Topic 7 Reproductive Conditions Flashcards
Topic 7
Describe the process of spermatogenesis
Spermatagonia (germ cells)
Mitosis to form primary spermatocytes
1st Meioisis to form secondary spermatocyte
2nd Meiosis to form spermatids
Mature to form spermatozoa (sperm) in 64 days
Head: genetic material
Midpiece: mitochondria
Tail: locomotion
Role of Testosterone
Powerful hormone causing major changes it the male body
Essential for spermatogenesis, changes in puberty and maintenance of function and size of reproductive organs.
Major function is to drive anabolism: increased muscle and bone growth
Role of Dihydrotestosterone
Converted from testosterone by 5-alpha-reductase.
More potent than testosterone.
Major function in the prostate, skin and hair. Responsible for differentiation of male tissues, essential for the prostate and other male reproductive functions.
Excess amounts can promote the growth of unwanted body hair
What is phimosis
Tightening of the foreskin preventing retraction
Foreskin that has retracted back over the glans of the penis and cannot be returned to the normal position having a tourniquet effect
Normal in young boys up to 3, may need circumcision
What is cryptorchism
Undescended testes
Testes may be retracted but not undescended as cremaster muscle is powerful and can pull the testes up into the groin and perineum.
Dx of cryptorchism
Physical examination and ultrasound
Tx of cryptorchism
Orchidoplexy or surgical release between 1 – 2 yrs age
Regular examinations for testicular cancer
Risks of cryptorchism
Fertility issues
Testicular cancer
Torsion
What is testicular torsion
Twisting of the spermatic cord that suspends the testis
Surgical emergency due to ischaemia of the testes
CM of testicular torsion
Severe distress
Nausea
Vomiting
Severe swelling
Tx of testicular torsion
Surgical release < 6hrs only treatment
What is Benign Prostatic Hyperplasia
Age associated benign prostate gland enlargement which can disrupt urinary flow
CM of benign prostatic hyperplasia
Backflow of urine into kidneys Post renal failure Alterations to urinary flow Nocturia Frequency Hesitancy Overflow incontinence Poor stream
Dx of benign prostatic hyperplasia
Digital rectal examination
- (normal prostate feels like smooth and soft donut, BPH smooth and symmetrical but firmer like bagel)
Prostate specific antigen
- non specific, only determines if cellular changes are present
Tx of benign prostatic hyperplasia
Surgical - trans urethral resection of prostate
Pharmacological management - alpha blockers as prostate has lots of alpha receptors
Positive effects of oestrogen
Bone mass - block bone resorption (only pre menopause)
Cholesterol - reduces LDL and increases HDL due to actions in liver (reduce incidence of MI premenopausal)
Blood coagulation - suppress and promote blood coagulation. Increases coagulation factors but encourage breakdown of fibrin
Adverse effects of oestrogen
Endometrial hyperplasia and carcinoma - oestrogen causes proliferation and hyperplasia.
Promotes growth of existing breast cancer and ovarian cancer - postmenopausal hormone therapy increases breast cancer risk
Cardiovascular events - oestrogen increases risk of DVT, stroke, coronary heart disease and MI (60+)
Nausea - response to oetrogens, diminishes with continued use
What is progestin
Compounds that act like progesterone prior to gestation to prepare the uterus for implantation and help maintain the uterus during pregnancy.
Adverse effects of progestin
Teratogenic effects - high dose therapy during first four months is associated with birth defects
Gynecologic effects - birth control, leads to decreased cervical mucous, involution of endometrial layer, spotting, breakthrough bleeding and irregular menses
Increased risk of breast cancer
Depression
Breast tenderness
Bloating
What is menopause
Cessation of menstrual cycle
Ovarian follicles and oestrogen decline as women grow older, ceasing several years after menstruation has ceased
When does menopause occur
Between 48 and 55 years
CM of menopause
Menstrual cycle becomes irregular, eventually cease Vasomotor instability (hot flushes) Sleep disturbances Urogenital atrophy (dry, itchy, burning) Osteoporosis (bone loss) Altered lipid metabolism ↓Body hair and skin elasticity ↓Breast tissue
Tx of menopause
Physiologic doses of oestrogen taken to manage symptoms caused by loss of oestrogen with menopause.
Hormone replacement therapy.
What is endometriosis
Presence of functional endometrial tissue outside the uterus.
CM of endometriosis
Infertility Pain Dysmenorrhoea Dyschezia Dyspareunia Constipation Abnormal vaginal bleeding Dyspareunuia – painful intercourse
Tx of endometriosis
Suppressing ovulation with medication
- NSAIDS
- combination OCPs
- medroxyprogesterone
- GnRH analogues
Laparoscopic ablation of endometriosis to treat pain and infertility
Surgery using laser cautery but 40% recurrence within 5 y
Dx of endometriosis
Difficult as may be dysmenorrhoea
History
Laparoscopic exam
What is PID
Pelvic imflammatory disease
Acute inflammatory disease caused by infection
Types of PID
Salpingitis: inflammation of the uterine tubes
Oophoritis: inflammation of the ovaries
Aetiology of PID
Sexually transmitted diseases migrate from vagina to upper genital tract (mostly initiated by gonorrhoea or chlamydia which induce necrosis with repeated infections)
CM of PID
Asymptomatic Severe abdominal pain - worse on walking, jumping or intercourse Dysuria Painful cervix Increased WBC Positive C reactive protein Infertility
Tx of PID
Requires aggressive treatment Hospitalisation IV ABs Avoid intercourse Treat peritonitis or tubo-ovarian abscess Treat partner with antibiotics Remove IUD
Risks of PID
16 -24 yr age group
Multiple partners
IUD
How does hormonal contraception work
Feedback to hypothalamus and pituitary to suppress LH and FSH inhibiting ovulation - low oestrogen stimulates corpus luteum to secrete oestrogen and progesterone.
Adverse effects of hormonal contraception
GIT upset Decrease ovary size Ovary unresponsive to LH and FSH Exacerbate menopausal symptoms Menorrhagia Thrombotic issues CVD Infertility Breast cancer Cervical cancer x2.5
Positive effects of hormonal contraception
Protection from ovarian and cervical cancer
Treat fibroids and ovarian cysts
Types of combination hormonal contraception
Monophasic (21 tablets followed by 7 tablets placebo)
Biphasic (10/11 tabs followed by 7 placebo)
Triphasic (7/9/5 tablets)
Quadriphasic
How do combined contraception pills work
Pills contain oestrogen and progesterone. They are taken for 21 days, FSH and LH suppressed, follicle doesn’t develop, endometrium develops and maintained by steroids in pill. Placebo for 7 days causing endometrium to break down
How do progesterone contraception pills work
Inhibits ovulation, inhibits development of endometrium, causes thickening of cervical mucous making it impenetrable (lasts 22-26 hours), must be taken at the same time every day
How do IUDs work
Reliable, reversible birth control. Remain in place for 5 to 10 years. Produce a harmless local inflammatory response that is spermicidal. Copper inhibits implantation. Levonorgestrel causes endometrial involution and thickening of the cervical mucous.
How do spermicides work
Chemical surfactants that kill sperm by destroying their cell membrane. Available in foam, gel, jelly, suppository, vaginal film and sponge. Moderately effective when used alone, increases efficacy when combined with a diaphragm or condom
How does post coital contraception work
Given up to 120 hours post sex
Causes as lack of hormonal synchronisation - fertilised egg cannot implant
Progesterone only preparations
Morning After Pill
Combined pill (prevent pregnancy or cause abortion)
STI Still to do
Still to do
