Sexuality And Sexual Health Flashcards
Female sex steroid hormones
Estrogens
Progestins
Pituitary gonadotropin hormones
Follicle stimulating hormone
Luteinizing hormone
Female sex steroid hormones and pituitary gonadotropin hormones promote
Development of primary and secondary sex characteristics
Start of menses and regulation of the menstrual cycle
Three major endogenous estrogens
Estradiol
Estrone
Estriol
Estrogens are responsible for
Development and maintenance of the female reproductive system
Development of female secondary sex characteristics
Shaping of body contours and development of the skeleton
Pharmacotherapy for estrogens (10)
Conjugated estrogens (Premarin) Esterified estrogens (Estragyn) Estradiol transdermal (Climara, Divigel) Estradiol vaginal ring (Estring) Estradiol valerate Estrone (Folliculum) Estropipate (Ogen) Ethinyl estradiol (Alesse) Estradiol, vaginal dose forms (Vagifem, Estring) Estrone (Vaginal cream)
Pharmacotherapy for Progestins
Levonorgestrel (Mon-Ovral) Medroxyprogesterone (Provera, Depo-Provera) Megestrol (Megace) Norethindrone (norlutate) Progesterone (Prometrium) Steroidal Nonsteroidal
Estrogen deficiency disorders that can be fixed with pharmacological estrogen
Atrophic vaginitis
Hypogonadism
Uterine bleeding
Vasomotor spasm of menopause “hot flashes”
Osteoporosis
Breast or prostrate cancer
Ovarian failure or castration (removal of ovaries)
Cross-gender hormone treatment for trans people
Severe acne
Contraindications of estrogen pharmacotherapy
Drug allergy Estrogen dependent cancer Undiagnosed abnormal vaginal bleeding Pregnancy Active thromboembolic disorder/history
Interactions of pharmacotherapy estrogens
Oral anticoagulants (estrogens decrease their activity) Rifampin (estrogens decrease it effect) St. John’s wort Tricyclic antidepressants Smoking
Adverse effects of estrogen pharmacotherapy
Thrombolytic events Nausea Hypertension Thrombophlebitis Edema Vomiting, diarrhea, constipation, abdominal pain Photosensitivity, chloasma Amenorrhea, breakthrough uterine bleeding Tender breasts, fluid retention Carbohydrate tolerance, headache
Progestins are used to treat
Functional uterine bleeding caused by hormonal imbalance, fibroids, uterine cancer
Primary and secondary amenorrhea
Adjunctive and palliative treatment of some cancer and endometriosis
Prevent contraception
Prevent potential miscarriage
Alleviate premenstrual syndrome symptoms
Liver dysfunction
Thrombophlebitis and thromboembolic disorders
Nausea/vomiting
Amenorrhea
Edema
Medroxyprogesterone
Provera, Depo-Provera
Inhibits secretion of pituitary gonadotropins
Prevents follicular maturation and ovulation
Stimulates growth of mammary tissues
Antineoplastic actions against endometrial cancer
Medroxyprogesterone used to treat
Uterine bleeding
Secondary amenorrhea
Endometrial cancer
Contraception
Nursing conditions for estrogens and Progestins doses
Give smallest does possible
Intramuscular injections into large muscles sites, rotate sites
Oral doses with meals to reduce GI problems
Educate on self admin and what to do if missed dose
Polycystic ovary syndrome
Few or anovulatory menstrual cycles
Elevated levels of androgens
Polycystic ovaries
Genetic predisposition and obesity
Endometriosis
Functioning endometrial tissue or implantation outside of the uterus
Possible causes of endometriosis
Coelomic metaplasia Retrograde menstruation Embryonic cell rest Latrogenic mechanical transplantation Lymphatic and vascular dissemination Genetic predisposition
Three forms of oral contraceptives
Monophasic, biphasic, triphasic
Forms of contraception
Oral, injection, transdermal patch, vaginal ring
Contraceptives mechanism of action
Prevent ovulation by inhibiting the release of gonadotropins and increasing uterine mucous viscosity
Cervical cancer is almost always associated with
HPV infection
HPV causes
High grade dysplasia and cancer
Cervical intraepithelial neoplasia and cervical carcinoma in situ
Risk factors for cervical cancer
Multiple sexual partners Young age at first sexual intercourse High parity Immunosuppression Oral contraceptives Use of nicotine
Vaginal cancer
Rare
Usually squamous cell carcinoma
Vulvar cancer
Usually squamous cell carcinoma
Associated with HPV, increasing age, previous cancer, autoimmune conditions, immunosuppression
Endometrial cancer
Most common uterine cancer and gynaecological malignancy
Primary risk factor for endometrial cancer
Unopposed estrogen exposure
Leads to endometrial hyperplasia
Endometrial cancer is associated wigh
Type 2 diabetes
Endometrial cancer usually occurs in — women
Post menopausal
Three types of ovarian cells
Germ cells
Endocrine and interstitial hormone producing cells
Epithelial cells
Benign and malignant tumours come from each of the three types of cells
Benign breast disease
Non cancerous changes in the breast
Common symptoms of benign breast disease
Pain, palpable mass, nipple discharge
Broad classifications of benign breast disease
Nonproliferative breast lesions
Proliferative breast disease without atypia
Atypical (atypia) hyperplasia
Non proliferative breast lesions
Simple breast cysts
Papillary apocrine change
Mild hyperplasia of the usual type
Simple breast cyst
Fluid filled sacs
Often rupture and release secretory material into tissues
Results in chronic inflammation and scarring
Papillary apocrine change
Increase in ductal epithelial cells that has apocrine changes or an eosinophilic cytoplasm
Mild hyperplasia of the usual type
Increase in the number of epithelial cells within a duct that is more than two but less than four cells in depth
Proliferative breast lesions without atypia
Proliferation of ductal epithelium or stroma without cellular signs of abnormality
PBLW/OA
usual ductal hyperplasia
Additional or proliferating epithelial cells that fill and distend the ducts and lobules
PBLW/A
Intraductal papillomas
Solitary papillomas
Diffuse papillomas
Can harbour areas of atypia requiring surgical excision
PBLW/A
Sclerosing adenosis
Lobular lesion with increased fibrous tissue and scattered glandular cells
PBLW/A
Radial scar
Irregular, radial proliferation of duct like small tubules entrapped in a dense central fibrosis
PBLW/A
Simple fibroademonas
Benign solid tumours that contain glandular and fibrous lesions
Proliferative breast lesions with atypia
Atypical hyperplasia
Increase in the number of cells or proliferation and the cells have some variance in structure
Proliferative breast lesions with atypia
Atypical ductal hyperplasia
Abnormal proliferating cells in breast ducts
Proliferative breast lesions with atypia
Atypical lobar hyperplasia
Proliferation of cells in the lumen of lobular units
Proliferative breast lesions with atypia is associated with
Increased risk of breast cancer
The younger the woman the higher the risk of developing breast cancer
Breast cancer risk is related to
Timing, duration, pattern of exposure
Terminal duct lobular units
Predominant source of breast cancer
Lobular involution
Postlactational involution
Lobular involution associated with
Reduced risk of breast cancer
Postlactational involution
Mammary gland regresses and remodels to it prepregnant State
Six factors that affect the risk of breast cancer
Protective effect of an early (20’s) first pregnancy
Protective effect of removal of the ovaries and pituitary gland
Increased risk associated with early menarche, late menopause, and nulliparity
Relationship between types of fate, free estrogen levels, oxidative changes in estrogen metabolism
Hormone dependent development and differentiation of mammary gland structures
Efficacy of anti hormone therapies for treatment and prevention of breast cancer
Insulin and insulin like growth factors
IGF’s regulate cellular functions involving cell proliferation, migratory, differentiation and apoptosis
Insulin therapy and sulfonylurea were found to be mildly associated with breast cancer risk
Prolactin and growth hormone
GH induces the production of IGF’s in the liver
IGF signalling is important for breast development and is implicated in breast cancer
Oral contraceptives
Combined estrogen and progesterone oral contraceptives increase the risk for breast, cervix amd live cancers
Mammographic breast density
Radiological appearance of the breast, reflecting variations in breast composition
Radiation
Ionizing radiation is a know mutagen and carcinogen for breast cancer
BRCA 1 gene
Breast cancer 1 gene
Located on chromosome 17
Tumour-suppressor gene
Carriers are at higher risk for breast and ovarian cancer
BRCA2
Breast cancer 2 gene
Located on chromosome 13
More likely in men who develop breast cancer
Pathogenesis of breast cancer
Ductal/lobular epithelium
Proliferation of epithelial cells that is confined to the ducts and lobules
Pathogenesis of breast cancer
Infiltrating ductal type
Invasive
Tumour stays small but metastasize early
70-80% of breast cancers
Pathogenesis of breast cancer
Heterogeneous
Diverse molecular, biological, phenotypical, and pathological changes
Ductal carcinoma in situ
Limited to breast ducts and lobules without invasion of the basement membrane
Does not progress from low grade to higher grades
Lobular carcinoma in situ
Originates from the terminal duct lobular unit
Cells grow non cohesively due to loss of the tumour suppressive adhesion protein E-cadherin
Manifestations of breast cancer
Painless lump Palpable nodes in axilla Dimpling of skin Edema Bone pain
Treatment of breast cancer is based on
The stage of the cancer
Breast cancer treatment
Surgery Radiation Chemo Hormone therapy Biological therapy
What reduces the risk of penile cancer
Circumcision at birth
Penile cancer is most commonly caused by what kind of cells
Squamous cell carcinoma
Penile cancer may be the site of
Metastatic spread of solid tumours from the bladder, prostate, rectum or kidney
Penile cancer is primarily managed with
Surgery
Cancer of the testis usually caused by
Germ cell tumours: Seminomas Embryonal carcinomas Tertomas Choriosarcomas
Cancer of the testis is treated with
Surgery
Chemotherapy
Radiation
Epididymitis
Inflammation of the epididymitis
Epididymitis is usually caused by
Sexually transmitted micro-organisms:
Neisseria gonorrhoea
Chlamydia trachomatis
How do sexually transmitted micro organisms reach the epididymitis
By ascending the vasa deferentia from an already infected urethra or bladder
Main syotoms of epididymitis
Scrotal or inguinal pain
