WEEK 8: Reproductive Health Male Flashcards
Reproductive Health: Male
What does the scrotum hold?
testicles (testes), nerves and blood vessels.
T or F
The scrotum is a tight sack of skin
F
It is loose and pouch like
What does the scrotum do?
protects testes and regulates temperature
T or F
Sperm development requires testes at a warmer temperature.
F
cooler
T or F
Muscles in wall of scrotum allow contraction (tighten) and relaxation, moving testicles closer to body for warmth and protection, or farther away to cool.
T
Testicles are secured at either end via the … cord
spermatic
The spermatic cord is responsible for the production of what?
testosterone and sperm
What is spermatogenesis?
The production of sperm cells
Within the testes are coiled masses of tubes called…
seminiferous tubules
During sexual arousal, contractions of the … force sperm into the …
Epididymis
vas deferens
T or F
Sperm that emerge from testes are immature and incapable of fertilisation
T
Sperm must be matured in the epididymus
What part of the male reproductive system brings sperm to maturity?
The epididymis
What am I?
I am a long, coiled tube at the back of each testicle which carries and stores sperm cells created in testes.
Epididymus
What am I called?
sac-like pouches that attach to vas deferens near base of bladder.
Seminal vesicles
The seminal vesicles make a fluid full of … that provides sperm with a source of energy and helps the sperms’ motility.
fructose
What is the purpose of the fluid produced by the seminal vesicles?
provides sperm with a source of energy and helps the sperms’ motility.
T or F
Seminal fluid makes up most of the volume of ejaculatory fluid.
T
T or F
The prostate is located above the bladder
F
Below the bladder
A healthy prostate is the size of a…
walnut
T or F
The prostate is located in front on the rectum.
T
T or F
The prostate gland contributes additional fluid to the ejaculate
T
What is the purpose of the fluid produced by the prostate gland?
It nourishes sperm.
The urethra, which carries ejaculate to be expelled during orgasm, runs through centre of the … gland.
prostate
What part of the male reproductive system carries ejaculate to be expelled during orgasm?
The urethra
What am I?
I am a long, muscular tube that travels from epididymis into pelvic cavity, to just behind bladder
The vas deferens
What does the vas deferens do?
The vas deferens transports mature sperm to the urethra in preparation for ejaculation.
The vas deferens travels from the … to the …
epididymis to the pelvic cavity (just behind the bladder)
T or F
The glans penis contains many sensitive nerve endings.
T
What am I called?
I am the tube that transports both semen and urine out of the body
The urethra
T or F
Both semen and a little urine are ejaculated during a male orgasm
F
When the penis is erect, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm.
The entire male reproductive system is regulated by key hormones via the ….. Axis
Hypothalamic-Pituitary-Gonadal
Name the 3 major male reproductive hormones
follicle-stimulating hormone (FSH)
luteinising hormone (LH), and
testosterone
What 2 hormones stimulate spermatogenesis?
Testosterone and FSH
What hormone stimulates testosterone secretion?
LH
Inhibin decreases the release of which hormone?
FSH
Testosterone decreases the release of … and …
GnRH and LH
T or F
Testosterone is necessary to continue the process of spermatogenesis
T
What can cause erectile dysfunction?
It can be caused by general ageing, medical conditions such as diabetes, use of some drugs or lifelong chronic smoking.
What is erectile dysfunction (ED)?
Erectile dysfunction is defined as a medical condition that prevents a man from achieving an erection or maintaining one throughout sexual intercourse.
1 in … men over the age of 40 experience ED
5
…% of men older than 70 years experience ED
50%
What part of the penis fills with blood during an erection?
The corpus cavernosum
T or F
The tunica albuginea contains smooth muscle.
F
The tunica albuginea contains fibrous tissue.
What am I?
I am made of fibrous tissue and I surround the corpus cavernosum and corpus spongiosum.
The tunica albuginea.
T or F
When the penis is in a flaccid state bidirectional blood flow remains unhindered.
T
When a penis is in the normal flaccid state the ….. system keeps smooth muscle in the corpus cavernosum and blood vessels (arterioles) contracted.
sympathetic nervous
What causes an erection?
Sexual stimulation results in the release of neurotransmitters from the cavernous nerve terminals. The smooth muscle relaxes which allow more blood flow in. The veins are compressed so blood is unable to escape and an erection results.
(SNCSVB)
Why is an erect penis hard?
When a penis is erect a massive increase in blood flow is trapped within the inelastic layers of the tunica albuginea which causes rigidity.
What types of stimulation can trigger the erection pathway?
Direct (touch), visual and auditory stimulation.
What does NANC stand for in the phrase “NANC nerves”?
Non-adrenergic non-cholinergic nerves
Central stimulation coming from the brain activates … nerves in the penis.
Non-adrenergic non-cholinergic nerves (NANC)
What is released from NANC nerve terminals when NANC nerves are activated?
Nitric oxide
What is stimulated when nitric oxide is released from NANC nerve terminals?
guanylate cyclase in the smooth muscle cells of the corpus cavernosa.
Guanylate cyclase activation leads to the synthesis of …
cGMP
What happens to the penis when cGMP is synthesized?
There is a decrease in intracellular Ca+2 concentrations and smooth muscle relaxation which dilates blood vessels, allowing more blood flow in.
Other than the stimulation of NANC nerves, what else in the penis can release nitric oxide?
Activation of cholinergic nerves can also cause endothelial cells to release nitric oxide.
T or F
Cholinergic nerves are responsible for the maintenance of the flaccid state of a penis.
F
Andronergic nerves are responsible.
How do adrenergic nerves maintain the flaccid state of a penis?
by releasing noradrenaline that causes smooth muscle contraction.
Other than the synthesis of cGMP what else can cause a decrease in intracellular Ca+2 in the penis?
When prostaglandin E receptors in the corpus cavernosum smooth muscle cells are activated they activate adenylate cyclase which decreases intracellular Ca+2.
The development of an erection is a complex event involving the integration of what anatomic systems?
psychologic, neurologic, endocrine, vascular, and local
What are the 4 organic classifications of ED?
Vasculogenic
Neurogenic
Anatomic
Endocrinologic
What are the three subtypes of vasculogenic ED?
Arteriogenic
Cavernosal
Mixed
What are the 2 classifications of psychogenic ED?
Generalised
Situational
What are the 2 subtypes of Generalised ED?
Generalised unresponsiveness
Generalised inhibition
What are the 3 subtypes of situational ED?
Partner related
Performance related
Psychological distress or adjustment related
The corpora cavernosa and the corpora spongiosum are collectively referred to as…?
The corpora
What are the causes primary ED?
The maldevelopment of the corpora or the blood and nerve supply.
Endocrine abnormalities (particularly low testosterone lvls).
Psychological, this can be anxiety or trauma related (pedophilia)
What are the causes of secondary ED?
Exogenous causes, including iatrogenic causes such as medication side-effects, toxins, or medical injury (e.g., post-surgical damage).
What are some underpinning pathophysiological causes of vasculogenic ED?
Endothelial dysfunction perhaps caused by chronic inflammation associated with metabolic syndrome
T or F
ED may be another manifestation of vascular disease.
T
ED and cardiovascular disease share the same risk factors such as …
hypertension, T2DM, hyperlipidaemia and smoking.
T or F
Hypergonadism is overrepresented among men with ED.
F
Hypogonadism
T or F
Whether primary or secondary, low hormones are thought to impact erectile function.
T
T or F
Hormone deficiency is frequently the cause of ED rather than diabetes or vascular disease.
F
Hormone deficiency is less frequently the cause of ED in comparison to diabetes or vascular disease.
Why might obesity, diabetes, and opioid use increase a male patient’s likelihood of developing ED?
Obesity, diabetes, and opioid use all diminish bioavailable testosterone.
T or F
Other hormones involved in testosterone metabolism or availability also may impact erectile quality
T
Presumably through regulating bioavailable testosterone.
The prevalence of ED is … times higher in diabetic men
3
T or F
There is a causal link between diabetes and ED.
T
…% of diabetic men aged 60 years have ED
55%
…% of diabetic men aged 30 have ED
15%
How might T2DM cause ED?
Through a number of pathophysiological changes affecting psychological function, central nervous system (CNS) function, androgen secretion, or peripheral nerve activity.
T or F
ED in diabetes is organically caused
F
it may also be psychogenic
What are some risk factors for ED?
Hypertension, sleep apnea, T2DM, smoking, alcohol, prostate surgery, pelvic trauma, hyperlipidemia, medications, depression, penile abnormalities, obesity, cardiovascular diseases, multiple sclerosis, spinal cord trauma, pelvic radiotherapy etc.
What types of medications can cause ED?
beta-blockers, psychiatric medications, Anti-hypertensive drugs, hormonal drugs, chemotherapy, recreational drugs, antihistamines among others
Key pharmacological treatments for erectile dysfunction target either the … pathway or the … pathway.
nitric oxide
prostaglandin
Drugs that act on the NO pathway are competitive reversible … inhibitors that slow the breakdown of cGMP, prolonging its action.
phosphodiesterase-5 (PDE-5)
What drug directly activates the prostaglandin pathway?
alprostadil (prostaglandin E1)
Contraindications to PDE5 inhibitors include…
The use of topical nitrates,
severe congestive cardiac failure, unstable angina (or angina with sexual intercourse), resting hypotension, recent stroke and
myocardial infarction.
The prostate is mainly composed of … and …. tissue.
glandular and smooth muscle
Fluid produced by the prostate contributes to …% of semen volume.
25%
What role does prostate fluid play in semen?
Prostate fluid contains citrate to feed sperm ATP production, and enzymes that keep semen liquefied.
Prostate anatomy is covered by what zones?
Central zone
Transition zone
Peripheral zone
BPH (more commonly referred to as enlarged prostate) is a common disorder that affects about …% of men aged over 50, and …% of men aged over 80.
50%
90%
The enlargement of the prostate is caused by what?
caused by inflammation and nodular prostatic remodelling
Where does enlargement of the prostate begin in patients that are developing/have BPH?
begins in the transition zone that immediately surrounds the urethra as it exits the bladder.
T or F
BPH is typically asymptomatic in the early stages
T
A healthy prostate is typically …cm^3 in size
20
In patients with BPH, once the prostate reaches approx. …cm^3, it begins pushing on the bladder and rectum, thereby constricting the urethra, leading to symptoms
30cm^3
What are the symptoms of BPH?
Difficulty urinating, or slow urine flow (due to constriction of the urethra)
Incontinence (as a result of the prostate pushing on the bladder)
Constant feeling of having to urinate
Abdominal pain
Prostate growth is stimulated by …
5α-dihydrotestosterone (DHT)
What is 5α-dihydrotestosterone (DHT) and how does it affect men in early and later life stages?
5α-dihydrotestosterone (DHT) a potent product of testosterone metabolism by the enzyme 5α-reductase (5AR). 5AR and DHT are important in prostate development, growth and differentiation in early life, but can cause BPH (and also male pattern baldness) in later life.
T or F
A pregnant female will have 3-4 times more testosterone than a healthy, non-pregnant female
T
T or F
Testosterone is the main sex hormone produced by males and is important in the development of the testicles, penis, and male characteristics
T
T or F
Males and females both produce testosterone
T
T or F
Males produce far more testosterone than females
T
T or F
In males, testosterone regulates sex drive and helps the testes make sperm
T
T or F
In females, testosterone is mainly converted to a form of oestrogen
T
Testosterone levels are usually highest between the ages of … and …, gradually decline after
20 and 30
Complementary medicines for womens reproductive health can be grouped into three areas
Menstrual cycle
Fertility
Menopause
T or F
No complementary medicines are as effective as oestrogen therapy for menopausal symptoms.
T
What are some common complementary medicines for female fertility? (irrespective of their effectiveness)
Vitex/chaste tree and ashwaganda
What are some common complementary medicines for male fertility? (irrespective of their effectiveness)
Carnitine, fenugreek and tribulus
What are some common complementary medicines for menopause? (irrespective of their effectiveness)
black cohosh, phytoestrogens (e.g. red clover) and sage
What is the largest human cell?
The female egg
What is the smallest human cell?
The male sperm
How long does it take for the male body to create sperm?
2-3 months
What illnesses or health problems might be MORE COMMON during pregnancy? (Think about what happens both PHYSICALLY and PHYSIOLOGICALLY during pregnancy)
Hormonal changes can cause nausea and vomiting, mood changes, headaches, metabolic changes. Physically, the growing belly can place pressure on the gastrointestinal tract and urinary tract, leading to gastroesophageal reflux, nausea, constipation, incontinence. In later stages of pregnancy, the combination of hormonal changes and added weight can cause peripheral oedema. There are a lot of health issues that may arise throughout pregnancy.
In which week of pregnancy (counting from fertilisation not last period) does vascular connection form between mother and foetus?
week 2
What is a teratogen?
an agent or factor which causes malformation of an embryo.
To be a proven teratogen a drug must…
produce deformities in more than 2-3% of pregnancies
Produce a consistent pattern of deformities
Regarding the TGA’s system for categorising drugs in pregnancy (A, B1, B2, B3, C, D and X), which category/categories would teratogens be found in?
Category X
What are the essential micronutrients where supplementation may be necessary during pregnancy?
Folic acid, iodine, vitamin D, iron
T or F
There is no evidence to support antiemetics being teratogenic
T
Why are NSAIDs not appropriate during pregnancy? (except for 100mg/day aspirin)
In the 3rd trimester NSAIDs can decrease the amount of fluid surrounding the baby and prematurely close/ constrict the ductus arteriosus. It can also cause bleeding in both the mother and baby
Are nicotine patches safe to use when breastfeeding?
Nicotine patches pass nicotine into breastmilk but at lower levels than smoking will. Breastfeeding patients are safer to use in pregnancy than smoking nicotine if nicotine use cannot be stopped altogether.
T or F
Nicotine can be found in breast milk if the mother inhales secondhand smoke.
T
T or F
All drugs pass into the breastmilk to some extent
T
