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Alterations of the Reproductive Systems Chapter 23 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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Presentation on theme: "Alterations of the Reproductive Systems Chapter 23 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc."— Presentation transcript:

1 Alterations of the Reproductive Systems Chapter 23 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

2 2 Overview Delayed sexual development Delayed sexual development Suboptimal sexual performance Suboptimal sexual performance Structural and functional abnormalities Structural and functional abnormalities

3 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Alterations of Sexual Maturation Delayed puberty Delayed puberty Secondary sex characteristics have not appeared in girls by age 13 Secondary sex characteristics have not appeared in girls by age 13 Breast development age decreasing Breast development age decreasing Secondary sex characteristics have not appeared in boys by age 14 Secondary sex characteristics have not appeared in boys by age 14 95% of cases are physiologic (hormonal- or hypothalamic-pituitary-gonadal axis delay) 95% of cases are physiologic (hormonal- or hypothalamic-pituitary-gonadal axis delay) 5% are caused by some type of disruption of the hypothalamic-pituitary-gonadal axis 5% are caused by some type of disruption of the hypothalamic-pituitary-gonadal axis

4 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Alterations of Sexual Maturation Precocious puberty (rare) Precocious puberty (rare) Sexual maturation before age 6 in black girls and age 7 in white girls Sexual maturation before age 6 in black girls and age 7 in white girls Sexual maturation before age 9 in boys Sexual maturation before age 9 in boys Forms Forms Isosexual precocious puberty Isosexual precocious puberty Heterosexual precocious puberty Heterosexual precocious puberty Incomplete precocious puberty Incomplete precocious puberty

5 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Precocious Puberty Central (GnRH dependent) Central (GnRH dependent) Hypothalamic-pituitary-gonadal axis is working normally but prematurely Hypothalamic-pituitary-gonadal axis is working normally but prematurely Failure of central inhibition of the GnRH Failure of central inhibition of the GnRH Peripheral (GnRH independent) Peripheral (GnRH independent) Sex hormones produced by mechanism other than stimulation by the gonadotropins Sex hormones produced by mechanism other than stimulation by the gonadotropins

6 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Disorders of the Female Reproductive System Hormonal and menstrual alterations Hormonal and menstrual alterations Primary dysmenorrhea 50%–90% of young women Primary dysmenorrhea 50%–90% of young women Painful menstruation associated with prostaglandin release in ovulatory cycles Painful menstruation associated with prostaglandin release in ovulatory cycles Related to duration and amount of menstrual flow Related to duration and amount of menstrual flow Secondary dysmenorrhea Secondary dysmenorrhea Painful menstruation related to pelvic pathology Painful menstruation related to pelvic pathology Can occur at any time in the menstrual cycle Can occur at any time in the menstrual cycle

7 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Hormonal and Menstrual Alterations Primary amenorrhea Primary amenorrhea Failure of menarche and the absence of menstruation by age 14 years without the development of secondary sex characteristics or by age 16 years regardless of the presence of secondary sex characteristics Failure of menarche and the absence of menstruation by age 14 years without the development of secondary sex characteristics or by age 16 years regardless of the presence of secondary sex characteristics Secondary amenorrhea Secondary amenorrhea Absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated Absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated

8 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Hormonal and Menstrual Alterations Secondary amenorrhea Secondary amenorrhea Causes Causes Pregnancy Pregnancy Dramatic weight loss Dramatic weight loss Malnutrition or excessive exercise Malnutrition or excessive exercise Hypothyroidism Hypothyroidism Polycystic ovary syndrome Polycystic ovary syndrome Common during early adolescence, perimenopause, pregnancy, and lactation Common during early adolescence, perimenopause, pregnancy, and lactation Anovulation Anovulation Hyperprolactinemia Hyperprolactinemia Clinical manifestations Clinical manifestations Infertility, vasomotor flushes, vaginal atrophy, acne, osteopenia, hirsutism Infertility, vasomotor flushes, vaginal atrophy, acne, osteopenia, hirsutism

9 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Hormonal and Menstrual Alterations Abnormal uterine bleeding Abnormal uterine bleeding Menstrual irregularity Menstrual irregularity Anovulatory cycles Anovulatory cycles Other: tumors, polyps, cysts Other: tumors, polyps, cysts Dysfunctional uterine bleeding Dysfunctional uterine bleeding Heavy or irregular bleeding without disease Heavy or irregular bleeding without disease Perimenopause Perimenopause

10 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Hormonal and Menstrual Alterations Polycystic ovary syndrome Polycystic ovary syndrome Oligo-ovulation or anovulation Oligo-ovulation or anovulation Elevated levels of androgens or clinical signs of hyperandrogenism and polycystic ovaries Elevated levels of androgens or clinical signs of hyperandrogenism and polycystic ovaries Leading cause of infertility in United States Leading cause of infertility in United States Multifactorial Multifactorial Hyperinsulinism Hyperinsulinism Dysfunction of follicle development Dysfunction of follicle development

11 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Hormonal and Menstrual Alterations Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) Cyclic physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities Cyclic physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities Occurs in the luteal (postovulatory) phase Occurs in the luteal (postovulatory) phase Abnormal nervous, immunologic, vascular, and GI tissue response to the normal menstrual cycle (>200 symptoms) Abnormal nervous, immunologic, vascular, and GI tissue response to the normal menstrual cycle (>200 symptoms)

12 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Infection and Inflammation Pelvic inflammatory disease (PID) Pelvic inflammatory disease (PID) Acute inflammation caused by infection Acute inflammation caused by infection May involve any organ of reproductive tract May involve any organ of reproductive tract Salpingitis Salpingitis Oophoritis Oophoritis Sexually transmitted diseases migrate from the vagina to the upper genital tract Sexually transmitted diseases migrate from the vagina to the upper genital tract Polymicrobial infection Polymicrobial infection Microbes ascend from infected cervix to endometrial tissue; infect uterus and adnexae Microbes ascend from infected cervix to endometrial tissue; infect uterus and adnexae

13 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Pelvic Inflammatory Disease (PID)

14 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Infection and Inflammation Vaginitis Vaginitis Infection of the vagina Infection of the vagina Sexually transmitted pathogens and Candida albicans Sexually transmitted pathogens and Candida albicans Acidic nature of vagina provides some protection Acidic nature of vagina provides some protection Maintained by cervical secretions, normal flora Maintained by cervical secretions, normal flora Cervicitis Cervicitis Inflammation or infection of the cervix Inflammation or infection of the cervix Mucopurulent cervicitis (MPC) Mucopurulent cervicitis (MPC)

15 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Infection and Inflammation Vulvitis Vulvitis Inflammation of the female external genitalia Inflammation of the female external genitalia Causes Causes Contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads, perfumed toilet paper, or nonabsorbing or tight-fitting clothing Contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads, perfumed toilet paper, or nonabsorbing or tight-fitting clothing Vaginal infections that spread to the labia Vaginal infections that spread to the labia

16 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Infection and Inflammation Bartholinitis Bartholinitis Inflammation of one or both ducts that lead from the vaginal opening to Bartholin glands Inflammation of one or both ducts that lead from the vaginal opening to Bartholin glands Caused by microorganisms that infect the lower female reproductive tract Caused by microorganisms that infect the lower female reproductive tract Inflammation narrows the distal portion of the ducts Inflammation narrows the distal portion of the ducts Leads to obstruction and stasis of glandular secretions Leads to obstruction and stasis of glandular secretions

17 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Pelvic Organ Prolapse The bladder, urethra, and rectum are supported by the endopelvic fascia and perineal muscles The bladder, urethra, and rectum are supported by the endopelvic fascia and perineal muscles The muscular and fascia tissue loses tone and strength with aging The muscular and fascia tissue loses tone and strength with aging

18 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Pelvic Organ Prolapse Uterine prolapse Uterine prolapse Cystocele and rectocele Cystocele and rectocele Vaginal prolapse Vaginal prolapse Urethrocele Urethrocele Cystourethrocele Cystourethrocele Enterocele Enterocele

19 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Pelvic Organ Prolapse

20 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Benign Growths and Proliferative Conditions Benign ovarian cysts (common) Benign ovarian cysts (common) Unilateral Unilateral Produced when a follicle or number of follicles are stimulated but no dominant follicle develops and reaches maturity Produced when a follicle or number of follicles are stimulated but no dominant follicle develops and reaches maturity Follicular cysts Follicular cysts Corpus luteum cysts Corpus luteum cysts Dermoid cysts Dermoid cysts

21 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Benign Growths and Proliferative Conditions Endometrial polyps Endometrial polyps Benign mass of endometrial tissue Benign mass of endometrial tissue Common cause of intermenstrual or excessive menstrual bleeding Common cause of intermenstrual or excessive menstrual bleeding Malignancy is rare Malignancy is rare

22 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Benign Growths and Proliferative Conditions Leiomyomas Leiomyomas Commonly called uterine fibroids Commonly called uterine fibroids Benign tumors of smooth muscle cells in the myometrium Benign tumors of smooth muscle cells in the myometrium Cause abnormal uterine bleeding, pain, and symptoms related to pressure on nearby structures Cause abnormal uterine bleeding, pain, and symptoms related to pressure on nearby structures Adenomyosis Adenomyosis Islands of endometrial glands surrounded by benign endometrial stroma within the myometrium Islands of endometrial glands surrounded by benign endometrial stroma within the myometrium

23 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Leiomyomas

24 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Benign Growths and Proliferative Conditions Endometriosis Endometriosis Functioning endometrial tissue or implants outside the uterus Functioning endometrial tissue or implants outside the uterus Responds to hormone fluctuations of the menstrual cycle Responds to hormone fluctuations of the menstrual cycle Possible causes Possible causes Retrograde menstruation, spread through vascular or lymphatic systems, stimulation of multipotential epithelial cells on reproductive organs, or depressed Tc cells tolerate ectopic tissue Retrograde menstruation, spread through vascular or lymphatic systems, stimulation of multipotential epithelial cells on reproductive organs, or depressed Tc cells tolerate ectopic tissue

25 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Endometriosis

26 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Female Reproductive Cancer Cervical cancer Cervical cancer Cervical dysplasia Cervical dysplasia Cervical carcinoma in situ Cervical carcinoma in situ Generally a precursor of invasive carcinoma of the cervix Generally a precursor of invasive carcinoma of the cervix Invasive carcinoma of the cervix Invasive carcinoma of the cervix Almost exclusively caused by cervical human papillomavirus (HPV) infection Almost exclusively caused by cervical human papillomavirus (HPV) infection With early detection and treatment, prognosis is excellent With early detection and treatment, prognosis is excellent

27 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Cervical Cancer

28 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Female Reproductive Cancer Vaginal cancer Vaginal cancer Vulvar cancer Vulvar cancer Endometrial cancer Endometrial cancer Uterine sarcoma Uterine sarcoma Ovarian cancer Ovarian cancer Frequently diagnosed after metastases have occurred Frequently diagnosed after metastases have occurred

29 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Sexual Dysfunction Disorders of desire (inhibited sexual desire, decreased libido) Disorders of desire (inhibited sexual desire, decreased libido) Vaginismus Vaginismus Anorgasmia (orgasmic dysfunction) Anorgasmia (orgasmic dysfunction) Rapid orgasm Rapid orgasm Dyspareunia (painful intercourse) Dyspareunia (painful intercourse)

30 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Impaired Fertility Infertility Infertility Inability to conceive after 1 year of unprotected intercourse with same partner Inability to conceive after 1 year of unprotected intercourse with same partner Fertility can be impaired by factors in the man, woman, or both Fertility can be impaired by factors in the man, woman, or both Fertility tests Fertility tests Structural Structural Hormonal Hormonal

31 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Disorders of the Male Reproductive System Disorders of the urethra Disorders of the urethra Urethritis Urethritis Inflammation of the urethra usually but not always caused by a STD Inflammation of the urethra usually but not always caused by a STD Nonsexual origins can be due to urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma Nonsexual origins can be due to urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma Urethral strictures Urethral strictures Fibrotic narrowing of urethra caused by scarring Fibrotic narrowing of urethra caused by scarring Commonly due to trauma or untreated or severe urethral infections Commonly due to trauma or untreated or severe urethral infections

32 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Disorders of the Male Reproductive System Disorders of the penis Disorders of the penis Penile foreskin (prepuce) is too tight Penile foreskin (prepuce) is too tight Phimosis Phimosis Inability to retract foreskin from the glans of the penis (distal to proximal) Inability to retract foreskin from the glans of the penis (distal to proximal) Paraphimosis Paraphimosis Inability to replace or cover the glans with the foreskin (proximal to distal) Inability to replace or cover the glans with the foreskin (proximal to distal) Frequently caused by poor hygiene or chronic infections Frequently caused by poor hygiene or chronic infections

33 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Disorders of the Male Reproductive System Disorders of the penis Disorders of the penis Peyronie disease Peyronie disease Bent nail syndrome Bent nail syndrome Slow development of fibrous plaques (thickening) in the erectile tissue of the corpus cavernosa, causing lateral curvature of penis during erection Slow development of fibrous plaques (thickening) in the erectile tissue of the corpus cavernosa, causing lateral curvature of penis during erection Occurs in middle-aged men and causes painful erections and intercourse Occurs in middle-aged men and causes painful erections and intercourse

34 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Disorders of the Male Reproductive System Disorders of the penis Disorders of the penis Priapism Priapism Condition of prolonged penile erection Condition of prolonged penile erection Balanitis Balanitis Inflammation of the glans penis Inflammation of the glans penis Usually associated with foreskin inflammation (posthitis) Usually associated with foreskin inflammation (posthitis) Accumulation under the foreskin (smegma) causes irritation of the glans Accumulation under the foreskin (smegma) causes irritation of the glans

35 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 35 Disorders of the Male Reproductive System Disorders of the penis Disorders of the penis Penile cancer Penile cancer Carcinoma of the penis is rare Carcinoma of the penis is rare Mostly squamous cell carcinomas Mostly squamous cell carcinomas HPV, smoking HPV, smoking Often diagnosed in men older than age 55 Often diagnosed in men older than age 55

36 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Disorders of the Scrotum, Testis, and Epididymis Disorders of the scrotum Disorders of the scrotum Varicocele Varicocele Inflammation/dilation of veins in spermatic cord Inflammation/dilation of veins in spermatic cord Cause: inadequate or absent valves in the spermatic veins Cause: inadequate or absent valves in the spermatic veins Hydrocele Hydrocele Scrotal swelling due to collection of fluid within the tunica vaginalis Scrotal swelling due to collection of fluid within the tunica vaginalis Imbalance between fluid secretion and reabsorption Imbalance between fluid secretion and reabsorption

37 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Disorders of the Scrotum, Testis, and Epididymis Disorders of the scrotum Disorders of the scrotum Spermatocele Spermatocele Painless diverticulum of the epididymis located between head of the epididymis and the testis Painless diverticulum of the epididymis located between head of the epididymis and the testis Contains milky fluid that contains sperm and does not cover the entire anterior scrotal surface Contains milky fluid that contains sperm and does not cover the entire anterior scrotal surface

38 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Disorders of the Scrotum

39 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Disorders of the Scrotum, Testis, and Epididymis Disorders of the testis Disorders of the testis Cryptorchidism Cryptorchidism Failure of one or more of the testes to descend from the abdominal cavity into the scrotum Failure of one or more of the testes to descend from the abdominal cavity into the scrotum Ectopic testis Ectopic testis Testis that has strayed from the normal pathway of descent Testis that has strayed from the normal pathway of descent

40 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Disorders of the Scrotum, Testis, and Epididymis Disorders of the testis Disorders of the testis Torsion of the testis Torsion of the testis Rotation of the testis Rotation of the testis The rotation causes the twisting of the blood vessels in the spermatic cord The rotation causes the twisting of the blood vessels in the spermatic cord Painful and swollen testis Painful and swollen testis Condition may be spontaneous or follow physical exertion or trauma Condition may be spontaneous or follow physical exertion or trauma

41 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Disorders of the Scrotum, Testis, and Epididymis Disorders of the testis Disorders of the testis Orchitis Orchitis Acute inflammation of the testis Acute inflammation of the testis Complication of a systemic disease or related to epididymitis Complication of a systemic disease or related to epididymitis Cancer of the testis Cancer of the testis Among the most curable of cancers Among the most curable of cancers Common in men between ages 15 and 35 Common in men between ages 15 and 35 Causes painless testicular enlargement Causes painless testicular enlargement

42 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Disorders of the Scrotum, Testis, and Epididymis Disorders of the epididymis Disorders of the epididymis Epididymitis Epididymitis Inflammation of the epididymis Inflammation of the epididymis Common in sexually active young men Common in sexually active young men The pathogenic microorganism reaches the epididymis by ascending the vas deferens from an already infected bladder or urethra The pathogenic microorganism reaches the epididymis by ascending the vas deferens from an already infected bladder or urethra

43 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Disorders of the Prostate Gland Benign prostatic hyperplasia Benign prostatic hyperplasia Enlargement of the prostate gland Enlargement of the prostate gland Symptoms associated with urethral compression Symptoms associated with urethral compression Relationship to aging Relationship to aging Evaluation Evaluation Digital rectal exams Digital rectal exams Prostate-specific antigen (PSA) monitoring Prostate-specific antigen (PSA) monitoring

44 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Disorders of the Prostate Gland Prostatitis Prostatitis Inflammation of the prostate Inflammation of the prostate Normal protective barriers Normal protective barriers Urethral length, micturition, and ejaculation Urethral length, micturition, and ejaculation Similar symptoms to BPH Similar symptoms to BPH Acute bacterial Acute bacterial Chronic bacterial Chronic bacterial Nonbacterial Nonbacterial Prostatodynia Prostatodynia

45 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Disorders of the Prostate Gland Cancer of the prostate Cancer of the prostate 95% of prostate neoplasms are adenocarcinomas and demonstrate peripheral zone growth 95% of prostate neoplasms are adenocarcinomas and demonstrate peripheral zone growth Prostatic cancer is asymptomatic until its advanced stages Prostatic cancer is asymptomatic until its advanced stages Symptoms are similar to BPH Symptoms are similar to BPH

46 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Disorders of the Prostate Gland Cancer of the prostate Cancer of the prostate Dietary factors Dietary factors Hormones Hormones Male equivalent of the female uterus Male equivalent of the female uterus Vasectomy Vasectomy Familial factors Familial factors

47 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Male Sexual Dysfunction Vascular, endocrine, and neurologic disorders Vascular, endocrine, and neurologic disorders Chronic diseases Chronic diseases Renal failure and diabetes mellitus Renal failure and diabetes mellitus Penile diseases and penile trauma Penile diseases and penile trauma Iatrogenic factors Iatrogenic factors Surgery and pharmaceuticals Surgery and pharmaceuticals

48 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Impairment of Sperm Production and Quality Hormone and growth factors Hormone and growth factors FSH, LH, and testosterone FSH, LH, and testosterone Androgen-binding protein, inhibin B, other peptides Androgen-binding protein, inhibin B, other peptides Adequate spermatogonia Adequate spermatogonia Sperm count >20 million/ml Sperm count >20 million/ml Sperm motility Sperm motility Antisperm antibodies Antisperm antibodies Drugs and toxins in the semen Drugs and toxins in the semen

49 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Disorders of the Breast Galactorrhea Galactorrhea Persistent and sometimes excessive secretion of milky fluid from the breasts of a woman who is not pregnant or nursing Persistent and sometimes excessive secretion of milky fluid from the breasts of a woman who is not pregnant or nursing Galactorrhea can also occur in men Galactorrhea can also occur in men Nonpuerperal hyperprolactinemia Nonpuerperal hyperprolactinemia Women with galactorrhea also experience menstrual abnormalities Women with galactorrhea also experience menstrual abnormalities

50 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Benign Breast Lesions Nonproliferative breast lesions Nonproliferative breast lesions Fibrocystic changes Fibrocystic changes Proliferative breast lesions without atypia Proliferative breast lesions without atypia Epithelial hyperplasia Epithelial hyperplasia Florid hyperplasia Florid hyperplasia Sclerosing adenosis Sclerosing adenosis Complex sclerosing lesion Complex sclerosing lesion Papillomas Papillomas

51 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Benign Breast Lesions Proliferative breast lesions with atypia Proliferative breast lesions with atypia Atypical hyperplasia Atypical hyperplasia Ductal hyperplasia Ductal hyperplasia Lobar hyperplasia Lobar hyperplasia

52 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Breast Cancer Most common cancer in American women Most common cancer in American women Leading cause of death from ages 40 to 44 Leading cause of death from ages 40 to 44 Second most common killer after lung cancer Second most common killer after lung cancer Ductal carcinoma in situ Ductal carcinoma in situ Controversy on whether lesions progress to infiltrative malignancy Controversy on whether lesions progress to infiltrative malignancy

53 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 53 Breast Cancer Reproductive factors Reproductive factors Hormonal factors Hormonal factors Environmental factors and lifestyle Environmental factors and lifestyle Radiation Radiation Diet Diet Chemicals Chemicals Physical activity Physical activity Familial factors and tumor-related genes Familial factors and tumor-related genes

54 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 54 Disorders of the Male Breast Gynecomastia Gynecomastia Overdevelopment of the breast tissue in a man Overdevelopment of the breast tissue in a man Results from hormone alterations Results from hormone alterations Idiopathic and system disorders, drugs, or neoplasms Idiopathic and system disorders, drugs, or neoplasms Male breast cancer Male breast cancer Most commonly seen after age 60 Most commonly seen after age 60 Tumors resemble carcinomas of the breast in women Tumors resemble carcinomas of the breast in women Crusting and nipple discharge are common clinical manifestations Crusting and nipple discharge are common clinical manifestations


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