Repro Flashcards
What are the internal and external genitalia in females?
Internal - ovaries, uterine tubes, uterus, vagina
External - labia majora, labia minora, clitoris
What are the internal and external genitalia in males?
Internal - testis, epididymis, ductus deferens, seminal glands, ejaculatory duct, prostate, bulbourethral glands
External - glans penis, shaft of penis, scrotum
What are the male secondary characteristics?
Increase in body size (compared to females) Body composition Fat distribution Hair/skin changes Facial hair and baldness Smell
What are the secondary sexual characteristics in females?
Less increase in body size compared to makes
Fat distribution
Hair/skin changes
Breasts
What are the gonads embryonic origins?
Intermediate mesoderm
Primordial germ cells from the yolk sac
What gene drives the development of testis?
SRY gene in Y chromosome
What are alternative names for mesonephric and para mesonephric ducts?
Wolffian duct
Müllerian duct
Explain how having XY chromosomes leads to the ducts preservation/regression
Testes secretes androgen which keeps mesonephric and Müllerian inhibiting substance which degenerates the paramesonephric
Explain how having XX chromosomes leads to duct preservation/regression
No androgen so mesonephric duct regresses and no Müllerian inhibiting substance so the Müllerian duct is maintained
What are the 3 components of the embryonic external genital? What happens to the in males and females?
Genital tubercle, folds and swelling
Tubercle and folds fuse in males due to androgens but remain open in females
Explain the development of oocytes before puberty
Germ cells become oogonia which proliferate and then enter meiosis. They become a primary oocyte which is surrounded by a single layer of granulosa cells and thus becoming a primordial follicle
What are the 3 stages in ovulation
0-12 days: preparation, follicular, proliferative phase
12-14 days: ovulation
14-28 days: waiting, luteal, secretory phase
What happens to the primordial follicle during menstruation?
Primordial follicle–>pre antral follicle–>secondary follicle–>pre ovulatory follicle–>corpus luteum–>death
What is the path sperm travels through?
Seminiferous tubules–>rete testis–>ducti efferentes–>epididymus–>vas deferens
Explain spermatogenesis
Germ cells–>spermatogonia (2n)–>two primary spermatocytes (2n) via mitosis. One acts as raw material and one progresses to become–>two secondary spermatocyte (n) via meiosis–>four spermatids (n) via meiosis–>spermatozoa via spermatogenesis (remodelling)
What makes up semen?
Sperm
Seminal vesicle secretion
Prostate secretion
Bulbourethral gland secretion
What are the feedback effects of: testosterone, oestrogen, progesterone and inhibin?
Testosterone - reduces GnRH, LH, FSH Low oestrogen - reduce GnRH, LH, FSH High oestrogen - increase LH, FSH and GnRH Progesterone - reduce GnRH, LH, FSH Inhibin - reduce FSH
Outline the hypothalamic pituitary gonadal axis
Hypothalamus releases GnRH which stimulates the pituitary to release LH (bind to leydig cells to release testosterone) and FSH (binds to Sertoli cells to release inhibin). Inhibin reduces FSH and testosterone negatively feedbacks to reduce FSH, LH and GnRH
What are some functions of oestrogen and progesterone?
Oestrogen - Fallopian tube function, thicken endometrium, thicken myometrium and increase its motility
Progesterone - thicken endometrium, thicken myometrium but reduce its motility
If there’s a successful pregnancy what maintains the corpus luteum?
Placenta releases HCG
What changes occur in girls during puberty and what is the usual age range?
Breast bud (thelarche) Pubic hair (adrenarche) Growth spurt Menstrual cycle (menarche) 8-13
What changes occur in boys during puberty and at what age?
Genital development Pubic hair Spermatogenesis Growth spurt 9-14
Why are men usually taller than women?
Their growth spurt is longer and faster. It ends when the epiphyseal plates fuse which happens earlier in girls due to oestrogen
What is the hormonal control for the following: adrenarche, thelarche, growth spurt and genital development.
Androgens
Oestrogen
GH and steroids
Testosterone
What is precocious puberty and some possible causes?
Puberty under 8 y/o
Pineal tumour, meningitis, hormone secreting tumours
Explain what occurs in pre-menopause
40 years
Shorter follicular phase causing lower oestrogen and higher LH and FSH. Fertility reduced
Explain menopause
Cessation of menstrual cycles 49-50
Lower oestrogen and higher LH and FSH
What changes may accompany menopause?
Hot flushes, regress/shrink endometrium/myometrium, thin cervix, lose vaginal rugae, involuted breast tissue, skin/bladder changes and reduced bone mass
Define amenorrhea
Absence of periods for 6+ months
Differ between primary and secondary amenorrhea
Primary - never had a period (by age 14 with no secondary sexual characteristics or 16 with them)
Secondary - established menstruation ceased for 3 months if regular or 6 if irregular
Define oligomenorrhoea, dysmenorrhea, menorrhagia and cryptomenorrhea
Infrequent
Painful
Heavy
Not visible due to obstruction
Differ between a ovulatory and ovulatory cycles
Anovulatory - no luteal phase, oligomenorrhoea and potentially heavy
Ovulatory - normal cycles with dysmenorrhea and mastalgia
Explain how hypothalamic/pituitary problems cause amenorrhe and give examples of primary and secondary types
Less FSH, less oestrogen so less lining
Kallmann syndrome
Exercise, stress, weight
Hypopituitarism
Explain how gonadal problems cause amenorrhea and give examples of primary and secondary types
Primary - dysgenesis and androgen insensitivity
Secondary - pregnancy, menopause, drug induced
What might cause outflow amenorrhea?
Müllerian agenesis
Vaginal atresia
Intra uterine adhesions
Explain dysfunctional uterine bleeding
No corpus luteum so no progesterone so oestrogen levels are higher and therefore the uterine lining is thicker
What is the difference between an STI and STD?
STI can be asymptomatic
Who is at risk of STIs?
Young people
Certain ethnicities
Low socio economic status
Behaviour - first intercourse, partners, orientation, unsafe
Why is incidence of STIs increasing?
Changing sexual/social behaviour
Better screening and diagnosis
Greater awareness
What is the burden of STIs?
Stigma, lead to PID, infertility, cancer, disseminate, transfer to foetus
In general how should STIs be managed?
Short course of antibiotics
Screen and treat for co infections
Contact tracing
Educate
Explain HPV and how it’s diagnosed/managed
Cutaneous, mucosal, painless anogenital warts
Increase risk of cervical cancer
Don’t treat unless prolonged (cyrotherapy/interferon)
Vaccine
What are the symptoms of chlamydia in a male and female?
Urethritis, epididymitis, prostatis, proctitis
Urethritis, cervicitis, salpingitis, peri hepatitis
Can affect eyes and neonates
How so chlamydia treated?
Doxycycline/azithromycin
What are the symptoms of herpes? How is it treated?
Painful genital ulceration, dysuria, inguinal lymphadenopathy, pyrexia
Aciclovir
How is gonorrhoea treated?
Ceftriaxone + testing and treatment for chlamydia (azithromycin)
What are the stages of syphilis?
1 - painless ulcer
2 - fever, rash, lesions, lymphadenopathy
Latent
3 - neuro/cardiovascular syphilis
Who is syphilis more common in, how is it diagnosed and how is it treated?
MSM
Serology/dark field microscopy
Penicillin
What symptoms does trichomonas vaginalis cause? How is it treated?
Thin, frothy, offensive discharge, irritation, dysuria, inflammation
Metronidazole
What is the cause of bacterial vaginosis? How is it diagnosed and treated?
Perturbed flora - gardnerella
Scanty, fishy discharge
pH>5, KOH whiff test, gram stain
Metronidazole
What is pelvic inflammatory disease?
Infection ascending from endocervix to uterus causing - endometritis, salpingitis, oophoritis, tubo-ovarian abscess
What are the features of PID?
Pyrexia, pain, discharge and bleeding
How is PID diagnosed and managed?
Triple swab - endocervix and high vagina
Analgesia
Antibiotics - ceftriaxone, doxycycline, metronidazole
What else could PID be mistaken for?
Ectopic pregnancy, endometriosis, ovarian cyst, irritable bowel syndrome, appendicitis and UTI
What is the blood supply to the ovaries and where do they come from/drain into?
Abdominal aorta–>ovarian artery
Right ovarian vein–>IVC
Left ovarian vein–>Left renal vein
What are the parts of the uterus?
Fundus
Body
Cervix
Uterine tubes
What are the uterus’ anterior and posterior pouches?
Anterior - uterovesical pouch
Posterior - recto uterine pouch (pouch of Douglas)
What are the main ligaments that support internal female genitalia?
Broad ligament - sheet if peritoneum supporting ovaries and uterus
Suspensory ligament of ovary
Round ligament - remnant of gubernaculum
How is the uterus normally positioned in regards to the vagina and cervix?
Vagina - anteVerted
Cervix - antefleXed
What are the main parts of the uterine tube?
Ostium, fimbriae, infundibulum, ampulla, isthmus
What are the main parts of the cervix?
Internal os
Endocervical canal
External os
What artery does the uterine and internal pudendal artery come off of?
Anterior division of internal iliac
Where does the ovary and uterus lymph drain to?
Ovary - para aortic nodes Uterus: Fundus - aortic nodes Body - external iliac nodes Cervix - external, internal iliac and sacral nodes
What is the nerve supply to the vagina?
Inferior 1/5 - pudendal
Superior 4/5 - uterovaginal plexus
What is contained within the scrotum?
Testis, epididymus and spermatic cord
Outline the anatomy of the testis
Tunica vaginalis
Tunica albuginea
Separated into lobules by fibrous septal
Outline the blood supply to the testis
Testicular arteries directly from abdominal aorta
Right testicular vein to IVC
Left testicular vein to left renal vein
What are the possible causes for scrotal swelling?
Hydrocoele - serous fluid in tunica vaginalis
Haematocoele - blood in tunica vaginalis
Varicocoele - pampiniform vein varicosities
Spermatocoele - cyst
Epididymitis
Testicular tortion
Indirect hernia
What are the contents of the spermatic cord?
Arteries - testicular, cremasteric, artery to vas Nerves - genitofemoral, 2x autonomic Pampiniform plexus Vas deferens Lymphatics
What are the coverings of the spermatic cord?
External spermatic fascia - external oblique
Cremasteric fascia - internal oblique/transversalis
Internal spermatic fascia - transversalis
What is the innervation to the scrotum?
Anteriorly - lumbar plexus
Posteroinferiorly - sacral plexus
Where do the lymphatics drain from the testis and the scrotum?
Testis-paraaortic nodes
Scrotum - superficial Inguinal nodes
What does the prostate interact with?
Base - neck of bladder
Anterior/apex - urethral sphincter
Posterior - rectum
What is BPH and what are the symptoms?
Benign prostate hyperplasia - obstruct internal urethral orifice
Dysuria, nocturia and urgency
What internal structures are found in the penis?
2x corpora cavernosa
1x corpus spongiosum
Internal pudendal artery
Bulbospongiosum - expel last urine and maintain erection
Ischiocavernosus - compress veins maintaining erection
What are the four parts of the male urethra?
Preprostatic
Prostatic
Membranous
Spongy
What are the functions of the pelvic floor?
Support pelvic organs
Continence
Child birth
Truncal stability
How can the pelvic floor be damaged and what may this cause?
Childbirth, age, menopause, obesity, chronic cough
Prolapse and incontinence
How is incontinence treated and what are some potential side effects?
Pelvic floor exercises
Surgery - vaginal tape
Voiding difficulties
How is prolapse treated and what are some potential side effects?
Remove organs, restore connective tissue support, maintain function
Recurrence, incontinence and dysparenunia
How long does sperm take to mature and how many are produced a second?
74 days
1000
What are the phases of coitus?
Excitement, plateau, orgasmic, resolution +- refractory
How does a male get an erection?
Stimulants - psychogenic or tactile
Efferents - pelvic nerve PNS, pudendal nerve somatic
Haemodynamic changes
What are the causes of erectile dysfunction?
Psychological Tear copra cavernosa Vascular Drugs Alcohol
What happens during ejaculation?
Contract glands and ducts and internal bladder sphincter
Rhythmic striatal contractions
What is abnormal sperm count?
30% abnormal morphology
Explain the contents of seminal vesicle, prostatic and bulbourethral secretions
Alkaline to neutralise acid. Fructose and clotting factors
Acidic and proteolytic
Lubricate
How does the cervical mucus differ during the menstrual cycle?
Progesterone and oestrogen - sticky plug at cervix
Oestrogen only - non viscous
When is the fertile period?
3 days prior and up to ovulation
How is an oocyte transported? How is polyspermy prevented?
Cilia and peristalsis
Cortical reaction
What are the types of contraception?
Natural - abstinence, rhythm, coitus interruptus
Prevent sperm entering ejaculate - vasectomy
Prevent sperm reaching cervix - condom, diaphragm, cap, spermicide
Prevent ovulation + sperm pass cervix-OCP, implant, progesterone only
Prevent Fallopian tube movement - hormones and clip/ligate
Prevent implantation - hormones, post coital and intrauterine device
What is primary and secondary infertility?
Never been pregnant
Been pregnant before
What are some reasons for infertility?
Anovulation
Tubal occlusion
Abnormal sperm
What does haemomonochorial mean?
The fetal and maternal blood is only separated by a single layer of trophoblast
What are the aims of implantation?
Establish unit of exchange
Anchor placenta
Establish maternal blood flow in placenta
What are the primary, secondary and tertiary villi?
Primary - trophoblast projection
Secondary - mesenchyme invasion of core
Tertiary - mesenchyme invasion by fetal vessels
What is decidualisation?
The endometrium resists the trophoblast invasive force
What is the difference between the placenta in the 1st trimester and the term?
Greater surface area, thin barrier with just one layer cytotrophoblast
What does the placenta synthesise?
Glycogen, cholesterol and fatty acids
What are the endocrine functions of the placenta?
Synthesise hCG, progesterone and oestrogen
What is transported to the foetus via simple diffusion, facilitated diffusion and active transport?
Water
Glucose
Amino acids
What maternal changes are there in the CVS?
Increase cardiac output, heart rate, stroke volume and blood volume
Decrease blood pressure until T3 and TPR
What are the differences between pre-eclampsia and normal pregnancy?
Eclampsia vasoconstrict and plasma contract as opposed to the opposite
What changes are there in the urinary system?
Increase GFR, clearance and protein excretion
Decrease urea, bicarbonate and creatinine
What changes are there in the respiratory system?
Decrease functional residual volume and PaCO2
Increase O2 consumption and tidal volume
What does the physiological hyperventilation in pregnancy cause?
Respiratory alkalosis leading then to more bicarbonate being produced
What metabolic changes accompany pregnancy?
Insulin resistance, gluconeogenesis, lipolysis causing more glucose available to the foetus
More T3/4
How does the GI system change in pregnancy?
Move appendix to RUQ
Delayed emptying and biliary stasis
How does the blood change in pregnancy?
Pro-thrombolytic state. Can’t give warfarin as teratogenic
Can get anaemia as more plasma but not more RBCs
Decrease immune function and can transfer antibodies to foetus such as Graves’ disease
What does haemomonochorial mean?
The fetal and maternal blood is only separated by a single layer of trophoblast
What are the aims of implantation?
Establish unit of exchange
Anchor placenta
Establish maternal blood flow in placenta
What are the primary, secondary and tertiary villi?
Primary - trophoblast projection
Secondary - mesenchyme invasion of core
Tertiary - mesenchyme invasion by fetal vessels
What is decidualisation?
The endometrium resists the trophoblast invasive force
What is the difference between the placenta in the 1st trimester and the term?
Greater surface area, thin barrier with just one layer cytotrophoblast
What does the placenta synthesise?
Glycogen, cholesterol and fatty acids
What are the endocrine functions of the placenta?
Synthesise hCG, progesterone and oestrogen
What is transported to the foetus via simple diffusion, facilitated diffusion and active transport?
Water
Glucose
Amino acids
What maternal changes are there in the CVS?
Increase cardiac output, heart rate, stroke volume and blood volume
Decrease blood pressure until T3 and TPR
What are the differences between pre-eclampsia and normal pregnancy?
Eclampsia vasoconstrict and plasma contract as opposed to the opposite
What changes are there in the urinary system?
Increase GFR, clearance and protein excretion
Decrease urea, bicarbonate and creatinine
What changes are there in the respiratory system?
Decrease functional residual volume and PaCO2
Increase O2 consumption and tidal volume
What does the physiological hyperventilation in pregnancy cause?
Respiratory alkalosis leading then to more bicarbonate being produced
What metabolic changes accompany pregnancy?
Insulin resistance, gluconeogenesis, lipolysis causing more glucose available to the foetus
More T3/4
How does the GI system change in pregnancy?
Move appendix to RUQ
Delayed emptying and biliary stasis
How does the blood change in pregnancy?
Pro-thrombolytic state. Can’t give warfarin as teratogenic
Can get anaemia as more plasma but not more RBCs
Decrease immune function and can transfer antibodies to foetus such as Graves’ disease
