman’s syndrome)


  • Ovarian, adrenal, or pituitary tumor


  • Emotional disorders — common in patients with depression or anorexia nervosa:



    • Mild emotional disturbances such as stress tend to distort the ovulatory cycle.


    • Severe psychic trauma may abruptly change the bleeding pattern or completely suppress one or more full ovulatory cycles.


  • Malnutrition or intense exercise — suppresses hormonal changes initiated by the hypothalamus


  • Pregnancy


  • Excessive weight loss


  • Thyroid disorder


  • Obesity or excessive weight gain


  • Ovarian or adrenal tumor


  • Anatomic defects








BREAST CANCER

Breast cancer is the most common cancer affecting women. It is estimated that one in eight women in the United States will develop breast cancer during her lifetime. Male breast cancer accounts for 1% of all male cancers and less than 1% of all breast cancers. The 5-year survival rate for localized breast cancer is 98% because of early diagnosis and a variety of treatments. Lymph node involvement is the most valuable prognostic predictor. With adjuvant therapy, 70% to 75% of women with negative nodes will survive 10 years or more, compared with 20% to 25% of women with positive nodes.



Causes


High Risk Factors



  • Family history of breast cancer, particularly first-degree relatives (mother, sister, and/or maternal aunt)


  • Positive tests for genetic mutations (BRCA1 and BRCA2)


  • Long menstrual cycles, early menarche, late menopause


  • Nulliparous or first pregnancy after age 30


  • History of unilateral breast cancer or ovarian cancer


  • Exposure to low-level radiation


Low Risk Factors



  • Pregnancy before age 20, history of multiple pregnancies


  • Native American or Asian ancestry







BENIGN BREAST CONDITIONS

Also known as fibrocystic disease of the breast, this disorder of benign changes in breast tissue is usually bilateral.


Although most lesions are benign, some may proliferate and show atypical cellular growth. Fibrocystic change by itself isn’t a precursor to breast cancer, but if atypical hyperplasia is present, the risk for breast carcinoma increases.


Causes

Exact cause unknown


Proposed Causes



  • Estrogen excess and progesterone deficiency during luteal phase of menstrual cycle


  • Environmental toxins that inhibit cyclic guanosine monophosphate enzymes:



    • methylxanthines — caffeine (coffee), theophylline (tea), theobromine (chocolate)


    • tyramine — in cheese, wine, nuts


    • tobacco.







CERVICAL CANCER

The third most common cancer of the female reproductive system, cervical cancer is classified as either microinvasive or invasive. Precancerous dysplasia, also called cervical intraepithelial carcinoma or cervical carcinoma in situ, is more frequent than invasive cancer and occurs more often in younger women.


Causes



  • Human papillomavirus (HPV)


Predisposing Factors



  • Frequent intercourse at a young age (under age 16)


  • Multiple sexual partners and/or partner with multiple partners


  • Multiple pregnancies


  • Sexually transmitted infections


  • Smoking







CRYPTORCHIDISM

Cryptorchidism is a congenital disorder in which one or both testes fail to descend into the scrotum, remaining in the abdomen inguinal canal or at the external ring. Although this condition may be bilateral, it more commonly affects the right testis. True undescended testes remain along the path of normal descent; ectopic testes deviate from that path.

Undescended testes are susceptible to neoplastic changes. The risk of testicular cancer is greater for men with cryptorchidism than for the general male population.



Causes

Primary cause unknown


Possible Causes



  • Testosterone deficiency resulting in a defect in the hypothalamic-pituitary-gonadal axis, causing failure of gonadal differentiation and gonadal descent


  • Structural factors impeding gonadal descent, such as ectopic testis or short spermatic cord


  • Genetic predisposition in a small number of cases; greater incidence of cryptorchidism in infants with neural tube defects


  • In premature neonates — early gestational age; normal descent of testes into the scrotum is in seventh month of gestation







ECTOPIC PREGNANCY

An ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube. Prognosis is good with prompt diagnosis, appropriate surgical intervention, and control of bleeding. Few ectopic pregnancies are carried to term; rarely, with abdominal implantation, the fetus survives to term.

In whites, ectopic pregnancy occurs in about 1 of 200 pregnancies. In nonwhites, the incidence is about 1 of 120 pregnancies.


Causes



  • Endosalpingitis


  • Diverticula


  • Tumors pressing against the tube


  • Previous surgery, such as tubal ligation or resection


  • Transmigration of the ovum


  • Congenital defects in reproductive tract


  • Ectopic endometrial implants in the tubal mucosa


  • Sexually transmitted tubal infection or history of STIs and/or PID


  • Intrauterine device




Diagnostic Tests



  • Blood test reveals abnormally low serum HCG; when repeated in 48 hours, level remains lower than levels found in a normal intrauterine pregnancy.


  • Real-time ultrasonography shows intrauterine pregnancy, tubal pregnancy, or ovarian cyst.


  • Culdocentesis shows free blood in the peritoneum.


  • Laparoscopy reveals pregnancy outside the uterus.




ENDOMETRIAL CANCER

Also known as uterine cancer (cancer of the endometrium), endometrial cancer is the most common gynecologic cancer.



Causes

Primary cause unknown


Predisposing Factors



  • Anovulation, abnormal uterine bleeding


  • History of atypical endometrial hyperplasia


  • Unopposed estrogen stimulation


  • Nulliparity


  • Polycystic ovarian syndrome


  • Familial tendency


  • Obesity, hypertension, diabetes







ENDOMETRIOSIS

Endometriosis is the presence of endometrial tissue outside the lining of the uterine cavity, which occurred during fetal development of the woman. Ectopic tissue is generally confined to the pelvic area, usually around the ovaries, uterovesical peritoneum, uterosacral ligaments, and cul-de-sac, but it can appear anywhere in the body.

Active endometriosis may occur at any age, including adolescence. As many as 50% of infertile women may have endometriosis, although the true incidence in both fertile and infertile women remains unknown.

Severe symptoms of endometriosis may have an abrupt onset or may develop over many years. Of women with endometriosis, 30% to 40% become infertile. Endometriosis usually manifests during the menstrual years; after menopause, it tends to subside.


Causes

Primary cause unknown


Suggested Causes (One or More may be True in Different Women)



  • Retrograde menstruation with implantation at ectopic sites; may not be causative alone; occurs in women with no clinical evidence of endometriosis


  • Genetic predisposition and depressed immune system


  • Coelomic metaplasia (metaplasia of mesothelial cells to the endometrial epithelium caused by repeated inflammation)


  • Lymphatic or hematogenous spread to extraperitoneal sites







ERECTILE DYSFUNCTION

Erectile dysfunction, or impotence, refers to a male’s inability to attain or maintain penile erection sufficient to complete intercourse. The patient with primary impotence has never achieved a sufficient erection. Secondary impotence is more common but no less disturbing than the primary form, and implies that the patient has succeeded in completing intercourse in the past.

Transient periods of impotence aren’t considered dysfunction and probably occur in half of adult males. The prognosis for erectile dysfunction patients depends on the severity and duration of their impotence and the underlying causes.



Causes


Psychogenic



  • Personal sexual anxieties that generally involve guilt, fear, depression, or feelings of inadequacy resulting from previous traumatic sexual experience, rejection by parents or peers, exaggerated religious orthodoxy, abnormal motherson intimacy, or homosexual experiences


  • Disturbed sexual relationship, possibly stemming from differences in sexual preferences between partners, lack of communication, insufficient knowledge of sexual function, or nonsexual personal conflicts


  • Situational impotence, a temporary condition in response to stress


Organic



  • Chronic diseases that cause neurologic and vascular impairment, such as cardiopulmonary disease, diabetes, multiple sclerosis, or renal failure


  • Liver cirrhosis causing increased circulating estrogen due to reduced hepatic inactivation


  • Spinal cord trauma


  • Complications of surgery, particularly radical prostatectomy


  • Drug- or alcohol-induced dysfunction


  • Genital anomalies or central nervous system defects

Sep 22, 2018 | Posted by in ANATOMY | Comments Off on Reproductive Disorders
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