Reproductive System
After completing the Reproductive System lesson, students will be able to identify and/or describe the:

The location, structure, and function of the glands, organs, and ducts of the male reproductive system

The location, structure, and function of the glands, organs, and ducts of the female reproductive system

The major male and female sexual hormones and their roles

The three phases of the female menstrual cycle

Anatomy and function of the mammary glands

Trimesters of pregnancy

Three stages of labor

Common infections of the male and female reproductive system

Neoplasms of the male and female reproductive system

Congenital anomalies of the male and female reproductive system

Other disorders of the male and female reproductive system

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Reproductive System
In this lesson on the reproductive system, we will review the structure and function of all the male and female reproductive organs. The female reproductive system must prepare for and support a pregnancy as well as delivery; therefore you will find it a more complex system than the male one.
Additionally this lesson contains information on trimesters and stages of labor as well as conditions and diseases not covered in your text.

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Reproductive System
1. Read Chapter 19: The Reproductive System.
2. Open your CD-ROM to Chapter 19 and complete the practice quiz and quiz.
Do the Image Labeling exercise and watch the animation.
3. Review this lesson, completing activities and the Test Yourself quizzes as you proceed.
4. If you need additional work, open your CD-ROM and complete additional exercises. The interactive games including Concentration, Hangman and
Championship are optional.
5. Complete this week
’s assessment.

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Reproductive System
Unlike the other body systems, the reproductive system does not function to maintain the individual but to produce new life. The system stays in the background until puberty when it springs into action. At this time, sexual maturity and the ability to reproduce occur. While the anatomy of the male and female reproductive systems is quite different, their joint function is to produce offspring.

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The testes are the primary sex organs of the male reproductive system but are also part of the endocrine system. The main functions of the testes are:

Production of sperm (exocrine function)

Production of the male sex hormone testosterone (endocrine function)
Testes are paired glands, about the size of a small plum, and are located external to the body. (Refer to Fig. 19-2 on p. 453 when reading the following)

Each testis is surrounded by a fibrous connective tissue called the tunica albuginea

The tunica albuginea extends into each testis and divides it into a number of wedge shaped compartments called lobules

Each lobule contains one
– three tightly coiled seminiferous tubules where sperm are produced

Sertoli cells in the seminiferous tubules produce secretions that supply nutrients to developing sperm cells

Interstitial cells of Leydig , located in the lobules between the seminiferous tubules, produce testosterone, the male hormone responsible for sexual development/ puberty, secondary sexual characteristics (deepening voice, hair growth on the body, increased muscle mass, etc), maturation of sperm cells, and sexual drive.
After being formed in the testes, sperm move on through a variety of ducts and accessory glands. First they enter the epididymis, and then move through the ductus/vas deferens to the ejaculatory duct which ejects the sperm into the urethra. Along the way there are three accessory glands that secrete the liquid portion of semen. These glands are the seminal vesicles, prostate, and bulbourethal glands. Let
’s look at these ducts and accessory glands in more detail.

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1. Testosterone is a male sex hormone produced by the interstitial cells of Leydig located in the testes.
True
False
Test your knowledge of what you've just read by answering the three following questions.

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2. The testes are part of the reproductive system and what other body system? digestive endocrine nervous circulatory

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3. ______________ are found in the lobes of the testes and are responsible for producing sperm. ductus deferens seminiferous tubules ejaculatory duct epididymis

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Epididymis is a comma-shaped structure that is located along the top and on the posterior of each testis. It is composed of a tightly coiled tube, the ductus epididymis, which is about 20 feet long. After leaving the testis, sperm move into the epididymis where they mature and develop their ability to move/swim.
This process takes about 20 days.
Ductus/Vas Deferens runs upward from the epididymis, passes through the inguinal canal, enters the pelvic cavity, and curves over the top of the urinary bladder. At its end, the vas deferens expands into the ampulla which empties into the ejaculatory duct. The vas deferens is a smooth muscular tube which is about 18 inches long. Its function is to transport sperm from the epididymis to the urethra. In order to accomplish the movement of sperm, the muscle in the walls of the vas deferens contracts creating peristaltic waves that move the sperm forward. The spermatic cord is a sheath of connective tissue that houses the ductus/vas deferens and its surrounding blood vessels and nerves. It passes from the abdominal cavity through the inguinal canal down into the scrotum. The function of the spermatic cord is to suspend the testes within the scrotum.
Ejaculatory duct is formed by the confluence of the duct from the seminal vesicle and the ductus/vas deferens. The ejaculatory duct travels through the prostate gland where it meets the urethra. It is at this point that the ejaculatory duct ejects its sperm into the urethra which is the final duct in the system.
Sperm travels through the urethra which eventually enters the penis and terminates at the external urinary meatus.
Urethra extends from the base of the bladder to the tip of the penis and carries both urine and semen. It is subdivided into three sections:

Prostatic urethra
– surrounded by the prostate gland

Membranous urethra
– section from prostatic urethra to penis

Spongy or cavernous urethra – section within the penis

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1. The _______ is the site of sperm storage and maturation. epididymis spermatic cord ductus deferens testes
Test your knowledge of what you've just read by answering the three following questions.

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2. _________ is a sheath of connective tissue that houses the vas deferens and its blood vessels and nerves. Its function is to suspend the testes within the scrotum. epididymis spermatic cord prostatic urethra cavernous urethra

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3. ___________ is formed by the confluence of the duct from the seminal vesicles and the vas deferens. ejactulatory duct spermatic cord prostate urethra

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As mentioned earlier, the male reproductive system is composed of a series of ducts and accessory glands. We have reviewed the ducts of the system and now will look at the accessory glands that add fluid to the sperm that are produced by the testes. The sperm combined with the fluids produced by these accessory glands is called semen or seminal fluid . Semen is alkaline which helps protect the sperm from the acidity of the female vagina.
There are three glands that secrete the liquid portion of semen (see Figure 19-1 on p. 452):

Seminal vesicles – located at the base of the bladder, these paired pouchlike structures produce about 60% of seminal fluid volume. Their secretion is high in sugar (fructose) that nourishes the sperm. The duct of the seminal vesicle joins the vas deferens to form the ejaculatory duct.

Prostate gland – a doughnut shaped gland that surrounds the prostatic urethra and is located just below the bladder. It produces a milky white, alkaline fluid that accounts for about 30% of seminal fluid.

Bulbourethral glands or Cowper ’s glands : these very tiny, pea sized glands, are found at the base of the prostate on either side of the membranous urethra. The fluid they produce is secreted first, before the other fluids, during sexual arousal and serves to lubricate the urethra for passage of sperm as well as cleansing the urethra of any acidic urine.

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Penis : consists of a shaft with an enlarged distal end called the glans penis which is covered by loose skin called the prepuce or foreskin . It is this prepuce or foreskin that is removed during circumcision.
There are three separate columns of erectile tissue in the shaft of the penis.
This is spongy tissue containing blood sinuses that fill during sexual stimulation and produce an erection.
Scrotum : is an out-pouching of the abdominal wall, located outside the body cavity that contains the testes. Externally it appears to be a single pouch separated into two portions that are divided by a median ridge called the raphe .
Internally it is actually separated by a septum into two separate sacs.

In order to survive, sperm require a lower temperature than our normal body temperature. This is the reason the testes are located outside the body proper.

The cremaster muscle , found in the spermatic cord, contracts and shortens during cold temperatures thus moving the testes closer to the body for warmth. The opposite (cremaster muscle relaxes) occurs when it is hot thus lengthening the spermatic cord and moving the testes farther away from the heat of the body.

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1. The ___________ muscle in the spermatic cord elevates the testes on exposure to cold. raphe detrusor muscle cremaster muscle ampulla
Test your knowledge of what you've just read by answering the four following questions.

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2. Which of the following is NOT one of the glands that secretes a portion of seminal fluid? prostate seminal vesicles epididymis bulbourethral glands

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3. Which of the following would you find in the scrotum? epididymis bulbourethral gland prostate ejactulatory duct

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4. _________ , is also called the Cowper's gland, and its secretion functions as both a lubricant during sexual intercourse and as an agent to clean the urethra of acidic urine. prostate seminal vesicle ejaculatory gland
Bulbourethral glands

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Open Your CD-ROM to Chapter 19 and view the animation of the male reproductive system.

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The role of the female reproductive system is more complex than the male as it must not only produce the ova (eggs) but it must also sustain the fertilized egg through nine months of pregnancy. The ovaries are considered the primary sex organs of the female while the other organs including the fallopian tubes, uterus, vagina, and external genitalia are considered accessory organs. The overall functions of the female reproductive system are:

Oogenesis – production of ova

Ovulation – release of the ovum

Conception
– receipt of sperm/fertilization of egg

Support of developing offspring

Production of the hormones estrogen and progesterone

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Ovaries
The ovaries are paired female gonads about the size and shape of large almonds. They are located on either side of the uterus in the pelvic cavity and are secured by three ligaments:

Suspensory ligaments
– secure ovary to the lateral wall of the pelvis

Ovarian ligaments – anchor ovaries medially to the uterus

Broad ligament – a fold of peritoneum that holds the ovary in place and encloses it
The function of the ovaries is:

Oogenesis
– production of eggs/ova

Ovulation – release or discharge of the ovum

Secretion of estrogen and progesterone – female sex hormones
During the development of a female fetus, female stem cells divide and produce primary oocytes , or immature eggs. These oocytes and their surrounding tissues are called ovarian follicles and in their early, immature stage are also called primary follicles . The follicles remain inactive until puberty when the anterior pituitary gland secretes follicle stimulating hormone. At this point, a small number of primary follicles will grow and develop. When the follicles mature, they contain a mature egg and are referred to as a graafian follicle . The egg eventually ruptures from the graafian follicle and the remaining follicle is known as the corpus luteum , which secretes estrogen and progesterone. Thus begins the ovarian cycle that grows and develops a small number of the primary follicles with release of one each month.

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Estrogen and progesterone are produced by the ovaries at the start of puberty.
Estrogen is responsible for:

Female secondary sex characteristics including breast development, pubic and axillary hair, widening of the pelvis and fatty deposits under the skin

Development and growth of the reproductive organs including fallopian tubes, uterus, vagina and external genitalia

Onset of the menstrual cycle

Metabolic effects such as keeping a low total cholesterol level and assisting in calcium uptake that helps to maintain bone density
Progesterone works in conjunction with estrogen to establish the menstrual cycle. In addition, progesterone (produced by the placenta not the ovary) assists in maintaining pregnancy and preparing for lactation, the production of milk by the breasts following delivery.

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1. The hormone progesterone works in conjunction with estrogen to establish the menstrual cycle is responsible for development of female secondary sex characteristics causes the growth and development of female sexual organs assists in calcium uptake thus maintaining bone density
Test your knowledge of what you've just read by answering the three following questions.

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2. A mature follicle with a mature egg that is ready for ovulation is called a graafian follicle.
True
False

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3. Estrogen and progesterone are produced by the ovaries throughout a women's lifetime.
True
False

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The fallopian tubes are also paired organs that transport ova from each ovary to the uterus as well as provide a site for fertilization. Each fallopian tube is about
4 inches long and at its distal end, close to but not touching the ovary, it expands into a funnel-shaped structure called the infundibulum . The infundibulum terminates in a fringe-like structure that is composed of fimbriae or finger-like projections. The infundibulum curves over the top of the ovary but does not attach to it. The infundibulum actually opens into the pelvic cavity.
When an egg is released from the ovary, it enters the abdominal cavity first and then makes its way into the fallopian tube due to a current created by the waving of the fimbriae and the ciliary action of the epithelial tissue lining the infundibulum. Since an egg remains viable for about 24 hours and the journey through the fallopian tube takes 3 to 4 days, most fertilization occurs in the upper portion of the fallopian tube.

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The uterus , also known as the womb , is shaped like an inverted pear and is located in the pelvic cavity between the urinary bladder and rectum. It is held in position by a series of ligaments including the broad, round, and uterosacral ligaments. Because it is composed of almost all muscle, it is a strong organ that can increase greatly in size during pregnancy and accommodate a fetus as well as a large amount of fluid. The uterus serves the following purposes:

Site of menstruation

Location where embryo implants and fetus grows and develops

Location where labor begins during delivery
As seen in the illustration and described below, the uterus has several anatomic divisions:

Fundus – dome shaped portion above the uterine tubes

Corpus/body –O major portion of the uterus, it is connected to the fallopian tubes and is the area beneath the fundus; the interior portion is called the uterine cavity

Cervix – narrow inferior portion that opens into the vagina

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Other anatomical areas in the uterus:

Internal os –O junction of the uterine cavity and cervical canal

External os
–O junction of the cervical canal and vagina
The walls of the uterus contain three layers of tissue:

Endometrium
–O innermost layer of tissue, this is shed during menstruation. In the pregnant female, the fertilized ovum implants here.

Myometrium
– middle layer of uterine tissue composed of smooth muscle, it stretches during pregnancy and contracts during and after delivery.

Perimetrium
–O outer layer made up of serous membrane, it is also the visceral peritoneum

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The typical menstrual cycle lasts 28 days although it can vary between 24 to 35 days. Ovulation or the rupture of the graafian follicle happens midway through the cycle, typically on day 14. The first menstrual cycle is called menarche while cessation of menstrual cycles is termed menopause . There are three phases to the menstrual cycle:
Phase
Menstrual
Proliferativ e/ preovulato ry
Secretory/ postovulat ory
Days
1 - 5
6 - 14
Uterus
Uterus sheds lining bleeding occurs
Endometrial lining
– thickens due to increased levels of estrogen produced by follicles
15 - 28 Increase in size of endometrium as well as its blood supply in preparation for implantation of embryo; endometrium also secretes nutrients into the uterine cavity in anticipation of implantation; if no pregnancy, cycle starts again
Ovary
Ovarian follicles begin to develop
Graafian follicle develops and ruptures causing ovulation on
Day 14
Increased amounts of progesteron e and estrogen are produced

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1. The womb, held in position by a series of ligaments and located in the pelvic cavity between the rectum and the urinary bladder, is also known as the
____________. uterus cervix ovary cul-de-sac
Test your knowledge of what you've just read by answering the five following questions.

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2. The innermost layer of the wall of the uterus that is shed approximately every
28 days is called the _____________. myometrium endometrium perimetrium epimetrium

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3. The junction of the uterine cavity with the cervical canal is called the
_______________. fimbriae internal os external os cul-de-sac

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4. Days 6 - 14 of the menstrual cycle during which the endometrial lining thickens is the _____________ . secretory phase menstrual phase proliferative phase postovulatory phase

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5. The __________ are the fringe or finger-like projections at the end of the fallopian tube that partially surround the ovary. cilia fimbriae infundibulum flagella

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The vagina extends from the cervix to the exterior of the body and is a tube about
3
– 4 inches in length. It is located between the bladder and the rectum in the pelvic cavity. Where the vagina attaches to the cervix, there is a recess called the fornix (see Fig. 19.6 on p. 459.) There is a posterior, anterior, and lateral fornix. It is this area that accommodates a diaphragm that is used as a contraceptive device. The diaphragm prevents sperm from reaching the uterus.
The functions of the vagina include:

Passageway for menstrual flow

Passageway or birth canal for delivery of an infant

Receptacle for penis during sexual intercourse

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Vulva or pudendum is the term used to include all the external female genitalia.
This includes the mons pubis, labia majora and minora, clitoris, urethral and vaginal openings, and the vestibular glands. Let
’s look at each in more detail.

Mons pubis is an elevated area of adipose tissue that becomes covered with hair at puberty. It is located directly over the pubic symphysis.

Labia majora are two elongated folds of skin that extend posterior and inferior to the mons pubis. Covered with hair on the outer surface but smooth on the inner surface, they are composed of adipose tissue and numerous sweat glands.

Labia minora are medial to the labia majora and are hair-free. They have a few sweat glands but numerous sebaceous glands.

Clitoris is located at the anterior junction of the labia minora. It
’s a small round mass composed of erectile tissue and is analogous to the male penis. The body of the clitoris is covered by the prepuce or foreskin and the exposed portion is called the glans.

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
Vestibule is the area between the labia minora. Within this area are located the hymen, the vaginal orifice, and the urethral orifice as well as two sets of glands.

Hymen is a thin fold of tissue that partially closes off the distal end of the vagina. Because it is highly vascular, it bleeds when broken during the first sexual intercourse.

Lesser vestibular or Skene ’s glands : located on either side of the urethral orifice, these glands secrete mucus

Greater vestibular or Bartholin ’s glands : located on either side of the vaginal orifice, these glands secrete mucus that lubricates the vagina during intercourse

Perineum is the diamond-shaped area between the vaginal orifice and the anus.

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Mammary glands are found in both men and women but are only functional in women during lactation (period in which the glands are producing milk for a newborn infant.) These glands are modified sweat glands and are located in the breasts that lie over the pectoral muscle. During puberty estrogen causes an increase in the size of the mammary glands in women.
Internally, a mammary gland is composed of 15 to 20 lobes that radiate from the nipple. Connective tissue and fat is found between lobes. Within each lobe are contained smaller segments called lobules that contain alveoli cells that secrete milk. The milk leaves the alveolar glands and passes through secondary tubules, mammary ducts and finally into lactiferous ducts that terminate in the nipple. The areola is the circular pigmented area that surrounds the nipple.

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Open Your CD-ROM to Chapter 19 and view the animation of the female reproductive system.

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1. The triangular area between the vagina and the anus is known as the
___________. vestibule fourchette peritoneum perineum
Test your knowledge of what you've just read by answering the five following questions.

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2. The modified sweat glands located in the breasts are known as the
__________. mammary glands
Skene's glands
Bartholin's glands
Cowper's glands

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3. The external female genitalia are collectively referred to as the pudendum or the _________. labia majora labia minora perineum vulva

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4. Which of the following is NOT a gland found in the female reproductive system? mammary glands
Skene's glands
Bartholin's glands
Cowper's glands

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5. Of the following, which is NOT considered a correct statement about the vagina?
It is part of the birth canal
It is considered part of the external female genitalia
It is a passage way for menstrual flow
It is the receptacle for the penis during intercourse.

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Pregnancy is the time from conception/fertilization to birth. Fertilization occurs when an egg and sperm unite and their genetic material is joined. This fertilized egg is now called a zygote and it undergoes rapid mitotic division. Because fertilization generally occurs in the fallopian tube, the zygote travels to the uterus and when it arrives there it has grown to about 100 cells and has developed into the chorionic vesicle . By the 7th day after ovulation, the embryo imbeds itself in the uterus.

The placenta is formed from both maternal and embryonic tissue and serves to anchor the embryo to the uterus and provide a conduit between mother and baby for nutrients and waste products.

Amnion is a fluid filled sac that surrounds the embryo

Umbilical cord connects the amnion to the placenta

Fetus – term used to describe the embryo by the 9th week

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The length of pregnancy (about 39 weeks) is divided into three trimesters that are counted from the first day of the last menstrual period. According to
ICD-10-CM they are defined as follows:

1st trimester : less than 14 weeks 0 days

2nd trimester : 14 weeks 0 days to less than 28 weeks 0 days

3rd trimester : 28 weeks 0 days until delivery

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Childbirth, also called parturition , usually occurs within 15 days (before or after) the due date. The fetus is expelled from the uterus by a process termed labor .
Oxytocin, a hormone, causes uterine muscles to contract. The placenta releases prostaglandins that together with oxytocin cause an increase in the severity and frequency of the contractions.
Labor is divided into three stages:

Stage 1 – Dilation stage

Longest stage, lasting up to 12 hrs.

Cervix becomes fully dilated due to fetal head

Amnion ruptures releasing amniotic fluid

Stage 2 – Expulsion stage

Time period from full dilation to delivery

Typically 50 minutes in first birth, 20 minutes subsequently

Infant passes through cervical canal and vagina to outside world

Umbilical cord is clamped and cut

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
Stage 3 – Placental stage

Usually occurs within 15 minutes after birth

Placenta detaches from the uterus

Afterbirth is the term used to describe the placenta and its attached fetal membranes

To prevent postpartum bleeding, all placenta fragments need to be removed at this time

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1. According to ICD-10, the third trimester of pregnancy is defined as 28 weeks,
0 days to delivery.
True
False
Test your knowledge of what you've just read by answering the four following questions.

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2. By the ninth week of pregnancy, the developing embryo is called a(n)
_________. blastoma fertilized egg fetus zygote

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3. Another term for childbirth is ___________. parturition gravida puerperal gestation

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4. The second stage of labor, the time period from full dilation to the delivery, is termed __________ stage. dilation expulsion placental none of the above

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Benign prostatic hypertrophy (BPH)
– this is a common problem in older men in which the prostate enlarges causing pressure and squeezing of the prostatic urethra. Urination becomes difficult and sometimes impossible. Medications and several surgical options including TUMT (transurethral microwave thermotherapy), TUNA (transurethral needle ablation), and TURP (transurethral resection of the prostate) are some current treatment options used for BPH.

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Hydrocele is a swelling of the scrotum caused by an accumulation of fluid within the scrotum. Hydrocele can be congenital due to a structural abnormality.
When it occurs in adults, it can be due to infection, trauma, or neoplasm but often times the cause is not determined.
Varicocele is a swelling or dilatation of the veins in the spermatic cord. It is caused because the valves within the veins are not allowing the blood to flow properly and as a result the veins become enlarged and swollen similar to varicose veins. Varicocele is more common in men ages 15 – 25 and is often a cause of male infertility. A varicocele is typically harmless but if surgery is required, varicocelectomy or varicocele embolization are options.

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Endometriosis occurs when endometrial tissue grows outside the uterus. This happens when endometrial cells leave the uterus via the fallopian tubes and wind up in the pelvic cavity. The endometrial cells can grow on the outer surface of the uterus, the ovaries, bladder, abdominal wall, kidneys, or sigmoid colon.
Since the endometrial cells are affected by estrogen and progesterone, they grow and develop but eventually degenerate and bleed. Occurring during the childbearing years, endometriosis can be asymptomatic or cause pain, abnormal bleeding, and/or infertility. While no real cure, endometriosis can be managed with medications and hormonal therapy during the child-bearing years and generally abates at menopause.

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Disorders Related to Pregnancy

Abruptio placenta is separation of the placenta from the uterine wall after
20 weeks of gestation but prior to delivery. Fetal and maternal mortality depend on the degree the placenta has separated. Complete separation is fatal to the fetus and a very serious condition for the mother.

Ectopic pregnancy occurs when a fertilized egg implants somewhere other than the normal uterine location. The most common site for an ectopic pregnancy is the fallopian tube but it can occur in the cervix, ovary, or abdomen as well. Death of the fetus almost always occurs and there is concern that if it is a fallopian tube pregnancy, the tube will rupture causing hemorrhage. Ectopic pregnancies in which the embryo has implanted where there is room for the fetus to grow and develop (e.g. the abdominal cavity), may be successful but must be delivered by C-section.

A miscarriage or spontaneous abortion is a spontaneous loss of a pregnancy that occurs before 20 weeks of gestation. Most, however, occur within the first 12 weeks of gestation. A spontaneous abortion is an involuntary process in which the fetus and placenta separate from the uterine wall. The most common cause is a genetic abnormality of the fetus.

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
Missed abortion is the term used to describe a pregnancy that is lost but the products of conception remain. In other words, a spontaneous abortion should have occurred but did not.

Placenta previa occurs when the placenta implants in the lower portion of the uterus, near the cervix, and partially or completely covers the cervix.
As the cervix starts to prepare for labor, it opens and the placenta can become detached causing bleeding. Vaginal bleeding is the main symptom of placenta previa and it usually occurs at the end of the second trimester or beginning of the third trimester. It is possible that the placenta will move away from the cervix prior to delivery. Treatment depends on many factors including the amount of hemorrhaging that occurs, gestational age of the fetus, and the position of the placenta.

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1. A swelling or twisting of veins in the spermatic cord is called ____________. varicocele hydrocele
BPH cryptorchidism
Test your knowledge of what you've just read by answering the five following questions.

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2. ___________ occurs when a pregnancy is lost but the products of conception remain. placenta abruptio placenta previa miscarriage missed abortion

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3. A TUNA, TUMT, or TURP are all surgical procedures performed for which of the following conditions? benign prostatic hypertrophy epididymitis cryptorchidism hydrocele

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4. A condition in which endometrial cells grow on the outer surface of the uterus, ovaries, or other pelvic organs is called __________. leiomyosarcoma endometriosis fibroids leukoplakia

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5. ___________ occurs when the placenta implants near the cervix and partially or completely covers it. placenta previa placenta abruptio eclampsia both a and c

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Epididymitis – a swelling or inflammation of the epididymis that is often caused by the spread of a bacterial infection from the bladder or urethra. It occurs most often in men between the ages of 19 and 35. Gonorrhea and chlamydia are the most common infections that cause epididymitis in young men while E. coli is most often the cause in children and older men. Amiodarone, a medication used to treat cardiac arrhythmias, is another cause of epididymitis. Symptoms include fever, chills, scrotal swelling, and testicular pain. Improvement occurs with antibiotic treatment. If left untreated, abscess and fistula development is possible as is infertility.

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Pelvic inflammatory disease - is an infection of the uterus, ovaries, and/or fallopian tubes that is caused by bacteria, often gonorrhea or chlamydia.
Symptoms include a vaginal discharge and pelvic pain. Antibiotics are used to treat PID.

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Sexually Transmitted Diseases (STD ’s) of the Male and Female
Reproductive Systems
STD ’s are caused by bacteria, viruses, and protozoas and are spread by intimate sexual contact with a partner who is already infected. Listed below are some of the more common STD
’s along with their pathogen and disease description.
Infection Pathogen Description
AIDS
Chlamydia
Virus: human immuno-deficiency virus (HIV)
Bacterium:
Chlamydia trachomatis
Transmitted by contact with body fluids containing the virus, sexual contact, contaminated needles and blood products, and during birth from an infected mother. Infection has 3 stages: initial symptoms, latency period, and full blown AIDS. Latency period can last from 5
– 10 yrs with no symptoms.
Death usually occurs from secondary infections due to patient
’s compromised immune system.
Most common STD in US.
Often very mild or no symptoms. Women may have an abnormal vaginal discharge or burning upon urination while men may have a discharge from the penis. If untreated in women it can cause PID with chronic pelvic pain and eventual infertility.

Genital warts
Genital herpes Virus: herpes simplex virus (HSV)
Gonorrhea
Syphilis
Trichomonas
Virus: human papilloma virus (HPV)
Bacterium: Neisseria gonorrhoeae
Bacterium:
Treponema pallidum
Protozoan:
Trichomonas vaginalis
Treatment with antibiotics is very successful.
Highly contagious, these warts vary from small growths to large clusters on the skin of the genitals.
Bleeding and painful intercourse can occur.
Treatment includes surgery and antiviral topical medications.
Causes lesions and blisters on the skin of the genitals.
Blisters are painful and after healing can reoccur during periods of stress. No cure available.
Affects the epithelial lining of the vagina and male urethra, causing a discharge of pus. If left untreated it can progress to PID in women. Treatment with antibiotics is successful.
Primary stage results in a chancre (sore) at infection site. If untreated, secondary stage with fever and skin rash can occur several weeks later.
Tertiary stage occurs many years later and produces neural lesions that can cause paralysis, insanity, and death. Treated with antibiotics.
More common in women than men; in women it affects the vagina and in men the urethra is infected.
Some women experience a frothy, yellow-green vaginal

discharge with a strong odor.

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Prostate cancer – is a cancer of the prostate gland that typically affects men over age 60. Many have no symptoms while those that do may experience urinary problems, erectile dysfunction, or blood in their urine and/or semen.
Most prostate cancer is adenocarcinoma and is thought to begin with small changes in the size and shape of the prostate cells. Prostatic intraepithelial neoplasia or PIN is the name given to these changes. There are many options to treat prostate cancer and because it is slow growing in many cases, watchful waiting is often chosen.
Testicular cancer
– is most common in men ages 15 to 30 years old. Risk factors include a genetic predisposition, testicular trauma, and cryptorchidism
(undescended testis.) Symptoms include a non-tender mass or lump in the testis. Tumors are broadly divided into seminomas and non-seminomas for treatment purposes because seminomas are more responsive to radiation therapy. Treatment usually involves a radical inguinal orchiectomy or removal of the involved testis. Depending on the histology and stage of the tumor, radiation and/or chemotherapy may also be utilized. Testicular cancer is considered highly treatable and often curable.

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Benign neoplasms of the uterus – fibroid tumors or leiomyomas are benign tumors that originate in the myometrium. Occurring during the middle and later reproductive years, many fibroids cause no symptoms while others grow and cause heavy, painful menstrual periods, painful intercourse, and urinary frequency. The location and size of a fibroid are the determining factors in whether fibroids cause symptoms. Fibroids located within the uterine cavity are much more apt to cause problems than those located on the outside of the uterus. Fibroids are categorized by the following locations:

Submucosal - located in the muscle, beneath the endometrium, they distort the uterine cavity and bleed even though they may be small. They can also cause infertility.

Intramural - most common type, located within the wall of the uterus; these are typically asymptomatic

Subserosal - located underneath the mucosal or peritoneal surface and can become large

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Fibroids are usually not treated unless they become symptomatic. If necessary, treatment options include medication to shrink the fibroid, ultrasonic destruction, surgical treatment to cut off blood supply to the tumor, myomectomy, or hysterectomy. Because fibroids are dependent on estrogen and progesterone to grow, they shrink and/or disappear at menopause.

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Breast Cancer – occurs more frequently in females but can occur in the male breast. It most often arises from the inner lining of the milk ducts or the lobules that provide milk for the ducts. If it arises in the ducts it is termed ductal carcinoma, and if it starts in the lobules, it is called lobular carcinoma.
Symptoms include a lump in the breast, nipple puckering or leakage, and change in skin texture of the breast. Treatment options include surgery, radiation, and chemotherapy and prognosis and survival rates vary a great deal depending on histology and stage.
Cervical Cancer
– occurs in the cervix or the lower portion of the uterus and is the third most common cancer in women, affecting women in the 30 – 50 age brackets most often. Usually cervical cancer develops from squamous cells found on the surface of the cervix. Cervical cancer begins as a precancerous condition called dysplasia and develops slowly. The dysplasia can be diagnosed from a Pap smear and when discovered at this stage it is 100% curable. Most cervical cancers are caused by the human papilloma virus (HPV) that is spread by sexual intercourse. Treatment varies depending on stage, age of woman, and interest in future pregnancies. For early cancers, treatment options include LEEP (loop electrosurgical excision procedure), cryotherapy, and laser therapy. With advanced disease, a radical hysterectomy or pelvic exenteration would be considered.

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Endometrial/Uterine Cancer – is cancer of the lining (endometrium) of the uterus. It occurs most often in women past the childbearing age with a common symptom being post menopausal bleeding. Endometrial hyperplasia, infertility, obesity, and history of taking estrogen are all risk factors. Treatment options include surgery, chemotherapy, radiation therapy, and hormonal therapy and are dependent on tumor grade and stage.
Ovarian Cancer – is often diagnosed at an advanced stage as its early symptoms which include abdominal pain and swelling, abnormal vaginal bleeding, and weight gain/loss are quite mild. Ovarian cancer usually occurs in women over age 50 but can occur in younger women. Surgery followed by chemotherapy is the typical treatment. According to SEER data, the overall
5-year relative survival for 1999-2006 was 45.6%.

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Cryptorchidism - also known as undescended testicles, occurs when one or both testes fail to descend prior to birth. During the development of the fetus, the testes are located in the abdominal cavity close to the kidneys. They typically descend into the scrotum several months before birth. About 80% of undescended testes descend by the age of one year with the majority descending within three months of birth. Because cryptorchidism is associated with decreased fertility and other problems, a surgical procedure called orchiopexy is undertaken when descension does not occur.

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Amenorrhea - lack of menstrual period during the reproductive years
Dysmenorrhea - difficult/painful menstrual period
Dyspareunia - painful sexual intercourse
Dystocia - difficult childbirth or labor
Gravida - refers to the number of times a woman has been pregnant including a current pregnancy
Nulligravida - refers to a woman who has never been pregnant
Parity (para) - refers to the number of viable (>20 wks) births
Primigravida - first time a woman has been pregnant
Puerperium - also called the postpartum period, it extends from the time of birth to about six weeks following birth

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Commonly prescribed medications are listed below. The list includes only examples of commonly prescribed medications and is not intended to be all inclusive. The generic name is listed first with brand name(s) in parenthesis. A generic drug may have more than one brand name – not all brand names are noted here.

Androgens (can be used in treatment of prostate cancer, breast cancer, endometriosis, and fibroids)

goserelin (Zoladex)

leuprolide (Lupron)

Antiandrogens (used to treat prostate cancer)

bicalutamide (Casodex)

flutamide (Eulexin)

nilutamide (Nilandron)

Estrogens

Estradiol (Estrace, Menest, Premarin)

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
Hormonal antineoplastic agents

anastrozole (Arimidex)

bicalutamide (Casodex)

tamoxifen (Nolvadex)

letrozole (Femara)

Benign Prostatic Hypertrophy (BPH)

doxazosin (Cardura)

dutasteride (Avodart)

finasteride (Propecia, Proscar)

tamsulosin (Flomax)

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Examples of commonly ordered tests are listed below. This list is not intended to be all inclusive.
Lab tests:

Papanicolaou test (Pap) - cells from the cervix are microscopically examined to detect premalignant and malignant cells. Early detection and treatment of precancerous conditions such as cervical intraepithelial neoplasia (CIN) can prevent cervical cancer. Most cases of CIN are caused by human papilloma viruses (HPV
’s) that are transmitted by sexual contact.
 prostatic specific antigen (PSA) - measures the amount of prostate specific antigen in the blood. This antigen is a protein produced by cells in the prostate and is normally found in small amounts in healthy males.
Elevated levels of PSA may signal prostate cancer or other prostatic disease.
Other tests:
 hysterosalpingography (HSG) - this is a radiological procedure using contrast medium. The test is used to determine fallopian tube patency as well as the shape of the uterine cavity. This is a frequently ordered exam for females with infertility problems.

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1. Testicular cancer is most frequently diagnosed in men ages 65 - 80 years of age.
True
False
Test your knowledge of what you've just read by answering the six following questions.

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Reproductive System
2. A benign muscle tumor found in the uterus is called a _________________. leiomyoma fibroid leiomyosarcoma
Both a and b are correct

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3. Genital warts are caused by the human papilloma virus or HPV.
True
False

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4. Sexually transmitted diseases are caused by: bacteria virus protozoa all of the above

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5. This type of cancer found in women is most often caused by the human papilloma virus. breast cancer cervical cancer endometrial cancer ovarian cancer

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6. ______________ cancer most often affects women past their childbearing years and a common symptom is postmenopausal bleeding. bladder cancer cervical cancer endometrial cancer ovarian cancer

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After reading this on-line material and the related textbook material, as well as completing the assignments and Test Yourself quizzes for this week you are ready to take the Weekly Assessment.

You need to score 80% on this test to earn CEUs for this week.

Once you do, you will be able to print your CEU form.
There is a one hour timer on the weekly assessment. There are 20-35 questions so be sure to pace yourself.
You will need a quiet area with computer access for the exam as you will need to finish the assessment once you start it.
Good luck!