Study Guide The Reproductive System and Disorders
INTRODUCTION
The medical curriculum has become increasingly vertically integrated, with a much greater
use of clinical examples and cases to help in the understanding of the relevance of the
underlying basic science, and conversely use of basic science concepts to help in the
understanding of the phatophysiology and treatment of disease. The reproductive system
and disorder block has been written to take account of this trend, and to integrate core
aspects of basic science, pathophysiology and treatment into a single, easy to use revision
aid.
In accordance the lectures that have been full integrated for studens in 6
semester, period of 2015, one of there is The Reproductive System and Disorders Block.
Th
There are many topics will be discuss as below:
Anatomy of male &female, histology of male and female, physiology of male and female,
antenatal care and normal labor, abnormal labor, obstetric emergency, puerperium and
disorders, benign and malignant diseases of the breast, common gynecologic and
disorders, male and female sexual dysfunction, male and female infertility, male and female
family planning, drugs therapy in pregnant and genital disorders.
Beside those topics, also describes the learning outcome, learning objective, learning task,
self assessment and references. The learning process will be carried out for 4 weeks (20
days).
Due to this theme has been prepared for the second time, so many locking mill is available
on it. Perhaps it will better in the future
Thank you.
Planners
Udayana University Faculty of Medicine, MEU
1
Study Guide The Reproductive System and Disorders
CURRICULUM CONTENTS
Aims:
 Comprehend the biologic function of reproductive system in male and female.
 Comprehend the pathological process of the reproductive disorders in male and
female.
 Diagnose and manage patient with male genital disorders.
 Diagnose and manage patient with gynecologic and obstetric problem.
 Educate patient and their family and community about reproductive disorders.
Learning outcome:
 Explain (differentiate) the functional structure of male and female reproductive
system.
 Explain pathological process related to symptom and sign of male disorders.
 Explain pathological process related to symptom and sign of gynecologic and
obstetric disorders.
 Interpret the common laboratory and imaging result in male genital disorders.
 Interpret the common laboratory and imaging result in gynecologic and obstetric
problems.
 Diagnose and manage patient with male genital disorders.
 Diagnose and manage patient with normal pregnant
 Diagnose and manage patient with infertility and family planning
 Diagnose and manage patient with gynecologic and obstetric problems
 Communicate the education principle in male genital problems, gynecologic and
obstetric problems.
Curriculum contents:
 Anatomy of male and female reproductive system
 Histology of male and female reproductive system
 Physiology of male and female reproductive system
 Male and female family planning
 Normal labor and ANC
 Abnormal labor
 Obstetric emergency
 Common gynecologic and disorders/ morphology
 Benign and malignant diseases of the breast/ morphology
 Puerperium and disorders
 Male and female sexual dysfunction
 Male and female infertility
 Pharmacology
Udayana University Faculty of Medicine, MEU
2
Study Guide The Reproductive System and Disorders
PLANNERS TEAM
NO
NAME
DEPARTEMENT
1.
dr. A. A.A.N. Susraini, Sp.PA
2.
dr. I.G.A Sri Darmayani, SpOG
3.
Prof.Dr.dr. Wimpie Pangkahila, Sp.And. FAAC
4.
dr. Wayan Sudarsa, Sp.B - K.Onk
5.
dr. Wayan Sugiritama. M.Kes
Histology
6.
dr. I Gusti Ayu Widianti, M.Biomed
Anatomy
7.
Dr. dr. Susi Purnawati.M.KK
Anatomy Pathology
Medical Education (DME)
Andrology
Oncology Surgery
Physiology
LECTURERS
NO
NAME
DEPARTEMENT
PHONE
1.
dr. A.A.A.N. Susraini, Sp.PA(K)
Anatomy
Pathology
0811398913
2.
dr. I.G.A Sri Darmayani, SpOG
DME
081338644411
3.
dr. I Gusti Ayu Widianti, M.Biomed
Anatomy
08123921765
4.
Dr. dr. Susi Purnawati.M.KK
Physiology
08123989891
5.
dr. I Wayan Artana Putra,Sp.OG (K)
Obgyn
6.
dr.I.G.P Mayun Mayura, Sp.OG
Obgyn
08123927235
08123800923
7.
dr. Tjok GA Suwardewa,Sp.OG(K)
Obgyn
8.
dr. I Gede Ngurah Harry Wijaya
Surya,Sp.OG
Obgyn
0811387482
0811386935
9.
dr.Anom Suardika,Sp.OG(K)
Obgyn
08123809218
10.
Obgyn
0811387564
11.
dr. I.B Putra Adnyana,Sp.OG(K)
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
Andrology and
sexology
0811395694
12.
dr. I Made Oka Negara, S.ked
Andrology and
sexology
08123979397
13.
dr.Gede Wirya Kusuma Duarsa M.Kes,SpU
Surgery/Urology
08155753377
14.
dr. Wayan Sudarsa, SpB.K.Onk
Surgery/Oncology
0811398971
15.
Dr.dr.Bagus Komang Satriyasa,M.Repro
Pharmacology
081805368922
16.
Histology
08164732743
17.
dr. I.W Sugiritama, M.Kes
dr. Putu Anda Tusta Adiputra, Sp.B (K) Onk
Surgery/Oncology
08123826430
18.
dr. Made Bagus Dwi Aryana, Sp.OG (K)
Obgyn
081933145766
19.
dr Luh Putu Ratna Sundari, MBiomed
Physiology
0361-7860532
Udayana University Faculty of Medicine, MEU
3
Study Guide The Reproductive System and Disorders
FACILITATORS
Regular Class (Class A)
No
Name
Group
Departement
Phone
1
dr. I G A Sri Darmayani,
Sp.OG
A1
DME
081338644411
2
Dr.dr. Susy Purnawati, MKK
A2
Fisiology
08123989891
3
dr. Putu Anda Tusta Adiputra
, Sp.B(K)Onk
A3
Surgery
08123826430
4
Dr.dr. Ni Made Linawati,M.Si
A4
Histology
081337222567
A5
Orthopaedi
0811388859
A6
Interna
08123657130
A7
Radiology
08123670196
A8
Anasthesi
081805755222
A9
Anatomy
087860405625
A10
Fisiology
08174742566
Group
Departement
Phone
B1
Interna
08123815025
B2
Surgery
081236288975
B3
ENT
08123937063
B4
Biochemistry
0811397960
B5
Neurology
081328049360
B6
Andrology
08123979397
B7
Fisiology
081338505350
B8
Histology
085339644145
B9
Obgyn
08123997401
B10
Interna
08123607874
5
6
7
8
9
10
dr. I Gusti Lanang Ngurah
Agung Artha Wiguna, Sp.OT
(K)
dr. I Made Pande Dwipayana,
Sp.PD
dr. I Made Dwijaputra
Ayustha, Sp.Rad
dr. I Putu Kurniyanta, Sp.An
dr. I Nyoman Gede
Wardana, M Biomed
dr. I Made Krisna Dinata,
S.Ked
Venue
(2nd floor)
2nd floor
R.2.09
2nd floor
R.2.11
2nd floor
R.2.12
2nd floor
R.2.13
2nd floor
R.2.14
2nd floor
R.2.15
2nd floor
R.2.16
2nd floor
R.2.20
2nd floor
R.2.21
2nd floor
R.2.22
English Class (Class B)
No
1
2
3
4
5
6
7
8
9
10
Name
dr. I Made Susila Utama,
Sp.PD-KPTI
dr. I Made Suka Adnyana,
Sp.BP
dr. I Made Sudipta, Sp.THTKL
dr. I Nyoman Arcana, Sp.Biok
dr. I Putu Eka Widyadharma,
M.Sc,SpS
dr. I Made Oka Negara,
S.Ked
dr. I Made Muliarta, M.Kes
dr. I G Kamasan Nyoman
Arijana, M.Si.Med
dr. I Nyoman Gede Budiana,
Sp.OG (K)
dr. I Made Bagiada, Sp.PD
Udayana University Faculty of Medicine, MEU
Venue
(2nd floor)
2nd floor
R.2.09
2nd floor
R.2.11
2nd floor
R.2.12
2nd floor
R.2.13
2nd floor
R.2.14
2nd floor
R.2.15
2nd floor
R.2.16
2nd floor
R.2.20
2nd floor
R.2.21
2nd floor
R.2.22
4
Study Guide The Reproductive System and Disorders
TIME TABLE
English Class (B)
DAY
TIME
LEARNING
ACTIVITY
VENUE
CONVEYER
Introduction to the Block
The Reproductive
System and Disorders
Lecture 1.
Anatomy of female
genital system
Individual Learning
SGD 1
Break
Student Project
Plenary
Lecture 2.
Histology of male and
female genital system
Individual Learning
SGD 2
Break
Student Project
Plenary
Lecture 3.
Physiology of male
genital system
Individual Learning
SGD 3
Break
Student Project
Plenary
4.02
dr.A.A.A.N.Susraini.Sp.PA(K)
4.02
dr. IGA Widianti. M.Biomed
DATE
1.
Fri
12 June
2015
2.
Mon
15 June
2015
3.
Tue
16 June
2015
4.
Wed
17 June
2015
08.00-08.10
08.10-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture 4.
Physiology of female
genital system
Individual Learning
SGD 4
Break
Student Project
Plenary
Udayana University Faculty of Medicine, MEU
Disc room
4.02
4.02
Disc room
4.02
4.02
Disc room
4.02
4.02
Disc room
4.02
Facilitators
dr. IGA Widianti. M.Biomed
dr. I.W. Sugiritama, MKes
Facilitators
dr. I.W. Sugiritama, MKes
dr Luh Putu Ratna Sundari,
MBiomed
Facilitators
dr Luh Putu Ratna Sundari,
MBiomed
Dr. dr. Susi Purnawati.M.KK
Facilitators
Dr. dr. Susi Purnawati.M.KK
5
Study Guide The Reproductive System and Disorders
DAY
TIME
DATE
5.
Thu
18 June
2015
6.
Fri
19 June
2015
7.
Mon
22 June
2015
8
Tue
23 June
2015
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
LEARNING
ACTIVITY
Lecture 5.
Antenatal Care and
Normal labor
Individual Learning
SGD 5
Break
Student Project
Plenary
VENUE
4.02
Disc room
4.02
08.00-09.00
Lecture 6.
Abnormal labor
09.00-10.30
Individual Learning
10.30-12.00
12.00-12.30
SGD 6
Break
12.30-14.00
Student Project
14.00-15.00
Plenary
4.02
08.00-09.00
Lecture 7.
Obstetric emergency
Individual Learning
SGD 7
Break
Student Project
Plenary
4.02
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture 8
Puerperium and
disorders
Individual Learning
SGD 8
Break
Student Project
Plenary
Udayana University Faculty of Medicine, MEU
4.02
Disc room
Disc room
4.02
4.02
Disc room
4.02
CONVEYER
dr. I Wayan Artana
Putra,SpOG(K)
Facilitators
dr. I Wayan Artana
Putra,SpOG(K)
dr. Tjok GA
Suwardewa,SpOG(K)
Facilitators
dr. Tjok GA
Suwardewa,SpOG(K)
dr. Harry Wijaya Surya,
SpOG
Facilitators
dr. Harry Wijaya Surya,
SpOG
Dr Made Bagus Dwi
Aryana, SpOG (K)
Facilitators
Dr Made Bagus Dwi
Aryana, SpOG (K)
6
Study Guide The Reproductive System and Disorders
DAY
TIME
LEARNING
ACTIVITY
VENUE
08.00-09.00
Lecture 9
Benign and malignant
diseases of the
breast
Individual Learning
SGD 9
Break
Student Project
Plenary
4.02
DATE
9
Wed
24 June
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
Lecture 10
Common gynecologic
and disorders
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD 10
Break
Student Project
Plenary
11
Fri
26 June
2015
08.00selesai
Basic clinical skill (1)
Practical Session
(Anatomy, Histology)
12.
Mon
29 June
2015
08.00-09.00
Lecture 11
Male and female
sexual dysfunction
Individual Learning
SGD 11
Break
Student Project
Plenary
10
Thu
25 June
2015
13.
Tue
30 June
2015
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Lecture 12.
Male infertility I
Individual Learning
SGD 12
Break
Student Project
Plenary
Udayana University Faculty of Medicine, MEU
Disc room
4.02
4.02
Disc room
4.02
Anatomi
Histologi
4.02
Disc room
4.02
4.02
Disc room
4.02
CONVEYER
dr. Wayan Sudarsa,SpB
K.Onk
dr. AAAN Susraini,SpPA
Facilitators
dr. Wayan Sudarsa,SpB
K.Onk
dr. AAAN Susraini,SpPA
dr.IGP Mayun
Mayura,SpOG
dr. AAAN
Susraini,SpPA(K)
Facilitators
dr.IGP Mayun
Mayura,SpOG
dr. AAAN
Susraini,SpPA(K)
dr. IGA Widianti. M.Biomed
dr. I.W. Sugiritama, MKes
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
Fasilitator
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
Fasilitators
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
7
Study Guide The Reproductive System and Disorders
DAY
TIME
LEARNING ACTIVITY
VENUE
CONVEYER
4.02
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
DATE
08.00-09.00
Lecture 13.
Male Infertility II
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD 13
Break
Student Project
Plenary
15
Thu
2 Jul
2015
08.00-15.00
Basic clinical skill (2)
(Leopold, normal labor,
puerperium)
16
Fri
3 Jul
2015
08.00-09.00
Lecture 14.
Female Infertility
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD 14
Break
Student Project
Plenary
08.00-09.00
Lecture 15
Drugs Therapy In
Pregnant and genital
disorders
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
Individual Learning
SGD 15
Break
Student Project
Plenary
18.
Tue
7 Jul
2015
08.00-15.00
Basic clinical skill (3)
Pap smear, IVA, swab
19.
Wed
8 Jul
2015
08.00-15.00
14
Wed
1 Jul
2015
17
Mon
6 Jul
2015
Disc room
Facilitators
4.02
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
4.02
dr. Harry Wijaya
Surya, SpOG
dr I.G.A Sri
Darmayani SpOG
Clinical skill lab
4.02
Disc room
dr.I.B Putra
Adnyana,SpOG(K)
Facilitators
4.02
dr.I.B Putra
Adnyana,SpOG(K)
4.02
DR.dr. Bgs Km
Satriyasa,M.Repro
Disc room
Facilitators
4.02
DR.dr. Bgs Km
Satriyasa,M.Repro
4.02
dr. AAAN
Susraini,SpPA(K)
Clinical skill lab
Basic clinical skill (4)
Breast examination, male
genital examination,
sperm analysis
Udayana University Faculty of Medicine, MEU
4.02
Clinical skill lab
Dr Putu Anda Tusta
Adiputra, SpB
Dr I Made Oka
Negara, S.ked
8
Study Guide The Reproductive System and Disorders
20.
Thu
9 Jul
2015
08.00-15.00
Basic clinical skill (5)
Male & female family
planning
21.
Fri
10 Jul
2015
22.
Mon
13 Jul
2015
Udayana University Faculty of Medicine, MEU
4.02
Clinical skill lab
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
dr. Anom
Suardika,SpOG (K)
Silent day
Examination
9
Study Guide The Reproductive System and Disorders
Regular Class (A)
DAY
TIME
LEARNING ACTIVITY
VENUE
CONVEYER
09.00-09.10
Introduction to the Block
The Reproductive
System and Disorders
Lecture 1.
Anatomy of female
genital system
Individual Learning
Student Project
Break
SGD
Plenary
Lecture 2.
Histology of male and
female genital system
Individual Learning
Student Project
Break
SGD 2
Plenary
Lecture 3.
Physiology of male
genital system
Individual Learning
Student Project
Break
SGD 3
Plenary
4.02
dr.A.A.A.N.Susraini.Sp.PA(K)
4.02
dr. IGA Widianti. M.Biomed
Disc room
4.02
4.02
Facilitators
dr. IGA Widianti. M.Biomed
dr. I.W. Sugiritama, MKes
Disc room
4.02
4.02
Facilitators
dr. I.W. Sugiritama, MKes
dr. Luh Putu Ratna Sundari,
MBiomed
Disc room
4.02
Lecture 4.
Physiology of female
genital system
Individual Learning
Student Project
Break
SGD 4
Plenary
4.02
Facilitators
dr. Luh Putu Ratna Sundari,
MBiomed
Dr. dr. Susi Purnawati.M.KK
Disc room
4.02
Facilitators
Dr. dr. Susi Purnawati.M.KK
DATE
1.
Fri
12 June
2015
2.
Mon
15 June
2015
3.
Tue
16 June
2015
4.
Wed
17 June
2015
09.10-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Udayana University Faculty of Medicine, MEU
10
Study Guide The Reproductive System and Disorders
DAY
TIME
DATE
5.
Thu
18 June
2015
6.
Fri
19 June
2015
7.
Mon
22 June
2015
8
Tue
23 June
2015
LEARNING
ACTIVITY
VENUE
CONVEYER
Lecture 5.
Antenatal Care and
Normal labor
Individual Learning
Student Project
Break
SGD 5
Plenary
4.02
dr. I Wayan Artana
Putra,SpOG(K)
Disc room
4.02
09.00-10.00
Lecture 6.
Abnormal labor
4.02
Facilitators
dr. I Wayan Artana
Putra,SpOG(K)
dr. Tjok GA
Suwardewa,SpOG(K)
10.00-11.30
Individual Learning
11.30-12.00
12.00-13.30
Student Project
Break
13.30-15.00
SGD 6
Disc room
Facilitators
15.00-16.00
Plenary
4.02
09.00-10.00
Lecture 7.
Obstetric emergency
Individual Learning
Student Project
Break
SGD 7
Plenary
4.02
dr. Tjok GA
Suwardewa,SpOG(K)
dr. Harry Wijaya Surya,
SpOG
Lecture 8
Puerperium and
disorders
Individual Learning
Student Project
Break
SGD 8
Plenary
4.02
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Udayana University Faculty of Medicine, MEU
Disc room
4.02
Disc room
4.02
Facilitators
dr. Harry Wijaya Surya,
SpOG
Dr Made Bagus Dwi
Aryana, SpOG (K)
Facilitators
Dr Made Bagus Dwi
Aryana, SpOG (K)
11
Study Guide The Reproductive System and Disorders
DAY
TIME
LEARNING
ACTIVITY
09.00-10.00
Lecture 9
Benign and malignant
diseases of the
breast
Individual Learning
Student Project
Break
SGD 9
Plenary
4.02
dr. Wayan Sudarsa,SpB
K.Onk
dr. AAAN Susraini,SpPA
Disc room
4.02
09.00-10.00
Lecture 10
Common gynecologic
and disorders
4.02
Facilitators
dr. Wayan Sudarsa,SpB
K.Onk
dr. AAAN Susraini,SpPA
dr.IGP Mayun
Mayura,SpOG
dr. AAAN
Susraini,SpPA(K)
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Individual Learning
Student Project
Break
SGD 10
Plenary
08.00selesai
Basic clinical skill (1)
Practical Session
(Anatomy, Histology)
Anatomi
Histologi
09.00-10.00
Lecture 11
Male and female
sexual dysfunction
Individual Learning
Student Project
Break
SGD 11
Plenary
4.02
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
Disc room
4.02
Lecture 12.
Male infertility I
Individual Learning
Student Project
Break
SGD 12
Plenary
4.02
Facilitators
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
DATE
9
Wed
24 June
2015
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
10
Thu
25 June
2015
11.
Fri
26 June
2015
12.
Mon
29 June
2015
13.
Tue
30 June
2015
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Udayana University Faculty of Medicine, MEU
VENUE
Disc room
4.02
Disc room
4.02
CONVEYER
Facilitators
dr.IGP Mayun
Mayura,SpOG
dr. AAAN
Susraini,SpPA(K)
dr. IGA Widianti. M.Biomed
dr. I.W. Sugiritama, MKes
Facilitators
Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
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Study Guide The Reproductive System and Disorders
DAY
TIME
LEARNING ACTIVITY
VENUE
CONVEYER
DATE
09.00-10.00
Lecture 13.
Male Infertility II
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Individual Learning
Student Project
Break
SGD 13
Plenary
15
Thu
2 Jul
2015
09.00-16.00
16
Fri
3 Jul
2015
14
Wed
1 Jul
2015
4.02
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
Disc room
4.02
Facilitators
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
Basic clinical skill (2)
Leopold, normal labor,
puerperium
4.02
Clinical skill lab
dr. Harry Wijaya
Surya, SpOG
dr I.G.A Sri
Darmayani SpOG
09.00-10.00
Lecture 14.
Female Infertility
4.02
dr.I.B Putra
Adnyana,SpOG(K)
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Individual Learning
Student Project
Break
SGD 14
Plenary
Disc room
4.02
Facilitators
dr.I.B Putra
Adnyana,SpOG(K)
09.00-10.00
Lecture 15
Drugs Therapy In
Pregnant and genital
disorders
4.02
DR.dr. Bgs Km
Satriyasa,M.Repro
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
Individual Learning
Student Project
Break
SGD 15
Plenary
Disc room
4.02
Facilitators
DR.dr. Bgs Km
Satriyasa,M.Repro
18.
Tue
7 Jul
2015
09.00-16.00
Basic clinical skill (3)
Pap smear, IVA, swab
4.02
Clinical skill lab
dr. AAAN
Susraini,SpPA(K)
19.
Wed
8 Jul
2015
09.00-16.00
Basic clinical skill (4)
Breast examination, male
genital examination,
sperm analysis
4.02
Clinical skill lab
Dr Putu Anda Tusta
Adiputra, SpB
Dr I Made Oka
Negara, S.ked
17
Mon
6 Jul
2015
Udayana University Faculty of Medicine, MEU
13
Study Guide The Reproductive System and Disorders
20.
Thu
9 Jul
2015
09.00-16.00
Basic clinical skill (5)
Male & female family
planning
21.
Fri
10 Jul
2015
22.
Mon
13 Jul
2015
Udayana University Faculty of Medicine, MEU
4.02
Clinical skill lab
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
dr. Anom
Suardika,SpOG (K)
Silent day
Examination
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Study Guide The Reproductive System and Disorders
BASIC CLINICAL SKILL
Jadwal Praktikum dan BCS Block Reproductive System
Day
Date
Fri
26
June
2015
Learning
Activity
Group
Time
Venue
Praktikum
anatomi
A1-A5
A6-A10
B1-B5
B6-B10
08.00 – 09.30
09.30 – 11.00
11.00 – 13.30
13.30 – 14.00
Lab.
Anatomi
09.30 – 11.00
Lab.
Histologi
dr. Widianti M.Biomed
Praktikum
Histologi
Thu
2 Jul
2015
Tue
7 Jul
2015
Wed
8 Jul
2015
Thu
9 Jul
2015
Conveyer
Pemeriksaaan
Leopold, normal
labor, puerperium
A1-A5
A6-A10
11.00 – 13.30
B1-B5
13.30 – 14.00
B6-B10
08.00 – 09.30
Kelas A
Kelas B
08.00 – 09.00
09.00 – 10.00
10.00 – 11.00
11.00 – 12.00
Kelas A
11.00 – 13.30
Kelas B
13.30 – 15.00
dr.Sugiritama, MKes
Ruang
Kuliah
4.02
dr. Harry, SpOG
dr. Sri, SpOG
dr. Harry, SpOG
dr. Sri, SpOG
Skill lab
Fasilitator
Fasilitator
dr. Susraini,SpPA(K)
Pap smear, IVA,
swab
Breast
examination,
male genital
examination,
sperm analysis
Male & female
family planning
Kelas A
08.00 – 09.30
Kelas B
09.30 – 11.00
Kelas A
Kelas B
11.00 – 13.30
13.30 – 15.00
Kelas B
Kelas A
08.00 – 09.00
09.00 – 10.00
10.00 – 11.00
11.00 – 12.00
Kelas B
Kelas A
11.00 – 13.30
13.30 – 15.00
Kelas B
08.00 – 09.00
09.00 – 10.00
Kelas A
10.00 – 11.00
11.00 – 12.00
Kelas B
Kelas A
11.00 – 13.30
13.30 – 15.00
Udayana University Faculty of Medicine, MEU
Ruang
Kuliah
4.02
Skill lab
Ruang
Kuliah
4.02
dr. Susraini,SpPA(K)
Fasilitator
Fasilitator
dr Anda Tusta, SpB
dr Oka Negara
dr Anda Tusta, SpB
dr Oka Negara
Skill lab
Ruang
Kuliah
4.02
Fasilitator
Fasilitator
dr. Anom,SpOG (K)
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
dr. G Wirya Kusuma
Duarsa,M.Kes,SpU
dr. Anom,SpOG (K)
Skill lab
Fasilitator
Fasilitator
15
Study Guide The Reproductive System and Disorders
MEETING
Meeting of the student representatives
The meetings between block planers and student group representatives will be held 30 of
June 2015, at 10.00 until 11.00 at class room. In this meeting, all of the student group
representatives are expected to give suggestions and inputs or complaints the team
planners for improvement. For this purpose, every student group should choose one student
as their representative to attend the meeting.
Meeting of the facilitators
The meeting between block planners and facilitators will take place on 30 of June 2015, at
11.00 until 12.00 at class room. In this meeting all the facilitators are expected to give
suggestions and inputs as evaluation to improve the study guide and the educational
process. Because of the importance of this meeting, all facilitators are expected to attend
the meeting.
ASSESSMENT METHOD
Assessment will be carried out on Monday 13th of July 2015. There will be 100 questions
consisting of Multiple Choice Questions (MCQ). The minimal passing score for the
assessment is 70. Other than the examinations score, your performance and attitude during
group discussions will be consider in the calculation of your average final score. Final score
will be sum up of student performance in small group discussion, student project and score
in final assessment. Clinical skill will be assessed in form of Objective structured clinical
examination (OSCE) at the end of semester as part of Basic Clinical Skill Block’s
examination.
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
STUDENT PROJECT
Students have to write a paperwork with topic given by the lecturer. The topic will be
chosen randomly on the first day. Each small group discussion must work on one paperwork
with different tittle. The paperwork will be written based on the direction of respective
lecturer. The paperwork is assigned as student project and will be presented in class. The
paper and the presentation will be evaluated by respective facilitator and lecturer.
Format of the paper :
1. Cover  Title (TNR 16)
Name
Student Registration Number
Faculty of Medicine, Udayana University 2013
2.
3.
4.
5.
Green coloured cover
Introduction
Journal critism/literature review
Conclusion
References
Example :
Journal
Porrini M, Risso PL. 2005. Lymphocyte Lycopene Concentration and DNA Protection from
Oxidative Damage is Increased in Woman. Am J Clin Nutr 11(1):79-84.
Textbook
Abbas AK, Lichtman AH, Pober JS. 2004. Cellular and Molecular Immunology. 4th ed.
Pennysylvania: WB Saunders Co. Pp 1636-1642.
Note.
Minimum 10 pages; line spacing 1.5; Times new roman 12
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
~ STUDENT PROJECT ~
Regular Class (Class A)
No
1
2
3
4
5
6
7
8
9
10
Group
A1
Topic
Inkontinensia urine
A2
Polip cerviks
A3
A4
Ectopic pregnancy
Preterm pregnancy
A5
Endometriosis
A6
Carsinoma cerviks
A7
Dermoid cyst
A8
Intra uterine Fetal Death (IUFD)
A9
Myoma uteri
A10
Ruptur Uteri
English Class (Class B)
No
1
2
3
4
5
6
7
8
9
10
Group
B1
Topic
Inkontinensia urine
B2
Polip serviks
B3
Ectopic pregnancy
B4
Preterm pregnancy
B5
Endometriosis
B6
Carsinoma cerviks
B7
Dermoid cyst
B8
Intra uterine Fetal Death (IUFD)
B9
Myoma Uteri
B10
Ruptur Uteri
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
LEARNING PROGRAMS
ABSTRACT AND TASK OF LECTURES
Lecture 1
Anatomy of Female Genital System
( dr. IGA Widianti, M.Biomed )
FEMALE GENITAL ORGANS
ABSTRACT:
The female internal genital organs
The female internal genital organs include the vagina, uterus, uterine tubes and ovaries.
The vagina, a musculomembranous tube, extends from yhe cervix of the uterus to the
vestibule, the cleft between the labia minora into which the vagina and urethra open. The
superior end of the vagina surrounds the cervix of the uterus. The vagina is usually
collapsed so its anterior and posterior walls are in contact, except at its superior end, where
the cervix holds them apart. The vagina : serves as a canal for menstrual fluid, form the
inferior part of the pelvic (birth) canal, receives the penis and ejaculate during sexual
intercourse.
The uterus is a thick-walled, pear-shaped, hollow muscular organ. The uterus usually lies in
the lesser pelvis, with its body lying on the urinary bladder and its cervix between the urinary
bladder and the rectum. The adult uterus is usually anteverted and anteflexed so that its
mass lies over the bladder. The uterus is divisible into two main part : the body and the
cervix. The wall of the body of the uterus consist of the three layers : perimetrium,
myometrium and endometrium.
The uterine tubes extend laterally from the uterine horns and open inyo the peritoneal cavity
near the ovaries. The uterine tubes lie in the mesosalphinx in the free edges of the broad
ligament. Each uterine tube is divisible into four parts : the infundibulum, ampulla, isthmus
and the uterine part.
Ovaries : the almond-shaped ovaries are typically near the attachment of the broad ligament
to the lateral pelvic walls, suspended from both by peritoneal folds, the mesovarium from the
posterosuperior aspect of the broad ligament and the suspensory ligament of the ovary from
the pelvic wall.
The female external genitalia organs
The female external genitalia include the mons pubis and labia majora (enclosing the
pudendal cleft), labia minora (enclosing the vestibule), clitoris, bulbs of the vestibule and
greater and lesser vestibular glands. The synonymous terms pudendum and vulva include
all these parts. The vulva serves as sensory and erectile tissue for sexual arousal and
intercourse, direct the flow of urine and prevent entry of foreign material into the urogenital
tract.
Breasts
Both males and females have breasts (mammae), normaly the mammary glands are well
developed only in women. Mammary glands in women are accessory to reproduction, but in
men they are functionless, consisting of only a few small ducts or cords. The mammary
glands are modified sweat glands and therefore have no special capsule or sheath. The
contour and volume of the breasts are produced by subcutaneous fat, except during
pregnancy when the mammary glands enlarge and new glandular tissue forms. Breast size
and shape result from genetic, racial, and dietary factors. The roughly circular base of the
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
female breast extends transversely from the lateral border of the sternum to the midaxillary
line and vertically from the 2nd – 6th ribs.
LEARNING TASK:
CASE 1:
A 42-year-old woman is referred for vaginal sonography to rule out a luteal cyst. The sonic
probe is placed in the anterior vaginal fornix and aimed anteriorly.
1. What is the normal position of the uterus and its relation to other structure in pelvic
cavity?
2. How much of the uterus can normally be felt per rectum?
3. What is the normal support of the uterus?
4. Why do you think the uterus is in that position?
5. Describe the ovaries, uterine tubes, uterus and broad ligaments
6. Describe the peritoneal relationships of the ovary and the uterine tube
7. Describe the walls, fornices and the immediate visceral relations of the vagina
8. To describe the blood supply and lymph drainage of the female genital tract
9. To describe general anatomy, vascularisation and lymphatic system of the breast
10. Explain the anatomical feature of the female pelvis and its difference the male pelvis
11. Describe the pelvic diaphragm and perineum
SELF ASSESSEMENT :
1. To describe the component parts of the uterine tube
2. To identify the female external genitalia
3. Describe the vascularisation, inervation and limphatic drinage of internal and
external female genital organs.
4. Discuss with your colleagues the growth and development and their anomalies of
female genital organs.
Lecture 2
Histology of Male & Female Genital System
( dr. I Wayan Sugiritama, M.Kes )
ABSTRACT
The Female Genital System
The female reproductive system consists of the internal reproductive organs (the
paired ovaries and oviducts, the uterus and the vagina) and the external genitalia (the
clitoris, the labia majora, and the labia minora).
The ovaries are indistinctly divided into a cortex and medulla. Cortex is composed of
connective tissue stroma that houses ovarian follicles in various stages of development
(primordial, primary, secondary and graafian follicles). During the follicle growth, fibroblast of
the stroma around the follicle differentiate to form the theca folliculi and it subsequently
differentiates into theca interna and theca externa. The cells of theca interna responsible for
synthesize a steroid hormone.
The oviducts are paired muscular-walled tubular structures, their walls are
composed of mucosa, muscularis and serosa. The mucosa layer lines by two different cells :
(1) non ciliated peg cells which is facilitated capacitation of spermatozoa, and (2) ciliated
cells which is responsible for transport of the fertilized ovum to the uterus. The oviducts act
as a conduit for spermatozoa to reach the primary oocyte and convey the fertilized egg to
uterus.
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Study Guide The Reproductive System and Disorders
The uterine wall of uterus composed by an endometrium, myometrium, and serosa.
The endometrium consists of two layer, the superficial functionalis which is sloughed at
menstruation, and deeper basalis whose glands and connective tissue elements.
Myometrium is composed of inner longitudinal, middle circular and outer longitudinal layers
of smooth muscle.
The vagina, a fibromuscular tubular structure, is compose of three layers that are :
mucosa, muscularis, and adventitia.
The mammary glands, although not strictly a part of the female reproductive tract
their physiology and function are so closely associated with the reproductive system. The
mammary gland is a compound tubuloalveolar gland of 15-20 lobes.
The reproductive organs are incompletely development and remain in a state of rest
until gonadotropic hormones secreted by the pituitary gland signal the initiation of puberty.
Thereafter, many changes take places in the entire reproductive system, culminating in
menarche. After the first menstrual flow (menarche), the menstrual cycle which involves
many hormonal and histological changes is repeated each month. Around the middle of
each cycle, a single ovum is released from one of the ovaries (ovulation) and passes in to
the oviduct, where it may, or may not, encounter a spermatozoon for its fertilization. The
menstrual cycle ceases after menopause, there is a slow involution of reproductive organ.
The Male Genital System
The male reproductive system is composed of the testes, genital ducts, accessory glands,
and penis . The dual function of the testis is to produce spermatozoa and hormones. The
genital ducts and accessory glands produce secretions that, conduct spermatozoa toward
the exterior. Spermatozoa and the secretions of the genital ducts and accessory glands
make up the semen.
Each testis is surrounded by tunica albuginea. The testis divide into 250 pyramidal
compartments called the testicular lobules. Each lobule is occupied by one to four
seminiferous tubules enmeshed in a web of loose connective tissue that is rich in blood and
lymphatic vessels, nerves, and Leydig cells. Seminiferous tubules produce spermatozoa,
whereas Ledig cells secrete testicular androgens.
These seminiferous tubules are enclosed by a thick basal lamina and surrounded by 3-4
layers of smooth muscle cells. The lumen are lined with seminiferous epithelium (germinal
epithelium), which consists of two types of cells: spermatogenic cells and Sertoli cells.The
cells of the spermatogenic lineage produce spermatozoa.
Spermatogenesis is the process by which spermatozoids are formed. It begins with
spermatogonium, at sexual maturity spermatogonia begin dividing, producing two type
cells: type A spermatogonia and type B spermatogonia. Type B spermatogonia will
differentiate into primary spermatocytes. After their formation, these cells divide into
secondary spermatocytes . Division of each secondary spermatocyte results in spermatids.
Spermiogenesis is the final stage of production of spermatozoids. Spermiogenesis is a
complex process that includes formation of the acrosome , condensation and elongation of
the nucleus, development of the flagellum, and loss of much of the cytoplasm. The end
result is the mature spermatozoon, which is then released into the lumen of the
seminiferous tubule.
Spermatozoa transported from seminiferous tubules to the ductus epididymidis by the
intratesticular genital ducts (tubulus rectus, rete testis, and ductuli efferentes). Excretory
genital ducts transport the spermatozoa produced in the testis toward the penile meatus.
These ducts are the ductus epididymidis, the ductus (vas) deferens, and the urethra
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The Sertoli cells are important for the function of the testes. These cells are elongated
pyramidal cells that partially envelop cells of the spermatogenic lineage. Adjacent Sertoli
cells are bound together by occluding junctions at the basolateral part of the cell, forming a
blood-testis barrier . Sertoli cells has another function are : Support, protection, and
nutritional regulation of the developing spermatozoa, Phagocytosis, Secretion of an ABP
and inhibin, Production of the anti-mullerian hormone and inhibin B.
Case :

A couple came to a doctor with complaints not having children. The couple has been
married for three years. Doctor recommend to do some examination to find out the
etiology. From the history taking is known that the woman had regular menstruation.
1. Describe the structure of the ovaries in each stage of the menstrual cycle!
2. If the endometrial biopsy was performed on the every stages of menstrual cycle,
try to describe the results!
3. Describe the changes in the cervix at each stage of the menstrual cycle!

HSG (Hystero Salpingo Graphy) was done to examination the patency of Tuba
Fallopian. Examination found there is no abnormalities
4. Describe the structure of the Tuba Fallopian !
5. Explain the structure of the Tuba Fallopian which plays an important role in
oocyte transport!

Semen examination results showed that the number of spermatozoa is low
(Oligospermia).
a. Describe the microscopic structure of organs that play a role in the formation
of semen!
b. Explain the process of spermatogenesis?
c. Explain the importance of Sertoli and Leydig cells in spermatogenesis?

On physical examination and additional tests are found abnormalities in his testes,
known as varicocele. His doctor suspected it as the cause of the low number of
sperm (oligospermia) on the semen.
d. Describe the structure that transports semen from the seminiferous tubules to
the meatus penis!
e. Explain the process of sperm maturation that occurs on genital duct!
Self Assessment
1. Describe the histological structure of the ovary !
2. Describe the stages of ovarian follicular development !
3. Describe the histological structure of the endometrium on menstrual, follicular and
luteal phase!
4. Describe the histological structure of oviduct !
5. Describe the histological structure of the vagina!
6. Describe the histological structure of the external genital system!
7. Describe the histological structure of mammary gland on the following : (a) before
puberty, (b) after puberty but nonpregnant, and (c) during pregnancy !
8. Describe the histological structure of the testis !
9. Describe the process of spermatogenesis !
10. Describe the structure and function of Blood-Testis Barrier !
11. Describe the intratesticular and external genital duct !
12. Describe the structure of accessory gland !
13. Describe the structure of Penis !
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
Lecture 3
Physiology of Male Genital System
(dr. Luh Putu Ratna Sundari, MBiomed)
ABSTRACT
The Male Reproduction system has two functions. First is the production of the male
gamete, called sperm, by a process called spermatogenesis. The second is the production
of the male sex hormones, a class of steroid, hormones called the androgens, which are
necessary for spermatogenesis to occur and also maintain sexual potency and secondary
sex characteristics. The testes or testicle are the pair of male gonads and the principal
androgen is testosterone. Testicular function is controlled by the hyphothalamo-pituitarytesticular axis which regulates both androgen synthesis and spermatogenesis.
Testosterone is the most potent and important of these androgens, and by far the
highest production of testosterone is in the testes. The testis is not a highly vascular tissue
like the adrenal cortex, and the presence of the blood testis barrier and a specific androgen
binding protein in the interstitial fluid of testis means that high concentrations of testosterone
accumulate. These high local level of testosterone in the testis are important for
spermatogenesis.
Spermatogenesis I the process by which the germ cells in the seminiferous tubules
develop into mature sperm. There are three distinct stages to this process: proliferation of
the spermatogonia, reduction of number of chromosomes (meiosis) and development of the
mature sperm structure. The whole process, from start of spermatogonium differentiation to
the formation of a mature sperm, takes 70 days, with a further 12-21 days required for
transport of the sperm through the epididymis to the ejaculatory duct.
Both spermatogenesis and androgen secretion are controlled by the hypothalamus
and pituitary glands. The hypothalamic hormone, gonadotropin releasing hormone (GnRH),
is secreted in a pulsatile manner to stimulate luteinizing hormone (LH) and follicle
stimulating hormone (FSH ) secretion. This pulsatile pattern of secretion is important: if Gn
RH is given as constant infusion it actually inhibit secretion of these hormones.
LEARNING OBJECTIVES
After studying this chapter, student should be able to:
1. Describe the structure and function of the testes.
2. Explain the control of steroid hormone production by the testes
3. Describe of the hormonal regulation of spermatogenesis
CASE
Could mine be bigger?
Arman, 35 years old, a bank worker, visited “Mak Erot” (alternative healer practical)
to enlarge his penis. He received information from his friend that the healer could make the
penis bigger and longer as needed for better function.
Learning task
1. Explain the role of androgens influence primary and secondary sex
characteristics of male.
2. Explain about hormonal control of testicular function.
3. Explain the possibility of Arman’s penis to be bigger and longer.
4. Explain the role of autonomic nerve system which influence male sexual
response.
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
Self assessment:
Explain the following items:
1. Control of FSH, LH, testosterone on male reproduction
2. Process of spermatogenesis.
3. Sperm production and factors are related
Lecture 4
Physiology of Female Genital System
(Dr. dr. Susi Purnawati.M.KK)
Abstract
The female reproductive system has gonad that produce egg or ovum and sex organs. The
system experience maturation of their reproductive organs, which become functional during
puberty as a result of the gonads secreting sex hormones. Female Reproductive System
functions are: produces eggs (ova), secretes sex hormones, receives the male
spermatozoa, protects and nourishes the fertilized egg until it is fully developed, delivers
fetus through birth canal, and provides nourishment to the baby through milk secreted by
mammary glands in the breast.
The development of women's "eggs" are arrested during fetal development. At about 5
months gestation, the ovaries contain approximately six to seven million oogonia, which
initiate meiosis. The oogonia produce primary oocytes that are arrested in prophase I of
meiosis from the time of birth until puberty. After puberty, during each menstrual cycle, one
or several oocytes resume meiosis and undergo their first meiotic division during ovulation.
The ovaries of a newborn baby girl contain about one million oocytes. This number declines
to 400,000 to 500,000 by the time puberty is reached. On average, 500-1000 oocytes are
ovulated during a woman's reproductive lifetime. Towards the end of puberty, girls begin to
release eggs as part of a monthly period called the female reproductive cycle, or menstrual
cycle (menstrual referring to "monthly"). Approximately every 28 days, during ovulation, an
ovary sends a tiny egg into one of the fallopian tubes. Unless the egg is fertilized by a
sperm while in the fallopian in the two to three days following ovulation, the egg dries up
and leaves the body about two weeks later through the vagina. This process is called
menstruation. Blood and tissues from the inner lining of the uterus (the endometrium)
combine to form the menstrual flow, which generally lasts from four to seven days. The first
period is called menarche. During menstruation arteries that supply the lining of the uterus
constrict and capillaries weaken. Blood spilling from the damaged vessels detaches layers
of the lining, not all at once but in random patches. Endometrium mucus and blood
descending from the uterus, through the liquid creates the menstruation flow. The
reproductive cycle can be divided into an ovarian cycle and a uterine cycle. During the
uterine cycle, the endometrial lining of the uterus builds up under the influence of increasing
levels of estrogen (labeled as estradiol in the image). Follicles develop, and within a few
days one matures into an ovum, or egg. The ovary then releases this egg, at the time of
ovulation. After ovulation the uterine lining enters a secretory phase, or the ovarian cycle, in
preparation for implantation, under the influence of progesterone. Progesterone is produced
by the corpus luteum (the follicle after ovulation) and enriches the uterus with a thick lining
Udayana University Faculty of Medicine, MEU
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Study Guide The Reproductive System and Disorders
of blood vessels and capillaries so that it can sustain the growing fetus. If fertilization and
implantation occur, the embryo produces Human Chorionic Gonadotropin (HCG), which
maintains the corpus luteum and causes it to continue producing progesterone until the
placenta can take over production of progesterone. Hence, progesterone is "pro gestational"
and maintains the uterine lining during all of pregnancy. If fertilization and implantation do
not occur the corpus luteum degenerates into a corpus albicans, and progesterone levels
fall. This fall in progesterone levels cause the endometrium lining to break down and sluff off
through the vagina. This is called menstruation, which marks the low point for estrogen
activity and is the starting point of a new cycle.
Learning Objectives:
Student should be able to explain:
1.
Female hormonal system
2.
Ovarian and endometrial cycle
3.
Regulation of the female monthly rhythm-interplay between the ovarian and
hypothalamic-pituitary hormones
4.
The female sexual act
Scenario:
Seven Days Period
Yunita, 29 years old, came for treatment to obstetrician because it was 7 days but her
menses have not stopped. This complaint has been encountered several times before. But,
only this time she visited doctor for treatment because she does not have enough money.
Yunita worried because sometimes feels dizzy and are afraid of losing a lot of blood since
the previous 7 days. Prior to the doctor Yunita already taking a Hemobion tablet once daily
that she bought in pharmacy. Discuss with your group the following items:
1. Some explanation Yunita had from the obstetrician.
2. The monthly ovarian cycle.
3. The menstruation
4. The influence of estrogens on female secondary sex characteristics
5. The correlation of ovulation and orgasm with fertility
Self assessment
Explain the following items:
1. Ovarian function in adult women
2. Hormonal and ovarian changes that occur at menopause
3. Puberty and menarche
4. Environmental factors influence female reproduction.
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Lecture 5
Antenatal Care and Normal labor
(dr. dr. I Wayan Artana Putra,Sp.OG (K))
Labor is a sequence of uterine contractions that result in effacement and dilatation of
the cervix and voluntary bearing down effort leading to expulsion pervagina of the product of
conception. Delivery is the mode of expulsion of the fetus and placenta. Labor and delivery
is a normal physiologic process that most women experience without complications.
Normal labor is a continuous process which has been devided into four stage of
labor for purposes of study, with the first stage further subdivided into two phases, latent
and active phase. The first stage of labor is the interval between the onset of labor and full
cervical dilatation. The second stage is the interval between full cervical dilatation and
delivery of the infant. The third stage of labor is the period between the delivery of the infant
and the delivery of the placenta. The hour immediately following delivery is critical and it has
been designated by some as the fourth stage of labor. Even thought oxytocins are
administered, postpartum hemorrhage as the result of uterine atony is more likely at this
time. The uterus frequently evaluated and perineum like wise is inspected frequently to
detect excessive bleeding.
The mechanism of labor in the vertex position consists of engagement of the
presenting part, flexion, descent, imternal rotation, extension and expulsion.
The partograph is a tool that can be used to assess the progress of labor and to
identify when intervention is necessary. Using the partograph can be highly effective in
reducing complications from prolonged labor for the mother and for the newborn.
The partograph is used to plot the following parameters for the progress of labor,
monitoring fetal conditions, and monitoring maternal conditions.
Learning Outcome
Learning Objective
PIC
SSR
Manage,establish
tentative
diagnosis,management
patient with normal
labor and delivery by
WHO partograph
1. Normal Labor , Delivery and WHO
Partograph
- Describe the mechanism of normal
labor and
delivery
- Apply to do anamnesis, physical
examination
patients in labor
- Capable to establish the diagnosis of
patients
In labor
- Capable to plan management of
patients in
labor
- Describe the plan monitoring of
patients in
labor
- Communicate all information about
labor and
delivery to the patients and family
- Describe the WHO partograph
- Apply the WHO partograph to
monitoring and
evaluation of patients in labor
Dr. I Wayan
Artana Putra
-Williams
Obstetrics
text
Book.
-WHO
Udayana University Faculty of Medicine, MEU
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Guidelines.
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Learning Task
Case:
Woman, 25 years old, para I ( 2 years, spontaneous labor, 3000 gr ) at 9.00 am
came with complaints of abdominal pain since two hour ago, she had complaints vaginal
discharge like blood slyms.Fetal movement was good,. Last menstrual period 3-12-2006,
her menstrual period is normal. She is in good condition, compos mentis,Blood Presure
120/80 mmHg,Pulse 88 x/mnt, Respiration rate 20 x/mnt, temp.ax 36.5 0C.
Status generalis was normal
Status obstetric ;
Abdominal : fundal uterine heigh 32 Cm, Head presentation 3/5, Back on the right Side,
Uterine contraction 3x / 10 mnt, duration 40’’, Fetal heart rate 140 bpm.
Vaginal examination : Cervical dilatation 4 Cm,efficement 50%,amniotic membrane
intack,Left occiput anterior, placenta and small part of fetus not palpable,
Lab : HGB 12 g/dl.
Questions :
1. What is the diagnosis of this patient?
2. What the anamnesis,sign and symptoms and examination to support the
diagnosis?
3. What is the management of this patient?
4. How to use WHO partograph for this case?
5. What are the communication, education and counseling to patient and her
family?
SELF ASSESSMENT :
1. How to diagnosis and confirmation of labor?
2. Explain the normal mechanism of labor?
3. Explain the stage and phase of labor?
4. How to assessment of engagement and descent of the fetus ?
5. How to identification of presentation and position of the fetus ?
6. How to assessment of progress of labor ?
7. How to assessment of fetal condition ?
8. What is the partograph ?
9. How to use the partograph ?
10. Explain the active management of the third stage of labor?
Lecture 6
Abnormal labor
(dr. Tjok GA Suwardewa,SpOG(K))
Preterm labor
Preterm or premature births are terms used to define neonates who are born too early.
Thus, infants born before term can be small or large for gestational age but still fit the
definition of preterm. Low birthweight refers to births 500 to 2500 g; very low birthweight
refers to births 500 to 1500 g; and extremely low birthweight refers to births 500 to 1000 g.
In the United States in 2005, 28,384 infants died in their first year of life Preterm birth,
which is defined as delivery before 37 completed weeks, was implicated in approximately
two thirds of these deaths.
A variety of morbidities, largely due to organ system immaturity, are significantly increased
in infants born before 37 weeks' gestation compared with those delivered at term.
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Corticosteroid therapy was effective in lowering the incidence of respiratory distress and
neonatal mortality rates if birth was delayed for at least 24 hours after initiation of
betamethasone. A National Institutes of Health Consensus Development Panel
recommended corticosteroids for fetal lung maturation in threatened preterm birth
Major Short- and Long-Term Problems in Very-Low-Birthweight Infants
Organ or System Short-Term Problems
Pulmonary
Long-Term Problems
Respiratory distress
Bronchopulmonary dysplasia,
syndrome, air leak,
reactive airway disease, asthma
bronchopulmonary dysplasia,
apnea of prematurity
Gastrointestinal or Hyperbilirubinemia, feeding
nutritional
intolerance, necrotizing
enterocolitis, growth failure
Failure to thrive, short-bowel
syndrome, cholestasis
Immunological
Hospital-acquired infection,
Respiratory syncytial virus
immune deficiency, perinatal infection, bronchiolitis
infection
Central nervous
system
Intraventricular hemorrhage, Cerebral palsy, hydrocephalus,
periventricular leukomalacia, cerebral atrophy,
hydrocephalus
neurodevelopmental delay,
hearing loss
Ophthalmological
Retinopathy of prematurity
Blindness, retinal detachment,
myopia, strabismus
Cardiovascular
Hypotension, patent ductus
arteriosus, pulmonary
hypertension
Pulmonary hypertension,
hypertension in adulthood
Renal
Water and electrolyte
imbalance, acid–base
disturbances
Hypertension in adulthood
Hematological
Iatrogenic anemia, need for
frequent transfusions, anemia
of prematurity
Endocrinological
Hypoglycemia, transiently low Impaired glucose regulation,
thyroxine levels, cortisol
increased insulin resistance
deficiency
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1. Placental abruption
Placental separation from its implantation site before delivery has been variously called
placental abruption, abruptio placentae, and in Great Britain, accidental hemorrhage. The
Latin term abruptioplacentae means "rending asunder of the placenta" and denotes a
sudden accident, which is a clinical characteristic of most cases. The cumbersome term
premature separation of the normally implanted placenta is most descriptive. It differentiates
the placenta that separates prematurely but is implanted some distance beyond the cervical
internal os from one that is implanted over the cervical internal os—that is, placenta previa.
The bleeding of placental abruption typically insinuates itself between the membranes and
uterus, ultimately escaping through the cervix, causing external hemorrhage (Fig. 35-3).
Less often, the blood does not escape externally but is retained between the detached
placenta and the uterus, leading to concealed hemorrhage.
Placental abruption may be total or partial. Concealed hemorrhage carries much greater
maternal and fetal hazards. This is not only because of possible consumptive coagulopathy,
but also because the extent of the hemorrhage is not readily appreciated, and the diagnosis
typically is delayed
Predisposition factors for placental abruption are, hypertension, prematurely ruptured of the
membrane, smoking, thrombophilias, traumatic abruption and leiomyomas.
Placental abruption is initiated by hemorrhage into the decidua basalis. The decidua then
splits, leaving a thin layer adhered to the myometrium. Consequently, the process in its
earliest stages consists of the development of a decidual hematoma that leads to
separation, compression, and ultimate destruction of the placenta adjacent to it
2. Post partum hemorrhage
Traditionally, postpartum hemorrhage has been defined as the loss of 500 mL of blood or
more after completion of the third stage of labor. This is problematic because half of all
women delivered vaginally shed that amount of blood or more when losses are measured
quantitatively
Pritchard and associates (1962) used precise methods and found that approximately 5
percent of women delivering vaginally lost more than 1000 mL of blood. They also reported
that estimated blood loss is commonly only approximately half the actual loss. Because of
this, estimated blood loss in excess of 500 mL should call attention to mothers who are
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bleeding excessively. Toledo and colleagues (2007) have shown that calibrated drape
markings improve estimation accuracy. Still, as shown by the study of Sosa and associates
(2009) cited above, even this technique underestimates blood loss when compared with
more precise methods described by Pritchard and colleagues
It is therefore readily apparent that fatal postpartum hemorrhage can result from uterine
atony despite normal coagulation. Conversely, if the myometrium within and adjacent to the
denuded implantation site contracts vigorously, fatal hemorrhage from the placental
implantation site is unlikely even in circumstances when coagulation may be severely
impaired
Except possibly when intrauterine and intravaginal accumulation of blood is not recognized,
or in some instances of uterine rupture with intraperitoneal bleeding, the diagnosis of
postpartum hemorrhage should be obvious. The differentiation between bleeding from
uterine atony and that from genital tract lacerations is tentatively determined by
predisposing risk factors and the condition of the uterus. If bleeding persists despite a firm,
well-contracted uterus, the cause of the hemorrhage most likely is from lacerations. Bright
red blood also suggests arterial blood from lacerations. To confirm that lacerations are a
cause of bleeding, careful inspection of the vagina, cervix, and uterus is essential.
Late Postpartum Hemorrhage is bleeding after the first 24 hours of birth. Most of cause was
placental rest.
Vignette 1:
A 20 year-old woman came to hospital with abdominal cram, and vaginal blood spotting.
She’s pregnancy of 29 weeks. The blood pressure 120/80 mmHg, pulse rate 80 bpm, RR
20 times/mt, Hb 11 g/dl. Abdominal examination: uterine fundal 29 cm, uterine contraction
twice within 10 minutes. Cervical dilatation 2 cm. estimated fetal weight 1000 g.
Learning task 1:
1. What is the diagnosis this patient?
2. What do you plan to maturation of the fetal lung?
3. How to manage a patient that diagnose like a case above?
Self assessment 1:
1. What is the definition of preterm pregnancy?
2. What are the short term and long term complications of preterm birth?
3. How to minimize that complications?
4. Describe about fetal lung maturity.
Vignette 2:
A 35 year-old woman complain about severe abdominal pain. She’s 3rd pregnancy 37
weeks, singleton baby. and there was history of high blood pressure. Current conditions;
BP 150/100 mmHg, pulse rate 96x/mt, RR 20x/mt, Hb 9 d/dl. Abdominal examination;
uterine fundal 4 cm below procesus xiphoideus, difficulty palpation of baby part, fetal heart
tone 170 bpm. There was dark brawn vaginal bleeding.
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Learning task 2:
1. What the diagnosis these patient?
2. What are predisposition factors in a case above?
3. What are differential diagnosis a case like this?
4. How to manage the patient in case above?
Self assessment 2:
1. What the definition of placental abruption?
2. What does it mean: concealed hemorrhage,
coagulopathy
3. Describe about pathogenesis of solutio placenta.
4. What are complications of the solution placenta?
external hemorrhage, consumptive
Vignette 3:
A 30 year-old woman, with history of spontaneous vaginal birth one hour ago. She was
referred by midwife at cause active vaginal bleeding. Blood pressure was 100/60 mmHg.
Pulse rate 100x/minute, RR 22x/minute, uterine fundus as level as umbilical. Weakness
uterine contraction. Vaginal examination, much of blood clot in vagina.
Learning task 3:
1.
2.
3.
4.
What is approximate diagnosis of this patient?
What are the predisposition factors in case like above?
What do you planning in “primary survey”?
Definitive management for this patient are?
Self assessment 3:
1.
2.
3.
4.
What is the definition of post partum hemorrhage?
The most frequents cause of post partum hemorrhage is?
Would you like explain about late post partum hemorrhage?
What kind of uterotonica usually need to make better uterine contraction?
Lecture 7
Obstetric Emergency
(dr. Harry Wijaya Surya, SpOG)
Abortus is the termination of pregnancy, either spontaneous or intionally,before the
fetus develops sufficiently to survive. By convention, abortion is usually define as pregnancy
termination prior to 20 weeks gestation or less than 500 gram birthweight. Definitions vary,
according to state laws for reprting abortions, fetal death and neonatal deaths. There are
five category of spontaneous abortion according to its clinical manifestations, such as
threatened abortion, inevitable abortion, complete / incomplete abortion , missed abortion
and recurrent abortion. The management are consevatif and curettage depend on clinical
manifestations.The other ante-partum bleeding of pregnancy that occurred in the 2nd
trimester of gestation are placenta previa and solutio placenta. Both may emerged the
emergency to mother and fetus and therefore have to recognized and perform the prompt
management.
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ABORTION
Learning
outcome
Manage,establ
ish tentative
diagnosis,provi
de initial
management,a
nd/or refer
patient with
Abortion
Learning Objective
Spontaneous abortion.
 Comprehend the clinical implications of
spontaneous abortion
 Apply basic principles of special investigation
on patient with spontaneous abortion
 Recognize clinically, management and refer
patient with spontaneous abortion
 Recognize clinically the subgroups of
spontaneous abortion
Student
reference
Williams
Obstetrics, 22nd
Edition,2005
Page 232- 247
And 254- 268
Threatened abortion.
 Comprehend the clinical implications of
threatened abortion
 Apply basic principles of clinical diagnosis of
threatened abortion
 Recognize management of patient with
threatened abortion
Inevitable abortion.
 Comprehend the clinical implications of
inevitable abortion
 Apply basic principles of clinical diagnosis of
inevitable abortion
 Recognize management of patient with
inevitable abortion
Incomplete abortion.
 Comprehend the clinical implications of
Incmplete abortion
 Apply basic principles of patient with
incomplete abortion
 Recognize clinically, management and refer
patient with incomplete abortion

Complete abortion
 Comprehend the clinical implication of
complete abortion
 Apply basic principle of patient with complete
abortion
 Recognize clinically, and management
patient with complete abortion
Ectopic pregnancy
 Comprehend the clinical implication of
ectopic pregnancy
 Recognize risk factors of ectopic pregnancy
 Recognize the patogenesis of ectopic
pregnancy
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Study Guide The Reproductive System and Disorders


Manage
establish
tentative
diagnosis,provi
de initial
management,a
nd/or refer
patient with
antepartum
hemorrhage
Apply basic principle and special
investigation on patient with ectopic
preganancy
Recognize medical and surgical
management and refer patient with ectopic
pregnancy
Placenta previa.
 Comprehend the implication of placenta
previa
 Capable to establish and communicate to the
family about the types,causes, effect and
management of placenta previa
 Capable to recognize clinical diagnosis and
special investigation of placenta previa
 Comprehend the patogensesis of bleeding in
placenta previa
 Comprehend the maternal and fetal and
prognosis of placenta previa.
 Capable to plan the management of placenta
previa
Placenta abruption.
 Comprehend the implication of Placenta
abruption
 Capable to establish and communicate to the
family about the types,causes,effect and
management of Placenta abruption
 Capable to recognize clinical diagnosis and
special investigation of placenta abruption
 Comprehend the patogenesis of bleeding in
placenta abruption
 Comprehend the maternal and fetal
complication and prognosis on placenta
abruption
 Capable to plan management of placenta
abruption
Williams
Obstetric, 22 nd
Edition page
810- 823
Learning Task :
Vignette 1
A 28 year-old woman para 0 came with complaint of vaginal bleeding and lower
abdominal cramp since 1 hour. Her LMP was unknown . She in good general condition,
compos mentis, Blood pressure 120/85 mmHg, pulse 90 x/minute, temp 37 C. No
Abnormality in heart and lung.
Uterine fundal height 2 finger above the symphysis, no tenderness, no pain
Gynecologic examination :
Inspic : v/v fl (- ), Flx( +)
VT : v/v Flx (+),
Portio : opening 1 finger, with fetal tissue
Soft , no pain
CU : AF 10-12 weeks
APCD : Normal
Lab: Hemoglobin 10 gr/dl
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Questions :
1.
2.
3.
4.
5.
What is the diagnosis of this patient?
What are the anamnesis, sign, symptoms and examination to support the diagnosis?
What is the planning treatment of this patient?
What complication may happen in this case?
What is the fertility prognosis of this patient?
II . Self Assesment :
1.
2.
3.
4.
5.
6.
What is the definition of Spontaneous abortion?
What is the subgroup/classification of spontaneous abortion ?
Explain the etiopatogenesis of spontaneous abortion
What is the definition of Induced abortion?
Expalin the surgical and medical techniques of abortion
Explain the impact of abortion on maternal mortality.
Vignette 2
A 32 year-old woman, Para 1 ( 4 year ), has been reffered by midwife with vaginal bleeding
since 2 hours ago. Her LMP is unknown. Acording to the data from previous scan in
OBGYN specialist she should be in 32-34 weeks of pregnancy. She in good general
condition, compos mentis, blood pressure 110/70 mmHg, pulse 92 x/minute,temperature
37C. Heart and lung are normal.
Obstetric :
fundal height ½ procesus xiphoideus- umbilicus, longitudinal lie, head floating, single, fetal
heart beat 12 11 12,uterine contraction negative.
Vaginal examination : vulva : blood clot (+)
Lab : hemoglobin 11,5 gr/dl.
Questions :
1. What is the diagnosis of this patient ?
2. What are the anamnesis, sign, symptoms and examination support the diagnosis?
3. What is the planning treatment of the patient?
4. What is the complication may be happen in this patient?
II . Self Assesment:
1.
2.
3.
4.
5.
What is the definition of antepartum hemorrhage?
What is the definition of placenta abruption and placenta previa?
What is the etiopatogenesis of placenta abruption and placenta previa?
Explain the clinical differentiation of placenta abruption and placenta previa
Explain the management of preterm and term pregnancy with placenta abruption
and placenta previa
6. What is the complication of placenta abruption and placenta previa
7. What are the placenta associated conditions with placenta previa?
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Lecture 8
Puerperium and Disorders
(Dr Made Bagus Dwi Aryana, SpOG (K))
Lecture 9
Benign and Malignant Diseases Of The Breast
(dr.Wayan Sudarsa, SpBK.Onk & dr.A.A.A.N.Susraini,SpPA)
LEARNING OUTCOME:
1. Able to manage the patients with benign disorders and diseases of THE BREAST
2. Able to manage the patients with Malignant Diseases of THE BREAST
CURRICULUM CONTENT:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
2.13
2.14
2.15
To demonstrate an understanding the concept of ANDI (Aberration of Normal
Development and Involution of the breast)
To identify the cause of benign palpable breast mass
To comprehend a systematic clinical diagnostic procedure of benign breast mass
To apply triple assessment as a diagnostic procedure of benign breast mass
To comprehend a systematic approach to the management of the patient with
dominant solid breast mass including referal
To comprehend a systematic approach to the management of the patient with cystic
breast mass
To recognize the clinical aspect (etiology, classification and evaluation) of breast pain
To Comprehend systematic approach to the management of patients with breast pain.
To demonstrate an understanding of the clinical aspect of nipple discharge and nipple
inversion and infections of the breast.
To comprehend systematic approach to the management of patients with breast pain.
To Recognize and to manage and refer the patients with other benign breast disorders
including: Hematome, fat necrosis, mondor disease, Gynecomastia, and abnormalities
of the breast during pregnancy and lactation.
To reflect upon the incidence and mortality rates of breast cancer
To identify women at risk for breast cancer
To appraise breast self-examination and population screening for breast cancer .
To identify the three most important histopathologic types of breast cancer
To Outline the biological behavior of breast cancer
To mention a characteristic of lobular breast carcinoma
To identify the Familial/Hereditary breast cancer: The molecular genetics and
syndromes.
To relate some clinical presentations of breast cancer to the site of the tumor in the
breast and to characteristics of local growth.
To discuss complaints and symptoms concerning one or both breasts, with which a
patient may present
To outline the medical history and the physical examination in the case of a patient
with complaints and / or symptoms of one or both breasts
To describe clinical characteristics of potential benign and malignant lumps
To interpretate specific presenting problems
To discuss the policy how to arrive at the diagnosis
To discuss the latest TNM system of breast cancer
To argue why there is no standardized treatment for patients with breast cancer
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2.16
2.17
2.18
2.19
2.20
2.21
2.22
2.23
2.24
2.25
2.26
2.27
To identify the options for treatment
To outline the components of surgical treatment and of breast conserving treatment
To compare advantages with disadvantages of breast conserving treatment and
mastectomy
To reflect upon a dilemma in the case of lobular breast carcinoma
To discuss the indications for adjuvant systemic treatment and for radiation therapy.
To indicate the value of hormone receptors in breast cancer
To identify potential complications of the primary treatment
To discuss three rehabilitative measures following primary treatment
To identify features of check-ups and potential presenting problems in the follow-up
To recognize the role of reconstructive surgery.
To outline the options for non-curative treatment
To outline the chances of cure for patients with breast cancer .
BENIGN AND MALIGNANT DISEASES OF THE BREAST
When a patient present with a breast problem the basic question for general
practitioner is, “Is there a chance that cancer is present, and, if not, can I manage
these symptoms myself?”
ABSTRACT
The Breast, or mammary glands, of mammals are important for the survival of the newborn
and thus of species. An understanding of the morphology an physiology of the breast and
the many endocrine interrelationships of both is essential to study of the pathophysiology of
the breast and the management of benign and malignant disorders.
One woman in four is referred to a Breast Clinic at some time in her life, and breast
problems constitute up to a quarter of all women in the general surgical workload. Although
breast cancer is the most common malignancy in women, 80-90% of clinical evaluations for
breast disorders are for benign conditions.
Triple assessment is most common used in the evaluation of patient with breast problem.
This is combination of clinical examination, imaging, and pathologic examination. The goal
is to avoid missing the diagnosis of a malignancy while providing reassurance for benign
conditions.
Breast cancer are derived from the epithelial cells that are found in the terminal lobular unit
(TDLU). Cancer cells that are remain within the basement membrane of the TDLU are
classified as in situ or non-invasive. An Invasive cancers is one in which there is
dissemination of cancer cells outside the basement membrane of the ducts and lobules into
surrounding adjacent normal tissue.
Epidemiologically, breast cancer is the most common malignancy in women in developed
countries and comprises 18% of all female cancers. Breast cancer is single most common
cause of death among women aged 40-50.
Lack of knowledge of the pathogenesis breast cancer means that primary prevention is
currently distant prospect for most women. Early detection (Screening for breast cancer)
represents an alternative approach for reducing mortality from this disease. Histopathology
examination is gold standard of benign or malignant tumor.
In general, comprehensive management of patient with breast cancer is needed to achieve
long overall survival, long disease free survival, and good quality of life.
LEARNING OUTCOME 1:
Able to manage the patients with Benign disorders and diseases of THE BREAST
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Learning task
CASE 1
A mother came to surgery outpatient department with her 9 years old daughter. She
complained that her daughter’s left breast hasn’t develop while the right one has developed
normally. She is very worry with her daughter’s condition.
1. Please try to discuss and explain to this mother about the abnormality that might
happen to her daughter and explain about the treatment.
CASE 2
A 2nd year students of faculty of medicine Udayana University came to a private practice of a
general doctor with chief complain a mass as big as marble in her right breast since 6 month
ago. This mass is getting bigger, rounded, solid, very mobile, and sometimes causing pain.
1. Please try to discuss what is might happen to this girl
2. Please try to discuss about the plan of treatment to this girl
3. Does this abnormality need to be referred immediately to the hospital?
4. Does this abnormality can be handled by a general practitioner?
CASE 3
A 30 years old woman complaining a yellowish liquid pour out from her right nipple since 1
month ago. She had married, had a 5 years old daughter, had a history of not breastfeed
her daughter, and consuming contraception tablet.
1. Discuss about the efforts that can be done to get the right diagnosis about the
abnormality that happen to this woman
2. Discuss about the plan of treatment to this abnormality schematically
CASE 4
A 25 years old woman, post partum 2 weeks ago, complaining her left breast is swollen, red,
and very painful. She also has had fever since 3 days ago. Her breastmilk can’t be pouring
out from her left breast.
1. Discuss about the abnormality that might be happen to this woman.
2 Does this abnormality need to be treated and referred to the hospital immediately?
3 Discuss about the plan of treatment of this case
CASE 5
A 25 years old woman, single, complaining pain in both of her breast since this last 3
months. Pain sometimes disturbing her activities.
1. Please discuss about diagnostic method (anamnesis, physical examination,
additional examination) dan complete plan of treatment to this case.
SELF ASSESSMENT:
1. Describe the symptoms, assessment, and guidelines for referral of woman with
breast problem.
2. Explain briefly what is ANDI (Aberrations of Normal Development and Involution) of
the Breast.
3. Explain the role of TRIPPLE ASSESSMENT in comprehensive approach of woman
with breast problem.
4. Describes the holistic approach in woman complain with breast pain, lump, or nipple
discharge.
5. Distinguish between breast infections (Mastitis) during lactation and non-lactation
6. Distinguish between FAM and and FCC macroscopically and microscopically
7. Distinguish between benign and malignant tumor macroscopically
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LEARNING OUTCOME 2:
Able to manage the patients with Malignant Diseases of THE BREAST
CASE 1
A 25 years old woman, came to the general practitioner because she is afraid and very
worry because her older sister, 35 years old, had breast cancer. Her mother was also died
when she was 40 years old because of breast cancer. Her mother’s sister was also died
because of ovarium cancer when she was 50 years old.
1. Discuss in your group about the efforts that can be done to the women in this family
2. Please discuss about the principles of breast cancer screening in high risk person.
CASE 2
A woman, 50 years old, single, came to surgery outpatient department with complain mass
with ulcus in her left breast since 6 month ago. She also complain shortness of breath.
1. Discuss about how to diagnose (anamnesis, risk factor, clinical examination, dan
additional examination) to this patient
2. Discuss about how to define the stage of the disease
3. Discuss about the complete plan of treatment of this case.
4. Discuss the plan for communication and follow up to this patient
SELF ASSESSMENT:
1. Describe briefly the epidemiology, risk factors, and genetics of breast cancer
2. Explain the principles of breast cancer prevention (primary prevention and
screening/early detection of breast cancer).
3. Describe the steps in comprehensive management of breast cancer.
4. Describe briefly the role of surgery, radiotherapy, chemotherapy, and hormonal
therapy in management of breast cancer.
Lecture 10
Common gynecologic disorders
(dr.IGP. Mayun Mayura, SpOG & dr.A,A.A.N.Susraini, SpPA)
Abstract
Genital Infection
Genital infection divided into : lower genital infection (vaginitis and cervicitis) and
upper genital infection (pelvic inflammatory disease), with internal uterine ostium neveu as
its border.
Lower Genital Infection
Vaginal infection (vaginitis) depends on it causes :
 Bacterial vaginosis cause by G. Vaginalis with clue cell as its patognomic sign
 Vaginitis caused by T. Vaginitis with fly bitten appearance
 Vulvovaginal candidiasis caused by Candida Albicans, with “hackneyed milk like”
appearance.
 Vaginitis caused by N. Gonorrhea with mucopurulent secret and often accompanied
with bartholinitis.
 Cervical infection - then named cervicitis – is cause by N. Gonorrhea and C.
Trachomatis.
Upper Genital Infection
Also known as pelvic inflammatory disease, which shows genital infection localized upper
than internal uterine ostium, which consists of : endometriosis, myometritis, and pelvic
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Study Guide The Reproductive System and Disorders
sellulitis, salphingitis, salphingoophoritis, and abscess (tubo ovarial abscess and Douglas
abscess).
Diagnostic criteria for pelvic inflammatory disease are :
Major criteria : Abdominal pressure pain, cervical movement pain, and adnexal pain.
With one or more of : Pathologic microorganism, endocervical secret, rectal temperature >
38 °, leucosyt > 10.000 mm3, intra peritoneal pus, and solid abscess shown from
ultrasonography or known from vaginal toucher.
Its Classification based on its grade :
Grade I : PID without complication, limited at the tube, ovarium with or without pelvic
peritonitis.
Grade II : PID with complication, inflamed / abscess mass at the tube or ovarium.
Grade III : PID with external pelvic organ metastation.
Pre cancer lesion and gynecologic tumor
An intra epithelial cervical neoplasia consist of : CIN I (L SIL), CIN II and CIN III (H SIL). In
general its asymptomatic, but if complains are present it will shows white discharge /
leucorrhea, post coital bleeding, supra simphical pain, with erosion, ectopion and sign of
cervicitis at inspecular inspection.
The etiology are HPV type 16 & 18, with associated risk factor : sexual activity at a very
young age, multipartnership, multiparity, low social economy, HIV infection, hormonal
contraception, and cigarette smoking.
Exact diagnosis could be obtain from pap smear and IVA (for screening), Colposcopy and
biopsy, and endocervical curettage.
Cervical Cancer
Cervical malignancy could be asymptomatic or symptomatic. Signs of cervical malignancy
would be faulty discharge, abnormal vaginal bleeding, post coital bleeding, post
menopausal bleeding, abnormal defecation or urination. Pain and metastatic sign.
Uterine myoma
Is a benign myometrial tumor, solid, clear bolder, pseudocapsule, painless, multiple or
soliter. The location of the tumor could be intra mural, sub serosal, intra ligamenter, with
stalk, migrating and parasitic.
Ovarian tumor
It usually benign in reproductive age (80-85%), with incidence of malignancy at this age
(<45) occurs under 1 % (from 15 ovarian tumor cases). The etiology remain unknown, but
several factors have been associated : herediter factor, physical and chemical environment,
ovulation, gonad abnormality, and virus.
Ovarian cancer is a malignancy with the ovary which derived primarily or secondarily from
choelomic epithelium, germinal cell, or metastated from other organ.
Suspicion of malignancy increases when the tumor grows rapidly, fixed, solid, with decrease
general physical condition, ascites, pleural effusion, disturbances of intestinal passage,
supraclavicular lymph enlargement, and metastase.
Gestational Thropoblastic Disease
Hydatiform mole is a benign thropoblastic neoplasia with failure of physiological placentation
and edematous villi showing grape like appearance.
While malignant thropoblastic disease is a thropoblastic disease showing neoplastic
tendency such as : invasive mole, choriocarcinoma and placental site thropoblastic tumor.
Hydatiform mole will remit in 80% cases and convert into malignant thropoblastic in 20%
cases.
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INFECTION OF FEMALE GENITAL TRACT
LEARNING
OUTCOME
LEARNING OBJECTIVE
PIC
STUDENT
REFERENCE
Vaginitis
 Comprehend the clinical
implications of vaginitis.
Manage,establish
dr. IGP
tentative
 Comprehend the
Mayun
diagnosis,
epidemiological
Mayura,SpOG
provide initial
significance of vaginitis to
management,
assist management :
and/or refer
patient education and
patient with
family involvement.
Infection of
 Apply basic principles of
female genital
special investigation on
tract
patient with vaginitis.
 Recognize clinically,
provide initial management,
and refer, with suspected
vaginitis.
Sevicitis
 Comprehend the clinical
implications of servicitis.
 Comprehend the
epidemiological
significance of servicitis to
assist management :
patient education and
family involvement.
 Apply basic principles of
special investigation on
patient with servicitis.
 Recognize
clinically,
provide initial management,
and refer, with suspected
servicitis.
PID
 Comprehend the clinical
implications of pelvic
inflamantory disease
 Comprehend the
epidemiological
significance of pelvic
inflamantory disease to
assist management :
patient education and
family involvement.
 Apply basic principles of
special investigation on
patient with pelvic
inflamantory disease
 Recognize clinically,
provide initial management,
and refer, with suspected
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Study Guide The Reproductive System and Disorders
pelvic inflamantory disease
Cervix lesion
 Comprehend the clinical
implications of intraepitelial
disease of the cervix (LSIL /
HSIL).
Manage,establish
 Comprehend the
tentative
epidemiological
diagnosis,
significance of intraepitelial
provide initial
disease of the cervix (LSIL /
management,
HSIL) to assist
and/or refer
management: patient
patient with
education and family
Infection of
involvement.
female genital

Apply basic principles of
tract
special investigation on
patient with. intraepitelial
disease of the cervix (LSIL /
HSIL).
 Recognize clinically,
provide initial management,
and refer, with suspected
intraepitelial disease of the
cervix (LSIL / HSIL).
dr. IGP
Mayun
Mayura,SpOG
Cervical cancer
 Comprehend the clinical
implications of intraepitelial
disease of the cervical
cancer
 Comprehend the
epidemiological
significance of intraepitelial
disease of the cervical
cancer to assist
management: patient
education and family
involvement.
 Apply basic principles of
special investigation on
patient with. cervical cancer
 Recognize clinically,
provide initial management,
and refer, with suspected
cervical cancer
Uterine myoma
 Comprehend the clinical
implications of intraepitelial
disease of the uterine
myoma
 Comprehend the
epidemiological
significance of intraepitelial
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Study Guide The Reproductive System and Disorders


disease of the uterine
myoma to assist
management: patient
education and family
involvement.
Apply basic principles of
special investigation on
patient with. uterine myoma
Recognize clinically,
provide initial management,
and refer, with suspected
uterine myoma
Ovarial tumors
 Comprehend the clinical
implications of intraepitelial
disease of the ovarial
tumors
 Comprehend the
epidemiological
significance of intraepitelial
disease of the ovarial
tumors to assist
management: patient
education and family
involvement.
 Apply basic principles of
special investigation on
patient with. ovarial tumors
 Recognize clinically,
provide initial management,
and refer, with suspected
ovarial tumors
Gestational throphoblastic
Manage,establish disease
 Comprehend the clinical
tentative
implications of gestational
diagnosis,
throphoblastic disease
provide initial
(hydatidide mole)
management,
and/or refer
 Comprehend the
patient with
epidemiological
Infection of
significance of intraepitelial
Gestational
disease of the gestational
throphoblastic
throphoblastic disease
disease
(hydatidide mole)to assist
management: patient
education and family
involvement.
 Apply basic principles of
special investigation on
patient with. gestational
throphoblastic disease
(hydatidide mole)
Udayana University Faculty of Medicine, MEU
dr. IGP
Mayun
Mayura,SpOG
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Study Guide The Reproductive System and Disorders

Recognize clinically,
provide initial management,
and refer, with suspected
gestational throphoblastic
disease (hydatidide mole)
Learning task :
Vignette 1
Woman 35 years old, P1, IUCD user (Copper T 380 A) since 3 years ago. Come to have
routine check up. No. complaint of unwanted effect. Her last menstruation period 1.5 month
ago. Actually she has period every 30 days. She in a good general condition. Compos
mentis, vital sign, lung and heart within normal limit
Lower abdomen examination : mass (-), pain (-)
Gynecologic examination :
Insp : fl (-), flx(-)
Portio, no thread
VT
: fl (-), flx (-)
Smooth portio, no thread
CUAF normal size, pain (-)
APCD mass (-), pain (-)
Question :
1. What is the diagnosis of this patient?
2. What are the anamnesis, sign and symptom, examination to suspect the diagnosis?
3. What is the planning treatment of this patient?
Self assessment :
1. What is the complete management of “lost” IUD thread
2. What is the possible cause of “lost thread”
3. What is the correlation between IUDs and PID
4. Describe macroscopic examination of Cervical carcinoma
5. How to diagnose Cervical Carcinoma?
6. What commonest is ovarian tumor ?
Vignette 2
Female, 35 yo, P0, married for 5 years. Regular monthly period but the amount was more
than normal.
General condition was fair, good level of conciuosness, composmetis, anemic (eyes) +/+,
BP 120/80, P 84x/min,
Tax 36,8⁰C , Trec 37⁰C, Lab. Hb : 82gr%
Abdominal examination : FH ½ umb-symphisis
Gynecological examination
Insp : v/v fl (-), flx (+)
smooth
VT
: v/v fl (-), flx (+)
smooth surface
Uterine corpus AF ~ 16-18 weeks
APCD ~WNL
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Study Guide The Reproductive System and Disorders
Question :
1. What the possible diagnosis of this patient?
2. What was the complain, sign, symptom and examination that support that
diagnosis?
3 . What cause the anemia in this case?
4. What supportive examination needed to make the definitive diagnosis of
this case?
5. What is the management of this case?
6. What this patient fertility prognosis?
Self assessment:
1. How the etiopathogenesis of uterine myoma?
2. What the influence of myoma in fertility
3. What secondary change that can happen to myoma
4. Management of uterine myoma
5. What is pregnancy effect in myoma
6. Mention type of ovarian tumor
7. Mention the classification of cytology of bethesda system and management of NIS
8. What are the risk factor and early detection of cervical cancer
9. Explain the difference of complete mole and partial molea
10. Explain the pathologic figure of partial hydatiform mole
Lecture 11
Male and Female sexual dysfunction
(Prof.Dr.dr.Wimpie Pangkahila, SpAnd, FAACS)
Sexual dysfunction in the male is not merely one kind of sexual disorder. The
classification of male sexual dysfunction (MSD) is as follows.
1. Sexual desire disorders:
- Hypoactive sexual desire disorder
- Sexual aversion disorder
2. Erectile disorders:
- Erectile dysfunction
- Prolonged erection
3. Ejaculatory disorders:
- Rapid ejaculation
- Retarded ejaculation
4. Orgasmic disorder
As in the male, sexual dysfunction in female is not merely one kind of sexual disorder.
Female sexual dysfunction (FSD) is classified as follows:
1. Sexual desire disorders:
- Hypoactive sexual desire disorder
- Sexual aversion disorder
2. Sexual arousal disorder
3. Orgasmic disorder
4. Sexual pain disorders:
- dyspareunia
- vaginismus
- non coital sexual pain disorder
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Study Guide The Reproductive System and Disorders
Many factors may cause one or more sexual dysfunction. Basically the etiologies of
sexual dysfunction are divided into 2 groups, i.e. physical factors and psychic factors. There
are 4 groups of physical factors as the causes of FSD and MSD, i.e. hormonal,
vasculogenic, neurogenic, and iatrogenic factors. In addition to these physical factors, there
are two other important factors that may cause FSD, i.e. sexual function of the male partner
and the coital position.
The psychic factors can be divided into three groups, i.e. predisposing, precipitating,
and maintaining factors.
Sexual dysfunctions, either in female or male, may result in psychological effects like
disappointment, anger, anxiety, infidelity, low self confidence, and low self esteem. Other
effects are psychosomatic symptoms and sexual dysfunctions.
The principle of management of FSD and MSD is as follows.
1. Diagnose the sexual dysfunction
2. Evaluation to find the etiology
3. Treatment toward the etiology
4. Treatment to recover the sexual function:
 Sexual counseling and sex therapy
 Medication
 Sexual device
 Surgery
Some medications have been clinically approved to recover the sexual function,
such as hormonal agents in sexual desire disorder due to hormonal insufficiency and
phosphodiesterase-5 inhibitors in erectile dysfunction. Alprostadil or its combination with
other vasodilator agents is used as intracavernous injection, as the second line therapy in
erectile dysfunction.
Certain cases of sexual dysfunction need special device to recover their sexual
function. Women with vaginismus need a series of dilator to perform sex therapy. Eros CTD
is a device to stimulate clitoris and brings to orgasm.
Surgical procedure as the use of implant in erectile dysfunction is the last choice of
treatment. However, this method is now almost never been practiced.
LEARNING TASK OF MALE SEXUAL DYSFUNCTION
1. Learn the classification of male sexual dysfunction:
a. Mention all kinds of male sexual dysfunction
b. Describe the definition of all kinds of male sexual dysfunction
2. Learn the causes, pathophysiology, efects, and management of male sexual
dysfunction:
a. Describe the causes, pathophysiology, efects, and management of erectile
dysfunction (ED)
b. Describe the causes, pathophysiology, efects, and management male sexual
desire disorders
c. Describe the causes, pathophysiology, efects, and management premature
ejaculation
d. Describe the causes, pathophysiology, efects, and management retrograde
ejaculation
e. Describe the causes, pathophysiology, efects, and management male
orgasmic disorder
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Study Guide The Reproductive System and Disorders
LEARNING TASK OF FEMALE SEXUAL DYSFUNCTION
1. Learn the classification of female sexual dysfunction:
a. Mention all kinds of female sexual dysfunction
b. Describe the definition of all kinds of female sexual dysfunction
2. Learn the causes, pathophysiology, efects, and management of female sexual
dysfunction:
a. Describe the causes, pathophysiology, efects, and management of female
sexual desire disorder
b. Describe the causes, pathophysiology, efects, and management of female
sexual arousal disorder
c. Describe the causes, pathophysiology, efects, and management of
orgasmic disorder
d. Describe the causes, pathophysiology, efects, and management of sexual
pain disorders
Self assessment Male and Female sexual dysfunction
1.
2.
3.
4.
5.
6.
Describe the classification of male sexual dysfunction
Describe the classification of female sexual dysfunction
Mention the causes of erectile dysfunction
Mention the causes of sexual desire disorder in female
Describe the management of erectile dysfunction
Describe the management of sexual arousal disorder in female
Lecture 12 and 13
Male Infertility
(Prof.Dr.dr.Wimpie Pangkahila, SpAnd, FAACS and dr. G.Wirya K. Duarsa, SpU, MKes)
Disorder of male genital system include penis (malformation, inflammation,
neoplasm), scrotum, testis (cryptorchidism, inflammation, neoplasma), epididymis, prostate
(prostatitis, BPH, carcinoma) and sexual transmitted diseases.
Malformation of the penis are hypospadia, epispadia, priapism, peyronie disease.
Hypospadia is more common than epispadia. These malformation may result in lower
urinary tract problem and failure to impregnate women.
Inflammatory condition of the penis that unrelated to STDs are called balanitis and
posthitis. In phimosis, where prepuce can not be retracted, smegma are deposited between
glans penis and prepuce. Therefore most cases of phimosis accompanied by balanoosthitis.
When phimosis is forcibly retracted it may result in paraphimosis. In this condition, the
circulation to the glans penis may be strangulated by the stenotic prepuce. This may cause
congestion, swelling and pain. In severe case, urinary retention may occur.
Carcinoma of the penis is the most neoplasm occurs in the penis. Some
predisposition factors are pimosis, BXO and chronic irritation. It is believed that smegma
and infection of HPV (type 16 & 18) have an important role in the occurrence of carcinoma
of the penis. Microscopically carcinoma of eht penis is squamous cell carcinoma.
Inflammation of the skin of scrotum may caused by fungi, predisposed by moist
condition and poor local hygiene. Some disorder may cause scrotal enlargement, those are
hydrocele, hematocele, spertmatocele, varicocele etc. Varicocele may result in sterility
Cryptorchidism is the failure of testes descent into the scrotum. The etiologies are
hormonal disorder, intrinsic testicle disorder and mechanical problems. Bilateral
cryptorchidism result in sterility. Chryporchidism is related with the reisk of testis
malignancy.
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Study Guide The Reproductive System and Disorders
Infertility is defined as the inability to achieve a pregnancy resulting in live birth after
1 year of unprotected intercourse (primary infertility). Fifteen percent of 25% infertility
couples in Europe and USA seek medical treatment for infertility. Infertility affects both men
and women. A male factor can be identified in nearly 50%-60% of these couples (20% male
factor only and 40% joint subfertility). Reduced male fertility can be the result of congenital
and acquired urogenital abnormalities.
Inflammation of the testis (orchitis) is caused by STD, non specific causes, parotitis
(mumps) and tuberculosis. Neeoplasm of the testis is the most important cause of the solid
and no pain testicle enlargement. There are some classification of testicle cancer.
Male Genital Disorder and Male Infertility
Varicocele, Hydrocele,
Manage,
establish
-Comprehend the definition, epidemiology
tentative
and etiology of varicocele, and hydrocele
diagnosis,
-Apply basic principles of special investigation
provide initial
of varicocele, hydrocele
management
-Recognize clinically, provide initial
and or refer
management and refer patients with
patient with
varicocele, and hydrocele
Cryptorchidism
male
Reproductive
-Comprehend the definition, epidemiology
Disorder &
and etiology of cryptorchidism
genital disorder -Apply basic principles of special investigation
Cryptorchidism
-Recognize clinically, provide initial
management and refer patients with
Cryptorchidism
Priapismus, Peyronie Diseases, Phymosis
and Paraphymosis
-Comprehend the definition, epidemiology
and aetiology of priapismus, pyeronie
diseases, phymosis and paraphymosis
-Apply basic principles of special investigation
of priapismus, pyeronie diseases, phymosis
and paraphymosis
-Recognize clinically, provide initial
management and refer patients with
priapismus, peyronie diseases, phymosis and
paraphymosis
Hypospadi and Epispadia
-Comprehend the definition, epidemiology,
variety of hypospadia and Epispadia
-Apply basic principles of special investigation
of hypospadia and epispadia
-Recognize clinically, provide initial
management and refer patients with
hypospadia and epispadia
Male infertility and Family planning
-Comprehend the definition, epidemiology,
variety and etiology of male infertility and
male family planning
-Apply basic principles of special investigation
of male infertility and family planning
-Recognize clinically, provide initial
management and refer patients with male
Udayana University Faculty of Medicine, MEU
Dr. G.
Wirya K.
Duarsa,
MKes,
Sp.U
1.EUA
Guideline
2008
2. Robbins
Basic
Pathology 7th
edition
3. Smiths
general
Urology, 17th
ed, 2008
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Study Guide The Reproductive System and Disorders
infertility and family planning
Prostate, Penile and Testicle diseases
-Comprehend the definition, epidemiology
and aetiology of prostate, penile and testcile
diseases
-Apply basic principles of special investigation
prostate, penile and testicle diseases
-Recognize clinically, provide initial and refer
patients with prostate, penile & testicle
diseases
MALE GENITAL DISORDER AND MALE INFERTILITY
LEARNING TASK
CASE 1
Man 34 years old, came with complaint of secondary infertile. His first child was born 6
years ago. He also complaint of intermittent left scrotal pain. No complaint on erectile
capability. He has a good general condition, composmentis, normal blood pressure 120/80,
pulse 88x/minutes. Normal scrotal finding, right testicle normal, left testicle a little bit smaller
than right one. Both of epydidimis are normal. Small, cystic, worm like mass was felt during
valsava maneuver.
Questions:
1. What is the diagnosis of this patient?
2. What are the anamnesis, signs, symptoms and examination to support the diagnosis?
3. What is your planning to complete the diagnosis?
4. What is your planning treatment of this patient?
CASE 2
A 2 years old boy comes to your clinic because of painless left scrotal enlargement. That
lump usually occur after crying or doing some physical exercise and spontaneous disappear
in the evening. Transilluminasi sign (+). No disturbance on erection and mictiutary.
Questions:
1. What is the most possible diagnose of your patients?
2. If you are in doubt, the best diagnostic tool that you propose?
3. What is the treatment of your patient?
SELF ASSESMENT
1. What is the definition of phimosis and paraphimosis, priapismus and peyronie
disease?
2. What is the complication of the long term phimosis and poor hygiene of the male
external genital?
3. What is the definition and aetiology of hypospadia?
4. What is the caused of
testicle undecensus? What is the complication of
cryptorchidism? How is the management of this condition?
5. How are the diagnostic and treatment management of obstructive azoospermia?
6. What are the symptoms of Varicocele that make patients visit the doctor?
7. When does the varicocele need an operation?
8. What is the differential diagnostic of scrotal testicle enlargement?
9. How are the diagnostic of seminoma testis
10. Describe macroscopic and microscopic figure of seminoma
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LEARNING TASK OF MALE INFERTILITY
1. Learn the etiology and pathophysiology of male infertility :
a. Describe the etiology and pathophysiology of male infertility
b. Describe the effect on spermatogenesis
2. Learn the management of male infertility:
a. Interprete the result of sperm analysis as the indicator of male infertility
b. Describe the anamnesis, physical examination, and initial treatment of male
infertility
Self assessment
1. Mention the etiologies of male infertility
2. Describe the management of male infertility
3. Describe the normal parameter of sperm
4. Describe the management of vaginismus
5. Mention the etiologies of rapid (premature) ejaculation
6. Mention the pathophysiology of erectile dysfunction
Lecture 14
Female Infertility,
dr.IB.Putra Adnyana, SpOG(K)
Infertility is defined as the situation where a couple does not succeed in achieving a
spontaneous pregnancy after one year unprotected normal coitus. Infertility is a couple
problems. It is a problem of male and or female fertility. Therefore the management of
infertility must include male and female as a couple.
Primary male infertility is a condition where a man has never impregnated a woman,
independent of the outcome of pregnancy. Secondary male infertility means a man has
impregnated a woman, irrespective whether she is his present partner and the outcome of
the pregnancy.
Etiology of male infertility is multifactor, i.e. diseases, lifestyle, environment and occupation,
and genetic abnormalities. Some diseases causing male infertility are varicocele, MAGI
(male accessory gland infection), antisperm antibody, acquired damage, iatrogenic, and
systemic. Lifestyle that cause male infertility include nutritional state and intake of certain
essential fatty acids, obesity, overweight, abuse of alcohol and cigarettes, regular hot bath,
and severe stress.
Environment and occupation that effect male infertility are toxic substances like heavy
metals, carbon disulphide, benzene, agents that disrupt hormonal balance as antiandrogen.
Genetic factors include abnormalities in the number of chromosomes and structural defects
like translocations. Clinically the man has congenital abnormalities, like congenital bilateral
agenesis of the vas deferentia.
Another cause of male infertility is sexual dysfunction. Sexual dysfunctions related to male
infertility are inadequate erection, inadequate frequency of coitus, ejaculation problems
including severe rapid ejaculation, retarded ejaculation, and retrograde ejaculation.
Anatomical abnormalities related to inadequate of erection are micropenis, hypospadia,
epispadia, and phimosis. On the other side, sexual dysfunctions may occur as the
consequence of male infertility. This occurs because the man is under control to have coitus
in the fertile period, so that coitus becomes stressful.
To perform the diagnosis of male infertility, the anamnesis, sperm analysis, and physical
examination are needed. In certain cases, the hormonal test is needed.
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Study Guide The Reproductive System and Disorders
Infertility is generally defined as 1 year of unprotected intercourse without
conception. The incidence of infertility among women aged 15 – 44 years has increased
slightly over the past 30 years, reaching 15 % in 1995 ( Indonesia : 12 % , Bali : 4,1 % ).
There were several factor declining the fertility rate such as : age, career , family planning
services, and lifestyle. The general causes of infertility include male and female factor ( 56
% ) , female factor ( 65 % ) and male factor ( 35 % ), but the specific causes of female
infertility consist of ovulatory dysfunction ( 40 % ), tubal and pelvic pathology ( 40 % ),
another cause – uterine pathology ( 10 % ) and unexplained ( 10 % ).
The evaluation or investigation of infertility focuses on the couple and not on one or
the other partner. Any investigation of infertility begins with a careful clinical evaluation by
taking history and physical examination , semen profile, ovulatory status, tubal patency,
tuboperitoneal defect and cervical mucous hostility. In the female partner, particularly
relevant medical history finding include : parity, cycle length and characteristic, coital
frequency, duration of infertility, past surgery, exposure to sexually-transmitted infection,
occupation and use of tobacco, alcohol, and other drugs, symptoms of thyroid disease,
galactorrhea, hirsutism, dysparenia. For the physical examination finding include : weight
and body mass index, any thyroid enlargement, breast secretion, signs of androgen excess,
pelvic or abdominal tenderness, vaginal or cervical abnormality.
The modalities of diagnostic tool for evaluating the cause of infertility include:
Ultrasonografi (transvaginal sonografi) to evaluate the ovarial reserve, follicle
development and ovulation, tubal and uterine patology; laboratory medical machine to
evaluate the hormonal status, hystrerosalpingografi (HSG) to evaluate tubal patency and
pathology of uterine cavity, hysteroscopy and laparoscopy to evaluate the pathology of
uterine cavity, tubal patency and any abnormality of the pelvic cavity, microscope to
evaluate the semen profile and cervical mucous hostility.
Based on the result of these investigations, couples are to be selected for treatment
at different levels of infertility care unit. Depending on the personnel competence and
availability of facilities for investigations and treatment, there should be three levels of
infertility care units. Primary infertility care unit responsible for completion of basic
investigations, treatment of minor anatomical defect, medical management of minimal and
mild endometriosis, induction ovulation in nonovulation women and to refer couples to
secondary or tertiary infertility care unit. Secondary infertility care unit responsible for
further in-depth investigations and extended treatment of infertility except assisted
reproductive technique. For instance, immunological test for infertility, hysteroscopy,
laparoscopy and TVS, facilities for semen preparation, conservative surgery. Tertiary
infertility care unit responsible for advanced diagnostic procedures, therapeutic and
research. For instance, endocrine assay, color doppler for growing follicle, all varieties of
assisted reproductive technologies including ICSI, special procedure of IUI, sperm or oocyte
banking and embryo cryopeservation.
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FEMALE INFERTILITY
LEARNING
OUTCOME
Manage,establish
tentative diagnosis,
provide initial
management,
and/or refer patien
with infertility
LEARNING OBJECTIVE
Female Infertility
 Capable to explain the
definition of infertility
 Capable to explain
some factor that
influence the fertility
couples.
 Capable to explain the
specific cause of female
infertility
 Capable to establish the
diagnosis of female
infertility
 Capable to explain the
fisiologi and abnormality
of the servix, uterus,
fallopian tubes, ovarium
and, peritoneum.
 Capable to plan the
treatment of female
infertility on primary
healt services
 Capable to refer the
female infertility to the
second/tertier healt
service for getting
spesialistic treatment
PIC
STUDENT
REFERENCE
Texts Books
dr. I.B Putra
of Assisted
Adnyana,SpOG(K)
Reproductive
Techniques
The Infertility
Manual
Kamini A
Rao
Peter k
Brinsden
Sperof
Contraception is not new, but its widespread development and application are new.
The need to use contraception is not only to provide pregnancy prevention but also give
prevention of unwanted pregnancy and to decrease maternal mortality rate.
General practitioners are often best placed to offer good contraceptive advice
because they already know the patien’s health and family circumstances.
For that reason, they should know how to manage, provide and prescribing female family
planning devices and also provide initial management and/or refer unwanted effects of
female family planning devices.
Some of the female family planning metode are female condoms, spermicides,
LAM,IUD, hormonal and operative.
LEARNING TASK OF FEMALE INFERTILITY
Woman 31 years old. Her husband 34 years old. Has been married for about 5 years. They
are routinly sexual intercourse twice a weeks without protection , but until now never getting
pregnant. Husband job as a bus driver and frequently have a uninary tract problem.
She come to the public health centre to need some help for getting pregnant.
After checking the health status, who are doing by the doctor, she has some medical
problem data that is consist of :
 Irreguler menstrual period starting for one year ago.
 Frequntly vaginal discharge with some what of lower abdominal point.
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Study Guide The Reproductive System and Disorders


Body mass index > 29
On gynecology examinitaion :
-Flour (+) intra vagina
-Uterin corpus : normal size
-Litle bit pain on the left & right adnexa, but not mass palpable.
Questions :
1. List the medical & reproductive problem of this patien
2. List the risk factor of reproductive disorder for this couple
3. What is the the diagnosis of this patien
4. What is the probability cause of difficulty to get a pregnant
5. What is the next examination should be doing to supporting the diagnosis
6. What is your suggestion for this patien to treat the main problem
Self Assessment :
1. What is the definition of infertility
2. Explain the risk factor of infertility
3. Explain the cause of infertility
4. Explain the examination method of male & female infertility
5. Explain the treatment method of male and female infertility
Lecture 15
Drugs Therapy in Pregnant and Genital Disorders
Dr. dr. Bgs Komang Satriyasa, M.Repro
Pregnant women commonly use medications. Although most drugs have an
excellent safety profile, some have unproven safety or are known to adversely affect the
fetus. The safety profile of some medications may change according to the gestational age
of the fetus. Because an estimated 10 percent or more of birth defects result from maternal
drug exposure.
For a drug to harm the fetus it must cross the placenta and be present in fetal tissue.
The drugs in this list are those for which evidence is either conclusive or highly suggestive.
Not included are drugs that are used infrequently during pregnancy or for which a
teratogenic effect may occur but for which evidence is lacking. The list does not include the
likely risk of fetal abnormality after exposure in the first trimester.
The risk of anatomic defects in the fetus recedes after the first trimester. For the
remainder of pregnancy, the fetus undergoes growth and development. The impact of drugs
after the first trimester moves from structural to physiologic effects. In addition, the long-term
use of some agents can have adverse effects on the mother that, if not unique to
pregnancy, are at least exaggerated by the State.
Many drugs have not been evaluated in controlled trials and probably will not be
because of ethical considerations. Of the commonly used over-the-counter medications,
acetaminophen, chlorpheniramine, kaolin and pectin preparations, and most antacids have
a good safety record. Other drugs, such as histamine H2-receptor blockers,
pseudoephedrine, and atropine/diphenoxylate should be used with caution. With all overthe-counter medications used during pregnancy, the benefit of the drug should outweigh the
risk to the fetus.
Learning Task drugs:
1. List commonly used drugs that have teratogenicity in humans!
2. Describe the teratogenic effect of warfarin in humans!
3. Describe the teratogenic effect of phenytoin in humans!
4. Describe clinical uses of estrogens and progestine!
5. List commonly used drugs and their function in male sexual disorders!
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Self assessment
1. Describe sites of actions of several ovarian hormones and their analogs.
2. Describe clinical uses and toxicity of testosterone
3. Explain the control of androgen secretion and activity and some of actions of
antiandrogens
MALE AND FEMALE FAMILY PLANNING
(dr. G Wirya Kusuma Duarsa,M.Kes,SpU and dr. Anom Suardika,SpOG)
Abstract
Family planning is a worldwide program to control the population growth. According to
WHO, there are 9100.000 conception per day of which 50% are unplanned and 25% are
involuntary. In order for men to take more responsibility for family planning, the male
contraceptive methods applied must be effective, reversible, acceptable and cheap.
Despite research efforts, there are four methods of male contraception, i.e. condoms,
periodic abstinence, withdrawal and vasectomy. The first three methods have been use for
more than 100 years. Vasectomy is a safe and effective method of permanent
contraception. Vasectomy can be safely performed as an outpatient procedure using local
anesthetics. In the United States, it is employed by nearly 7% of all married couples and
performed on approximately 0.5 million men per year, which is more than any other urologic
surgical procedure is performed. Impressive as these numbers may seem, far fewer
vasectomies are performed than female sterilizations by tubal ligation worldwide. This is in
spite of the fact that vasectomy is less expensive and associated with much less morbidity
and mortality than tubal ligation. Some men fear pain and complications, whereas others
falsely equate vasectomy with castration or loss of masculinity.
Contraception is not new, but its widespread development and application are new. The
need to use contraception is not only to provide pregnancy prevention but also give
prevention of unwanted pregnancy and to decrease maternal mortality rate.
General practitioners are often best placed to offer good contraceptive advice
because they already know the patien’s health and family circumstances.
For that reason, they should know how to manage, provide and prescribing female family
planning devices and also provide initial management and/or refer unwanted effects of
female family planning devices.
Some of the female family planning metode are female condoms, spermicides, LAM,
IUD, hormonal and operative.
LEARNING TASK
A reproductive age couple come to your clinic to ask about contraception. They already
have 4 healthy children and the youngest boy is 2 years old. She had been undergone SC
for her last child. The mother has a strong family history of breast cancer. She removed he
IUD (Intra Uterine Device) 2 weeks ago due to prolong vaginal bleeding and pain.
Question:
1. What kind of contraception will you offer to this couple?
2. If they ask for permanent contraception what will you offer to them and why?
SELF ASSESMENT
1. How many methods of male contraception that already exist?
2. What is the benefit of vasectomy over tuba ligation?
3. What are the advantages no scalpel vasectomy over scalpel vasectomy
4. What is the counseling that has to be understood by the acceptors?
5. What will you do if the vasectomy acceptors want to have a baby?
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Reference
Moore KL, Agur AMR: Essential Clinical Anatomy, 3 nd ed. Philadelphia, Lippincott &
Wilkins,2007.p. 130-135, 230-235, 248-254, 259-265, 56-60, 235-253, 266-270
Sadler TW : Langman’s Medical embryology, 10th ed. Philadelphia, Lippincott & Wilkins,
2006. p. 239-256
Gartner.2007.color textbook of histologiy 3rd edition.p 489-510; 463-488
Crooks R. and Baur K,2008. Our Sexuality. Tenth Edition. Thomson Wadsworth
Eardley I and Krishna Sethia. 1998. Erectiloe Disfunction. Current Investigation
and Management. Mosby-Wolf. Medical Communications
Kolodny R., Masters H and Johnson V. 1979.Texbook of Sexual Mediciine. Little, Brown
and Company. Boston First Edition.
Silverthorn A C , Garrison C W and William C O. Edition. Page 745 – 761.
Stuart, Ira fox. Human Physiology 2006 9th edition, p. 664 - 710
Kumar, Cotran, Robbins.2003. Basic Pathology, Elsevier Inc. New York. 7th edition, p.
Kolodny R., Masters H and Johnson V. 1979.Texbook of Sexual Mediciine. Little, Brown
and Company. Boston 1st Edition.
Silverthorn A C , Garrison C W and William C O. Edition, p. 745 – 761.
Kumar, Cotran, Robbins. 2003. Basic Pathology 7th edition., p.658 -670,679 - 717
Dixon JM 2006. ABC The Breast Disease, 3th, p1-105
EUA Guidelines on Paediatric Urology. 2008, p 44-47
Wein Alan J. Campbell’s Urology 2007, p. 1098-1127
Smith’s General Urology, 17th edition, 2008
Berek J.S. 2002. Novaks Gynecology.13th edition, p. 351 -421, 1199 – 1345, 1353 - 1375
Phillips NA.2000.American Family Physician.
Shill WB, Comhaire FH, HargreaveTB. Andrology for the Clinician.2007
Sperof Leon and Fritz Marc A. 2005. Cilinical Gynecologic Endocrinology and Infertility 7th
edition,
Gary Cuninggham. F. at al. 2005. Williams Obtetrics, 22nd edition, p.409 – 417
WHO Partograph Guidelines.
Gary Cuninggham. F.at al. Williams Obtetrics, 2005, 21st edition, p. 689 - , 729 - ,743 - .
Gary Cuninggham. F at al. Williams Obtetrics, 2007, 22nd edition, p. 232-247, 254-268,
810 - 823
Rao AR, Peter K Brinsen. The infertility manual kamini.
Currerhers SG, Hoffman BB, Melmon KL, Nierenberg DW. 2000. Clinical Pharmacology,4th
edition.p1117 -1131
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~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
10
Senior Clerkship
9
Senior Clerkship
8
Senior clerkship
7
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Elective Study III
(6 weeks)
Clinic Orientation
(Clerkship)
(6 weeks)
6
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The
Cardiovascular
System and
Disorders
(4 weeks)
The Urinary
System and
Disorders
(3 weeks)
The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(3 weeks)
BCS (1 weeks)
Health Systembased Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
-
BCS (1 weeks)
Stadium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
BCS (1 weeks)
Elective Study
II
(1 weeks)
5
4
3
2
1
BCS (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
Pendidikan Pancasila & Kewarganegaraan (3 weeks)
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