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Disorders of the Female and Male Reproductive Tract - PCOS is manifested by an ovulation, hirsutism,

infertility, dyslipidemia, and either abnormal


uterine bleeding or amenorrhea.
Disorders of the Female Reproductive Tract
DISORDERS OF THE UTERUS, FALLOPIAN TUBES, &
OVERVIEW OF FEMALE REPRODUCTIVE TRACT VAGINA
DISORDERS
- Because normal menstrual bleeding is most
- Many female reproductive disorders can be directly a function of the growth state of the
traced to a particular level of the uterine endometrium, disorders of the uterus,
neuroendocrine feedback axis and thus can be including hormonal dysfunction, myomas
categorized as resulting from central (pituitary, (fibroids, benign tumors of the underlying
hypothalamus, or other brain centers which myometrium), and cancer of the endometrium
influence the hypothalamus), ovarian or end- itself, often present with abnormal vaginal
organ (target tissue, eg. uterine) dysfunction. bleeding.

DISORDERS OF CENTRAL HYPOTHALAMIC PITUITARY - Pelvic infections can produce adhesions and
FUNCTION scarring of the endometrium or fallopian tubes
- Any change in the precise rate or amplitude of that may result in infertility.
GnRH secretion by the hypothalamus can result
in altered pituitary responsiveness (eg, down - The initial presentation typically includes
regulation of GnRH receptors or altered abdominal and pelvic (cervical and adnexal)
gonadotropin secretion). pain and with fever, an elevated white blood
cell count, or a positive endocervical culture.
- This altered pituitary function, in turn, results in Common infectious agents include gonorrhea,
disordered ovarian function (eg, inadequate anaerobic bacteria, and Chlamydia.
steroidogenesis with or without an ovulation)
and altered target tissue response (eg, - Multiple organisms are usually involved,
endometrial atrophy and menstrual
abnormalities). - Pelvic infections can develop into tubo-ovarian
abscesses requiring surgical drainage.
- Many central (eg. psychic stress) and peripheral
(eg. body fat content) inputs affecting pulsatile DISORDERS OF PREGNANCY
GnRH release are integrated in the
hypothalamus. - The normal events of pregnancy potentially set
the stage for a wide array of localized and
- Thus, altered GnRH release from the systemic disorders.
hypothalamus is a common cause of - Abnormalities in the process of implantation,
amenorrhea (eg. in athletic young women). for example, appear to predispose to recurrent
miscarriage and preeclampsia-eclampsia.
DISORDERS OF THE OVARY - In addition, genetic predisposition to diseases
- Proper ovarian function involves responsiveness that might otherwise remain latent for decades
to gonadotropins, intrinsic viability of follicles, may be manifested first—often transiently—
and a host of paracrine interactions within and during pregnancy.
between individual follicles. - A good example of the latter is the genetic
- Polycystic ovary syndrome (PCOS) is an example predisposition to development of diabetes
of ovarian dysfunction resulting from a self- mellitus
perpetuating cycle of altered feedback
relationships (see later discussion).
Disorders of the MaleReproductive Tract - However, aging and hormonal factors are both
clearly important. Age-related increases in
prostate size are evident at autopsy, and the
MALE INFERTILITY development of symptoms is age-related.
- Data from autopsy studies show pathologic
evidence of benign prostatic hyperplasia in less
than 10% of men in their 30s, in 40% of men in
their 50s, in more than 70% of men in their
60s,and in almost 90% of men in their 80s.
- Clinical symptoms of bladder outlet obstruction
are seldom found in men younger than 40 years
but are found in about one-third of men older
than 65 years and in up to three-fourths of men
at age 80 years.Prostatic androgen levels,
particularly DHT levels, play an important role in
development of the disorder.

Pathology

- The normal prostate is composed of both


stromal (smooth muscle) and epithelial
(glandular) elements.
- Growth of each of these elements—alone or in
combination—can result in hyperplastic nodules
and ultimately the symptoms of benign
prostatic hyperplasia.
- Pathologically, the hyperplastic gland is
enlarged, with a firm, rubbery consistency.
Although small nodules are often present
throughout the gland, benign prostatic
hyperplasia arises most commonly in the peri-
BENIGN PROSTATIC HYPERPLASIA
urethral and transition zones.
- Benign prostatic hyperplasia is nonmalignant
growth of the prostate stroma and epithelial
glands that causes enlargement of the prostate
gland. Growing slowly over decades, the gland
can eventually reach up to 10 times the normal
adult prostatesize in severe cases.
- Benign prostatic hyperplasia is a common age-
related disorder.
- Most men are asymptomatic, but clinical
symptoms and signs occur in up to one-third of
men older than 65 years, and each year more
than 500,000 men in the United States undergo
TURP.

Etiology

- The cause of benign prostatic hyperplasia is


unknown.

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