Essentials of Human Diseases and Conditions 4 th edition

Essentials of Human Diseases Essentials of Human Diseases and Conditions and Conditions

44thth edition edition

Margaret Schell FrazierMargaret Schell Frazier

Jeanette Wist DrzymkowskiJeanette Wist Drzymkowski

Chapter 12 Chapter 12 Diseases and Conditions of the Reproductive Diseases and Conditions of the Reproductive

SystemSystem

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

Learning ObjectivesLearning Objectives

Identify risk factors for sexually transmitted diseases Identify risk factors for sexually transmitted diseases (STDs).(STDs).

Explain what a silent STD is, and give an example.Explain what a silent STD is, and give an example. Name the complications of untreated gonorrhea.Name the complications of untreated gonorrhea. Recall how trichomoniasis is diagnosed.Recall how trichomoniasis is diagnosed. Explain how genital herpes is transmitted.Explain how genital herpes is transmitted. Explain why women with genital herpes are advised Explain why women with genital herpes are advised

to have regular Pap (Papanicolaou) smears.to have regular Pap (Papanicolaou) smears.


Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Describe the stages of untreated syphilis.Describe the stages of untreated syphilis. Explain why hepatitis B is classified as sexually Explain why hepatitis B is classified as sexually

transmitted. transmitted. List the possible causes of dyspareunia in men and List the possible causes of dyspareunia in men and

women.women. Name drugs that can contribute to impotence.Name drugs that can contribute to impotence. Name a common causative factor in male and female Name a common causative factor in male and female

infertility.infertility.



Explain the value of prostate-specific antigen Explain the value of prostate-specific antigen (PSA) as a screening test.(PSA) as a screening test.

Discuss the medical interventions for prostatic Discuss the medical interventions for prostatic cancer. cancer.

Explain how varicocele may contribute to Explain how varicocele may contribute to male infertility. male infertility.

Explain why physicians encourage monthly Explain why physicians encourage monthly testicular self-examinations for younger men.testicular self-examinations for younger men.



Explain what causes the dysmenorrhea Explain what causes the dysmenorrhea associated with endometriosis. associated with endometriosis.

Discuss the importance of early diagnosis Discuss the importance of early diagnosis and prompt treatment of pelvic inflammatory and prompt treatment of pelvic inflammatory disease.disease.

Discuss the advantages and possible risks of Discuss the advantages and possible risks of hormone replacement therapy for the hormone replacement therapy for the postmenopausal woman.postmenopausal woman.



Explain how uterine prolapse, cystocele, and Explain how uterine prolapse, cystocele, and rectocele may be corrected surgically. rectocele may be corrected surgically.

List the risk factors for cervical cancer.List the risk factors for cervical cancer. Name the leading cause of deaths attributed Name the leading cause of deaths attributed

to female reproductive system disorders. to female reproductive system disorders. List some possible causes of ectopic List some possible causes of ectopic

pregnancy.pregnancy.



Explain how a pregnant woman is monitored Explain how a pregnant woman is monitored for toxemia.for toxemia.

Describe abruptio placentae.Describe abruptio placentae. List the factors that place women at higher List the factors that place women at higher

risk for breast cancer.risk for breast cancer.

Chapter 12Chapter 12Lesson 12.1 Lesson 12.1


The human reproductive system is classified The human reproductive system is classified into two groups:into two groups: Gonads: produces germ cells and hormonesGonads: produces germ cells and hormones

• Testes (males)Testes (males)

• Ovaries (females)Ovaries (females)

Ducts: transport germs cellsDucts: transport germs cells

The Normally Functioning Reproductive The Normally Functioning Reproductive SystemsSystems


Both the male and female reproductive Both the male and female reproductive systems are vulnerable to a number of systems are vulnerable to a number of diseases or dysfunctionsdiseases or dysfunctions

The origin of these conditions may be:The origin of these conditions may be: Functional Functional StructuralStructural EmotionalEmotional

The Normally Functioning Reproductive The Normally Functioning Reproductive Systems Systems (cont’d.)(cont’d.)


Sexually Transmitted DiseasesSexually Transmitted Diseases

More than 20 infectious diseases are spread More than 20 infectious diseases are spread by sexual contactby sexual contact

Sexually transmitted diseases (STDs) are Sexually transmitted diseases (STDs) are spread from one person to another through spread from one person to another through bodily fluids (blood, semen, vaginal bodily fluids (blood, semen, vaginal secretions) during vaginal, anal, or oral sexsecretions) during vaginal, anal, or oral sex

Some spread by direct contact with infected Some spread by direct contact with infected skinskin


A person is at greater risk for getting anA person is at greater risk for getting an

STD if he or she:STD if he or she: Has sex without knowledge of partner’s Has sex without knowledge of partner’s

historyhistory Shares drug-related needlesShares drug-related needles Has sex with multiple partnersHas sex with multiple partners Has direct skin contact with an open wound of Has direct skin contact with an open wound of

an infected personan infected person

Sexually Transmitted Disease Risk Sexually Transmitted Disease Risk FactorsFactors


ChlamydiaChlamydia

One of the most frequently reported infectious One of the most frequently reported infectious diseases in the U.S. diseases in the U.S.

More common than gonorrhea and the More common than gonorrhea and the leading cause of pelvic inflammatory disease leading cause of pelvic inflammatory disease and sterility in womenand sterility in women

Sometimes called the silent STD because it Sometimes called the silent STD because it often has no symptoms often has no symptoms


Chlamydia Chlamydia (cont’d.)(cont’d.)

SymptomsSymptoms When symptoms are present they are When symptoms are present they are

evidenced in both females and males and evidenced in both females and males and include:include:

FemalesFemales Thick vaginal discharge with burning sensationThick vaginal discharge with burning sensation ItchingItching Abdominal painAbdominal pain Pain during intercourse (dyspareunia)Pain during intercourse (dyspareunia)



MalesMales Discharge from penis with burning sensationDischarge from penis with burning sensation ItchingItching Burning sensation when urinatingBurning sensation when urinating Scrotum may be swollenScrotum may be swollen



TreatmentTreatment Antibiotic therapy is given to both partnersAntibiotic therapy is given to both partners Initially: a single injectionInitially: a single injection Followed by: oral antibioticsFollowed by: oral antibiotics

Patients are encouraged to abstain from Patients are encouraged to abstain from intercourse until both partners are curedintercourse until both partners are cured


GonorrheaGonorrhea

A common STD with symptoms similar to A common STD with symptoms similar to chlamydiachlamydia

Additional symptoms:Additional symptoms: A discharge of pus from the genital tract in both A discharge of pus from the genital tract in both

males and femalesmales and females Difficult or painful urinationDifficult or painful urination Symptoms vary in severitySymptoms vary in severity


Gonorrhea Gonorrhea (cont’d.)(cont’d.)

TreatmentTreatment Antibiotic therapy for both partnersAntibiotic therapy for both partners Because many strains of the bacteria that cause Because many strains of the bacteria that cause

gonorrhea have become resistant to standard gonorrhea have become resistant to standard antibiotic therapy (tetracycline and penicillin), antibiotic therapy (tetracycline and penicillin), follow-up cultures are routinely ordered to ensure follow-up cultures are routinely ordered to ensure a complete curea complete cure


Gonorrhea Gonorrhea (cont’d.)(cont’d.)

Neglecting treatment can lead to the following Neglecting treatment can lead to the following complications:complications: Pelvic inflammatory diseasePelvic inflammatory disease Blood poisoning (septicemia)Blood poisoning (septicemia) Septic arthritisSeptic arthritis


TrichomoniasisTrichomoniasis

Infection of the lower genitourinary tractInfection of the lower genitourinary tract Affects about 15 percent of sexually active Affects about 15 percent of sexually active

peoplepeople Most infected men and women are without Most infected men and women are without

symptomssymptoms


Trichomoniasis Trichomoniasis (cont’d.)(cont’d.)

SymptomsSymptoms When symptoms are present they are evidenced When symptoms are present they are evidenced

in both females and males and include:in both females and males and include:• Difficult or painful urinationDifficult or painful urination

• ItchingItching

• Women: profuse greenish yellow discharge from the Women: profuse greenish yellow discharge from the vaginavagina



DiagnosisDiagnosis Discharge from either the male or female is Discharge from either the male or female is

typically studied for the microorganism typically studied for the microorganism responsible.responsible.

Urinalysis may be performedUrinalysis may be performed Cervix may also be examined for the presence of Cervix may also be examined for the presence of

small hemorrhages with a strawberry-like small hemorrhages with a strawberry-like appearanceappearance



TreatmentTreatment Anti-infective drugs are given orally or in some Anti-infective drugs are given orally or in some

cases vaginally.cases vaginally. Follow-up examinations to ensure the infection Follow-up examinations to ensure the infection

has been eliminatedhas been eliminated


Genital HerpesGenital Herpes

Infection of the skin in the genital area Infection of the skin in the genital area resulting in painful genital sores resulting in painful genital sores

Spread by direct skin-to-skin contactSpread by direct skin-to-skin contact Caused by herpes simplex virus type 2 (HSV-Caused by herpes simplex virus type 2 (HSV-

2)2) Large percentage of infections go unnoticedLarge percentage of infections go unnoticed


Genital Herpes Genital Herpes (cont’d.)(cont’d.)

SymptomsSymptoms One or more blister-like lesions on or around the One or more blister-like lesions on or around the

genitals or anusgenitals or anus Swollen glandsSwollen glands Fever Fever HeadacheHeadache Painful urinationPainful urination



DiagnosisDiagnosis Presence of characteristic lesions on the male or Presence of characteristic lesions on the male or

female genitaliafemale genitalia An antigen test or tissue culture may confirm the An antigen test or tissue culture may confirm the

diagnosis.diagnosis.



TreatmentTreatment There is no cure.There is no cure. Prescription drugs are routinely used to reduce the Prescription drugs are routinely used to reduce the

frequency and duration of outbreaks.frequency and duration of outbreaks. Women with genital herpes are at increased risk Women with genital herpes are at increased risk

for cervical cancer and are encouraged to obtain a for cervical cancer and are encouraged to obtain a Pap smear every six months for screening.Pap smear every six months for screening.


A genital infection that causes raised A genital infection that causes raised cauliflower-like growths in or near the vagina cauliflower-like growths in or near the vagina or rectum or along the penisor rectum or along the penis

Warts are caused by the human Warts are caused by the human papillomavirus (HPV) and is usually papillomavirus (HPV) and is usually transmitted through sexual contact.transmitted through sexual contact.

Genital WartsGenital Warts(Condylomata Acuminata)(Condylomata Acuminata)


Genital Warts Genital Warts (cont’d.)(cont’d.)

SymptomsSymptoms Possible itching or burningPossible itching or burning Discomfort varies by size, number, and locationDiscomfort varies by size, number, and location

Added risk factorAdded risk factor Women with HPV infection are at greater risk for Women with HPV infection are at greater risk for

cervical cancercervical cancer


Genital Warts Genital Warts (cont’d.)(cont’d.)

TreatmentTreatment Topical drug therapyTopical drug therapy Surgical proceduresSurgical procedures

• Cryosurgery: freezing and removing affected tissueCryosurgery: freezing and removing affected tissue

• Electrodesiccation: removing warts using lasersElectrodesiccation: removing warts using lasers

Some genital warts disappear without Some genital warts disappear without treatmenttreatment


SyphilisSyphilis

A chronic, sexually transmitted infection that A chronic, sexually transmitted infection that can affect the entire body if left untreatedcan affect the entire body if left untreated


Syphilis Syphilis (cont’d.)(cont’d.)

Symptoms manifest in four stages:Symptoms manifest in four stages: Presence of a painless but highly contagious local Presence of a painless but highly contagious local

lesion called a chancre (pronounced “shang-ker”) lesion called a chancre (pronounced “shang-ker”) found on the genitaliafound on the genitalia

Within one-two months, the primary lesion heals, Within one-two months, the primary lesion heals, but the infection spreads throughout the body and but the infection spreads throughout the body and can cause similar lesions anywherecan cause similar lesions anywhere



Symptom stages Symptom stages The infection begins spreading systemically The infection begins spreading systemically

throughout the body and may present with:throughout the body and may present with:• FeverFever

• HeadacheHeadache

• Aching jointsAching joints

• Mouth sores Mouth sores

• Rashes on palms or soles of feetRashes on palms or soles of feet



Symptom stages Symptom stages A latent period follows where the infection is A latent period follows where the infection is

without symptoms but can be transmitted in the without symptoms but can be transmitted in the first few years of this stage.first few years of this stage.• This stage can last from one to 40 years and varies by This stage can last from one to 40 years and varies by

person.person.



Symptom stages Symptom stages In the final stage, lesions (called gummas) invade In the final stage, lesions (called gummas) invade

the body organs and systems and cause the body organs and systems and cause widespread damage that can be disabling and life-widespread damage that can be disabling and life-threatening.threatening.



TreatmentTreatment Can be cured with a course of antibiotic therapy Can be cured with a course of antibiotic therapy

using penicillin Gusing penicillin G Patients are monitored with follow-up blood tests Patients are monitored with follow-up blood tests

for up to one year to ensure elimination of for up to one year to ensure elimination of infection.infection.


ChancroidChancroid

A bacterial infection of the genitalia that A bacterial infection of the genitalia that causes a shallow and painless lesion on the causes a shallow and painless lesion on the skin or mucous membrane that appears skin or mucous membrane that appears seven to 10 days after sexual contact with an seven to 10 days after sexual contact with an infected personinfected person

Symptoms:Symptoms: Over time, ulcer usually deepens and oozes pusOver time, ulcer usually deepens and oozes pus


Chancroid Chancroid (cont’d.)(cont’d.)

TreatmentTreatment Antibiotic therapyAntibiotic therapy Lesions must sometimes be drained surgicallyLesions must sometimes be drained surgically Good personal hygieneGood personal hygiene Refrain from sexual contact during treatmentRefrain from sexual contact during treatment


Hepatitis BHepatitis B

An infection of the liver that is caused by a An infection of the liver that is caused by a DNA virusDNA virus

The disease has a long incubation and The disease has a long incubation and symptoms may become severe or chronic, symptoms may become severe or chronic, causing serious damage to the livercausing serious damage to the liver


Hepatitis B Hepatitis B (cont’d.)(cont’d.)

CausesCauses Can be transmitted by: Can be transmitted by:

• Contaminated blood or blood derivatives in transfusionsContaminated blood or blood derivatives in transfusions

• Sexual contact with an infected personSexual contact with an infected person

• Use of contaminated needles and instruments Use of contaminated needles and instruments



SymptomsSymptoms Fatigue Fatigue Loss of appetite Loss of appetite Nausea Nausea Abdominal discomfort Abdominal discomfort Dark urine Dark urine Clay-colored bowel movements Clay-colored bowel movements Yellowing of the skin and eyes (jaundice)Yellowing of the skin and eyes (jaundice)



TreatmentTreatment Some cases are self-limitingSome cases are self-limiting Medications to control nausea and painMedications to control nausea and pain Low-fat, high-carbohydrate diet Low-fat, high-carbohydrate diet Restriction of physical activityRestriction of physical activity Alcohol should be avoided at all costs because of Alcohol should be avoided at all costs because of

its potential to strain the liverits potential to strain the liver Antiviral therapy for chronic casesAntiviral therapy for chronic cases



PrognosisPrognosis Acute cases: prognosis is good Acute cases: prognosis is good

• Liver heals and regeneratesLiver heals and regenerates

• May take several monthsMay take several months

Chronic cases: prognosis is poorChronic cases: prognosis is poor• Inflammation causes destruction of liver cells and Inflammation causes destruction of liver cells and

possible liver failurepossible liver failure

Chapter 12Chapter 12Lesson 12.2Lesson 12.2


Sexual DysfunctionSexual Dysfunction

Sexual dysfunction is the abnormal or Sexual dysfunction is the abnormal or impaired function of sexual behavior resulting impaired function of sexual behavior resulting from physical and/or mental imbalances in the from physical and/or mental imbalances in the systemsystem


DyspareuniaDyspareunia

Refers to recurrent painful or difficult sexual Refers to recurrent painful or difficult sexual intercourse intercourse

Can occur in men and women but is more Can occur in men and women but is more common in womencommon in women


Dyspareunia Dyspareunia (cont’d.)(cont’d.)

Physical causes (women)Physical causes (women) Intact hymenIntact hymen Insufficient lubricationInsufficient lubrication Presence of an STDPresence of an STD Use of spermicideUse of spermicide EndometriosisEndometriosis Pelvic inflammatory diseasePelvic inflammatory disease Presence of cysts or tumors in pelvic regionPresence of cysts or tumors in pelvic region



Psychological causes (women)Psychological causes (women) Past traumaPast trauma Sexual abuseSexual abuse Fears (including fear of pregnancy)Fears (including fear of pregnancy) AnxietyAnxiety



Causes (men)Causes (men) A “bowed” erectionA “bowed” erection Tight foreskinTight foreskin Inflammation of the prostateInflammation of the prostate Anxiety or guiltAnxiety or guilt



TreatmentTreatment Determined by cause but could include:Determined by cause but could include:

• Use of lubricants during intercourseUse of lubricants during intercourse

• Gentle stretching of vaginal openingGentle stretching of vaginal opening

• Treat existing infectionsTreat existing infections

• Address psychosexual issues in counselingAddress psychosexual issues in counseling

• Corrective surgery, if necessaryCorrective surgery, if necessary


DescriptionDescription The inability of a man to perform sexual The inability of a man to perform sexual

intercourse, usually because he is unable to attain intercourse, usually because he is unable to attain or maintain an erection of the penisor maintain an erection of the penis

Erectile Dysfunction (ED)/Erectile Dysfunction (ED)/ImpotenceImpotence


ED/Impotence ED/Impotence (cont’d.)(cont’d.)

Medical conditionsMedical conditions Diabetes mellitusDiabetes mellitus Heart diseaseHeart disease High cholesterolHigh cholesterol HypertensionHypertension Nerve disorders arising Nerve disorders arising

from:from:• Prostate surgeryProstate surgery

• TraumaTrauma

Psychological causes:Psychological causes: DepressionDepression Unconscious guiltUnconscious guilt Sexual traumaSexual trauma Discordant relationshipsDiscordant relationships Anxiety about sexAnxiety about sex Chronic fatigue Chronic fatigue StressStress



Other causesOther causes Medications used to treat hypertension and Medications used to treat hypertension and

depressiondepression AlcoholAlcohol Recreational drugsRecreational drugs AntihistaminesAntihistamines DiureticsDiuretics



DiagnosisDiagnosis Physical examinationPhysical examination Lab tests to rule out organic diseaseLab tests to rule out organic disease Measurement of testosterone levelMeasurement of testosterone level Medical history of patient and family:Medical history of patient and family:

• Any chronic disease such as diabetes, hypertension heart Any chronic disease such as diabetes, hypertension heart disease, renal or vascular problem, etc.disease, renal or vascular problem, etc.

• Lifestyle habits such as smoking, alcohol use, stress levels, Lifestyle habits such as smoking, alcohol use, stress levels, and degree of sexual activityand degree of sexual activity



TreatmentTreatment Change or discontinue medicationsChange or discontinue medications Testosterone therapyTestosterone therapy Psychological counselingPsychological counseling Penile implants/injection therapyPenile implants/injection therapy External vacuum therapyExternal vacuum therapy Oral drug therapyOral drug therapy


FrigidityFrigidity

The lack of sexual desire or response in a The lack of sexual desire or response in a woman woman

A patient may report an inability to experience A patient may report an inability to experience sexual arousal, excitement, or achieve an sexual arousal, excitement, or achieve an orgasm.orgasm.


Frigidity Frigidity (cont’d.)(cont’d.)

CausesCauses MedicationsMedications Chronic fatigueChronic fatigue StressStress DepressionDepression Past trauma such as rape or sexual abusePast trauma such as rape or sexual abuse


Frigidity Frigidity (cont’d.)(cont’d.)

TreatmentTreatment Training to enhance sensation and focusTraining to enhance sensation and focus Psychological counselingPsychological counseling Drug therapy (testosterone cream) to help Drug therapy (testosterone cream) to help

increase libidoincrease libido


Premature EjaculationPremature Ejaculation

Ejaculation of semen that occurs prior to or Ejaculation of semen that occurs prior to or immediately after penetration of the vagina by immediately after penetration of the vagina by the penis the penis

Problematic in that it may allow for little Problematic in that it may allow for little foreplay or may result in an inability to satisfy foreplay or may result in an inability to satisfy partner or impregnatepartner or impregnate


Premature Ejaculation Premature Ejaculation (cont’d.)(cont’d.)

CausesCauses Psychological: guilt or anxietyPsychological: guilt or anxiety Relational: a troubled or negative relationship with Relational: a troubled or negative relationship with

a sex partnera sex partner Diseases: infections or neurological conditionsDiseases: infections or neurological conditions


Premature Ejaculation Premature Ejaculation (cont’d.)(cont’d.)

TreatmentTreatment Address underlying psychological issuesAddress underlying psychological issues Techniques for delaying ejaculationTechniques for delaying ejaculation


Male and Female InfertilityMale and Female Infertility

The involuntary inability to conceiveThe involuntary inability to conceive With regular unprotected intercourse, about With regular unprotected intercourse, about

90 percent of couples conceive within one 90 percent of couples conceive within one yearyear

Of those unable: approximately 40 percent Of those unable: approximately 40 percent can be attributed to male factors, 40 percent can be attributed to male factors, 40 percent more to female factors, and less than 10 more to female factors, and less than 10 percent unknownpercent unknown


Male and Female Infertility Male and Female Infertility (cont’d.)(cont’d.)

Causes (male)Causes (male) Insufficient number of spermInsufficient number of sperm Inadequate motility (movement) of spermInadequate motility (movement) of sperm Presence of an STD or any infection or blockagePresence of an STD or any infection or blockage Other physical conditions (genetic disorders) or Other physical conditions (genetic disorders) or

injuries (radiation exposure, hormonal imbalances) injuries (radiation exposure, hormonal imbalances) that may result in sterilitythat may result in sterility



Causes (female)Causes (female) STD or infection of the reproductive systemSTD or infection of the reproductive system Failure to ovulate Failure to ovulate EndometriosisEndometriosis Blocked fallopian tubesBlocked fallopian tubes Congenital structural or chromosomal disordersCongenital structural or chromosomal disorders Scar tissue from infection, ectopic pregnancy, or Scar tissue from infection, ectopic pregnancy, or

surgerysurgery Psychological distressPsychological distress



DiagnosisDiagnosis Men: Men:

• Medical history with special attention to childhood Medical history with special attention to childhood diseasesdiseases

• Thorough physical examThorough physical exam

• Semen analysisSemen analysis



DiagnosisDiagnosis Women:Women:

• Charting of menstrual cycleCharting of menstrual cycle

• Blood tests to asses hormone levelsBlood tests to asses hormone levels

• Visual examination of fallopian tubes and uterine cavity Visual examination of fallopian tubes and uterine cavity using radiography to determine tubal patencyusing radiography to determine tubal patency

• Laparoscopy may be necessary to rule out Laparoscopy may be necessary to rule out endometriosisendometriosis



TreatmentTreatment Varies based on diagnosed problem, but Varies based on diagnosed problem, but

commonly includes:commonly includes:• Infection controlInfection control

• Surgery to remove blockageSurgery to remove blockage

• Use of fertility drugsUse of fertility drugs

• Artificial inseminationArtificial insemination

Intrauterine insemination (IUI)Intrauterine insemination (IUI)

In vitro fertilization (IVF)In vitro fertilization (IVF)


Male Reproductive DiseasesMale Reproductive Diseases

Most commonly affected organ is the prostate Most commonly affected organ is the prostate glandgland

The gland can become inflamed or enlarged The gland can become inflamed or enlarged as a result of bacteria and cause urinary as a result of bacteria and cause urinary problems.problems.

Symptoms may include: Symptoms may include: Urinary problems (incontinence, difficulty urinating)Urinary problems (incontinence, difficulty urinating) Pain or swelling of reproductive organsPain or swelling of reproductive organs Sexual dysfunction (ED/impotence)Sexual dysfunction (ED/impotence)


EpididymitisEpididymitis

The inflammation of the epididymis, which is The inflammation of the epididymis, which is a long convoluted tube in the sperm duct a long convoluted tube in the sperm duct system located in the testessystem located in the testes


Epididymitis Epididymitis (cont’d.)(cont’d.)

Symptoms & SignsSymptoms & Signs FeverFever DysuriaDysuria MalaiseMalaise Groin or scrotal tenderness/painGroin or scrotal tenderness/pain Difficulty walkingDifficulty walking Epididymis may become enlarged, tender, or hardEpididymis may become enlarged, tender, or hard Prehn’s signPrehn’s sign



CausesCauses STDs (gonorrhea and syphilis)STDs (gonorrhea and syphilis) Urinary tract infectionUrinary tract infection Inflamed prostate (prostatitis)Inflamed prostate (prostatitis)



DiagnosisDiagnosis Physical examinationPhysical examination UrinalysisUrinalysis Urine culturesUrine cultures



TreatmentTreatment Antibiotic therapyAntibiotic therapy Analgesics (pain relief)Analgesics (pain relief) Anti-inflammatoriesAnti-inflammatories RestRest Avoidance of alcohol and spicy foodsAvoidance of alcohol and spicy foods Scrotum support & elevationScrotum support & elevation


OrchitisOrchitis

Orchitis is an infection of the testis causing:Orchitis is an infection of the testis causing: SwellingSwelling Tenderness Tenderness Acute painAcute pain FeverFever Chills Chills Nausea/vomitingNausea/vomiting General malaiseGeneral malaise


Orchitis Orchitis (cont’d.)(cont’d.)

CausesCauses May be an infection from the mumps virusMay be an infection from the mumps virus Can also be attributed to other viruses and Can also be attributed to other viruses and

bacteriabacteria May follow epididymitisMay follow epididymitis May accompany the presence of an STDMay accompany the presence of an STD


Orchitis Orchitis (cont’d.)(cont’d.)

TreatmentTreatment Antibiotic therapy (if infection is bacterial)Antibiotic therapy (if infection is bacterial) Mumps virus has no specific treatment besides:Mumps virus has no specific treatment besides:

• Bed restBed rest

• Adrenal steroid drugs (reduces fever and swelling in Adrenal steroid drugs (reduces fever and swelling in severe cases)severe cases)

• Scrotum supportScrotum support


Torsion of the TesticleTorsion of the Testicle

A condition where one testicle is twisted out A condition where one testicle is twisted out of its normal position, causing a reduction in of its normal position, causing a reduction in blood flow to the affected testicleblood flow to the affected testicle

The primary symptom is sudden, severe pain The primary symptom is sudden, severe pain in one testiclein one testicle

The scrotum becomes red, swollen, and The scrotum becomes red, swollen, and tendertender

Fever and urinary frequency may occurFever and urinary frequency may occur


Torsion of the Testicle Torsion of the Testicle (cont’d.)(cont’d.)



DiagnosisDiagnosis Patient historyPatient history Gentle physical examinationGentle physical examination Ultrasound may be necessary to distinguish Ultrasound may be necessary to distinguish

torsion from epididymitistorsion from epididymitis



TreatmentTreatment Gentle manipulation to untwist the testicleGentle manipulation to untwist the testicle Surgery may be necessary if the above fails to Surgery may be necessary if the above fails to

correct problemcorrect problem


VaricoceleVaricocele

The veins of one testicle become abnormally The veins of one testicle become abnormally distended, causing swelling around the distended, causing swelling around the testicletesticle

Symptoms includeSymptoms include Discomfort (especially in hot weather or following Discomfort (especially in hot weather or following

exercise)exercise) Possible lower sperm countPossible lower sperm count


Varicocele Varicocele (cont’d.)(cont’d.)

TreatmentTreatment Use of scrotal supportUse of scrotal support Surgery may be indicated to remove distended Surgery may be indicated to remove distended

veins if fertility is threatenedveins if fertility is threatened


ProstatitisProstatitis

Acute or chronic inflammation of the prostate Acute or chronic inflammation of the prostate glandgland

Infection (bacterial or nonbacterial) is the Infection (bacterial or nonbacterial) is the most likely causemost likely cause


Prostatitis Prostatitis (cont’d.)(cont’d.)

SymptomsSymptoms Pain or burning sensation during urinationPain or burning sensation during urination Low back painLow back pain FeverFever Muscular pain and tendernessMuscular pain and tenderness Frequent urinationFrequent urination Blood in urine possibleBlood in urine possible


Prostatitis Prostatitis (cont’d.)(cont’d.)

TreatmentTreatment Antimicrobial penicillin and other antibioticsAntimicrobial penicillin and other antibiotics Sitz bathsSitz baths RestRest Increase fluid intakeIncrease fluid intake Analgesics (for pain)Analgesics (for pain)


A nonmalignant, noninflammatory A nonmalignant, noninflammatory enlargement of the prostate glandenlargement of the prostate gland

SymptomsSymptoms May compress urethra and cause urinary blockageMay compress urethra and cause urinary blockage Difficulty starting urinationDifficulty starting urination Weak urinary streamWeak urinary stream Inability to empty bladderInability to empty bladder

Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH)


Benign Prostatic Hyperplasia Benign Prostatic Hyperplasia (cont’d.)(cont’d.)

TreatmentTreatment Watchful waitingWatchful waiting Control fluid intake before bedtimeControl fluid intake before bedtime Avoid medications that cause urinary retention Avoid medications that cause urinary retention

(decongestants)(decongestants) Drug therapy (to relax tightened muscles inside Drug therapy (to relax tightened muscles inside

the prostate or shrink enlarged prostate gland)the prostate or shrink enlarged prostate gland) Surgery may be performed to remove urinary tract Surgery may be performed to remove urinary tract

obstructionobstruction


Prostate CancerProstate Cancer

Malignancy of the prostate glandMalignancy of the prostate gland Risk factorsRisk factors

• Age (most cases occur in men over age 45)Age (most cases occur in men over age 45)

• Heredity (presence of certain genes)Heredity (presence of certain genes)

• Lifestyle (diet high in animal fat, low in vegetables and Lifestyle (diet high in animal fat, low in vegetables and selenium)selenium)

• Ethnicity (more common in African-Americans)Ethnicity (more common in African-Americans)


Prostate Cancer Prostate Cancer (cont’d.)(cont’d.)

SymptomsSymptoms Weak or interrupted urine flowWeak or interrupted urine flow Frequent urinationFrequent urination Difficulty starting or stopping urinationDifficulty starting or stopping urination Urinary retentionUrinary retention Blood in urineBlood in urine Erectile dysfunctionErectile dysfunction



DiagnosisDiagnosis Digital rectal examDigital rectal exam Blood test to determine level of prostate specific Blood test to determine level of prostate specific

antigen (PSA)antigen (PSA) Biopsy (indicated if PSA level is 10ng/ml)Biopsy (indicated if PSA level is 10ng/ml)



TreatmentTreatment Type of treatment depends on several factors:Type of treatment depends on several factors:

• PSA levelPSA level

• AgeAge

• Stage of diseaseStage of disease

• Physical condition of patientPhysical condition of patient



Treatment optionsTreatment options Radical resection of the prostate (TURP)Radical resection of the prostate (TURP) Hormone therapy (for metastatic prostate cancer)Hormone therapy (for metastatic prostate cancer) Radiation therapyRadiation therapy No intervention (for men 70 years or older or who No intervention (for men 70 years or older or who

have other co-existing illnesses)have other co-existing illnesses)



PreventionPrevention Annual screening for all men 50 years of age or Annual screening for all men 50 years of age or

older, which consists of:older, which consists of:• Digital rectal exams Digital rectal exams

• Serum PSA testSerum PSA test

• If either test is positive transrectal ultrasound biopsy is If either test is positive transrectal ultrasound biopsy is performedperformed


Testicular CancerTesticular Cancer

Malignant tumor of the testisMalignant tumor of the testis SymptomsSymptoms

Nodule on or swelling of one testicleNodule on or swelling of one testicle Dull ache or heavy sensation in abdomenDull ache or heavy sensation in abdomen Advanced disease symptoms:Advanced disease symptoms:

• Lower extremity swellingLower extremity swelling

• AnorexiaAnorexia

• Bone painBone pain


Testicular Cancer Testicular Cancer (cont’d.)(cont’d.)

Risk factorsRisk factors Family history of testicular cancerFamily history of testicular cancer A testicle that has not descended into the scrotumA testicle that has not descended into the scrotum InfertilityInfertility HIV infectionHIV infection



DiagnosisDiagnosis Physical examination of the testes to detect Physical examination of the testes to detect

possible nodespossible nodes Suspected testicular cancer may be followed by: Suspected testicular cancer may be followed by:

• Scrotal ultrasoundScrotal ultrasound

• CT scan of abdomen and pelvisCT scan of abdomen and pelvis

• Chest x-rayChest x-ray

• Blood testsBlood tests



TreatmentTreatment ChemotherapyChemotherapy Surgical resectionSurgical resection Radiation therapyRadiation therapy



PreventionPrevention Monthly testicular self-exam is the most reliable Monthly testicular self-exam is the most reliable

screening methodscreening method Enhances body awareness (allows males to Enhances body awareness (allows males to

assess the normal size and shape of testicles) assess the normal size and shape of testicles) Enables early detection of abnormalitiesEnables early detection of abnormalities


Female Reproductive DiseasesFemale Reproductive Diseases

The female reproductive organs are The female reproductive organs are susceptible to disease in two distinct ways:susceptible to disease in two distinct ways: Microorganisms can invade the organs, allowing Microorganisms can invade the organs, allowing

infections to developinfections to develop Tumors (both benign and malignant) and cysts Tumors (both benign and malignant) and cysts

can developcan develop


Premenstrual SyndromePremenstrual Syndrome

A cluster of physical and emotional symptoms A cluster of physical and emotional symptoms that appear shortly after ovulation and that appear shortly after ovulation and subside with the onset of menstruation or subside with the onset of menstruation or shortly thereafter.shortly thereafter.


Premenstrual Syndrome Premenstrual Syndrome (cont’d.)(cont’d.)

Common symptomsCommon symptoms AnxietyAnxiety AngerAnger SadnessSadness Food cravingsFood cravings FatiqueFatique Breast tenderness Breast tenderness IrritabilityIrritability

Some women alsoSome women also

experienceexperience:: EdemaEdema Bloated feelingBloated feeling Abdominal painAbdominal pain


Premenstrual Syndrome Premenstrual Syndrome (cont’d.)(cont’d.)

TreatmentTreatment Directed toward the relief of symptomsDirected toward the relief of symptoms Reduce dietary intake of sodiumReduce dietary intake of sodium Moderate exerciseModerate exercise Mild analgesicsMild analgesics DiureticsDiuretics Emotional supportEmotional support Antidepressant medication or hormone therapy Antidepressant medication or hormone therapy

especially for PMDDespecially for PMDD Increase calcium intakeIncrease calcium intake


AmenorrheaAmenorrhea

The absence of menstrual periodsThe absence of menstrual periods Two classifications:Two classifications:

• Primary – if menstruation has not occurred by age 16Primary – if menstruation has not occurred by age 16

• Secondary – no menses after a woman has been having Secondary – no menses after a woman has been having menstrual cyclesmenstrual cycles


Amenorrhea Amenorrhea (cont’d.)(cont’d.)

Causes of Primary AmenorrheaCauses of Primary Amenorrhea Late onset of pubertyLate onset of puberty Abnormalities of the reproductive systemAbnormalities of the reproductive system Hormonal imbalancesHormonal imbalances



Causes of Secondary AmenorrheaCauses of Secondary Amenorrhea Hormone-related issues such as:Hormone-related issues such as:

• PregnancyPregnancy

• Emotional factorsEmotional factors

Illness (anorexia, malnutrition, sudden weight gain Illness (anorexia, malnutrition, sudden weight gain or loss)or loss)

Pituitary tumorsPituitary tumors Thyroid diseaseThyroid disease Excessive athletic trainingExcessive athletic training



DiagnosisDiagnosis Physical examination that includes:Physical examination that includes:

• Pelvic exam (rules out physical abnormalities and Pelvic exam (rules out physical abnormalities and pregnancy)pregnancy)

• Blood tests (detects hormone problems)Blood tests (detects hormone problems)

• Urine samples (detects hormone problems)Urine samples (detects hormone problems)

• Radiographic studies (detects tumors)Radiographic studies (detects tumors)



Treatment of Primary or SecondaryTreatment of Primary or Secondary• Treat underlying condition if possibleTreat underlying condition if possible

• Contraceptive hormones or cyclic progesteroneContraceptive hormones or cyclic progesterone

May require long-term hormone therapyMay require long-term hormone therapy


DysmenorrheaDysmenorrhea

Pain associated with menstruationPain associated with menstruation Two classifications for cause:Two classifications for cause:

• PrimaryPrimary Results from normal hormonal changes (not considered a Results from normal hormonal changes (not considered a

pathologic disorder)pathologic disorder)

• SecondarySecondary Usually caused by underlying disorder or disease (pelvic Usually caused by underlying disorder or disease (pelvic

infections, fibroids, endometriosis, etc.)infections, fibroids, endometriosis, etc.)


Dysmenorrhea Dysmenorrhea (cont’d.)(cont’d.)

SymptomsSymptoms

Pain or cramping shortly before or after the onset of Pain or cramping shortly before or after the onset of menstrual flowmenstrual flow Pain in the uterine area, lower pelvis that may Pain in the uterine area, lower pelvis that may

radiate to thighs and buttocksradiate to thighs and buttocks Painful bowel or bladder functionPainful bowel or bladder function

Symptoms usually abate by the end of Symptoms usually abate by the end of menstruationmenstruation


Dysmenorrhea Dysmenorrhea (cont’d.)(cont’d.)

TreatmentTreatment Non-steroidal anti-inflammatory drugs (prescription Non-steroidal anti-inflammatory drugs (prescription

or OTC) for pain reliefor OTC) for pain relief Heating pad for abdominal painHeating pad for abdominal pain Hormonal therapy or surgery may be necessary if Hormonal therapy or surgery may be necessary if

endometriosis, fibroids, or if cervical abnormalities endometriosis, fibroids, or if cervical abnormalities are present.are present.


Ovarian CystsOvarian Cysts

Fluid-filled semi-solid or solid masses that Fluid-filled semi-solid or solid masses that originate within ovariesoriginate within ovaries

Two types:Two types: Physiologic cysts (those caused by normal Physiologic cysts (those caused by normal

functioning of the ovary)functioning of the ovary) Neoplastic cysts (benign or malignant and not Neoplastic cysts (benign or malignant and not

related to normal functioning)related to normal functioning)


Ovarian Cysts Ovarian Cysts (cont’d.)(cont’d.)

SymptomsSymptoms Most are small and unnoticed by the patientMost are small and unnoticed by the patient Large cysts can cause urinary retentionLarge cysts can cause urinary retention If cyst produces hormones various symptoms If cyst produces hormones various symptoms

resultresult Cysts may twist on themselves causing pain, Cysts may twist on themselves causing pain,

nausea and vomitingnausea and vomiting


Ovarian Cysts Ovarian Cysts (cont’d.)(cont’d.)

TreatmentTreatment Small cysts are common and seldom require Small cysts are common and seldom require

treatmenttreatment Large cystsLarge cysts

• Can be drained or removedCan be drained or removed


EndometriosisEndometriosis

A condition in which the endometrial tissue A condition in which the endometrial tissue implants outside the uterus in the pelvic implants outside the uterus in the pelvic cavity or in other distant sitescavity or in other distant sites


Endometriosis Endometriosis (cont’d.)(cont’d.)

SymptomsSymptoms Secondary dysmenorrhea is a classic symptomSecondary dysmenorrhea is a classic symptom

Constant pain and cramping in lower abdomen Constant pain and cramping in lower abdomen beginning before and lasting several days after beginning before and lasting several days after menstruationmenstruation

InfertilityInfertility Pelvic pain during intercoursePelvic pain during intercourse Pain during defecationPain during defecation



The thickening and bleeding in these The thickening and bleeding in these unnatural areas (and the resulting cysts, scar unnatural areas (and the resulting cysts, scar tissue, and adhesions) are the cause of pain tissue, and adhesions) are the cause of pain and discomfort.and discomfort.

Risk factors include: family history of the Risk factors include: family history of the disease, menstrual cycles shorter than 28 disease, menstrual cycles shorter than 28 days, uterine structural abnormalities and days, uterine structural abnormalities and periods lasting longer than a week.periods lasting longer than a week.



TreatmentTreatment Hormone treatment for younger patientsHormone treatment for younger patients Pregnancy, nursing, and menopause usually bring Pregnancy, nursing, and menopause usually bring

a remission of symptomsa remission of symptoms Surgery to remove or destroy endometrial growthSurgery to remove or destroy endometrial growth Total hysterectomy with bilateral salpingo-Total hysterectomy with bilateral salpingo-

oophorectomy may be indicated in severe casesoophorectomy may be indicated in severe cases


An infection of a women’s pelvis An infection of a women’s pelvis Is self limiting to life-threateningIs self limiting to life-threatening

Pelvic Inflammatory Disease (PID)Pelvic Inflammatory Disease (PID)


Pelvic Inflammatory Disease Pelvic Inflammatory Disease (cont’d.)(cont’d.)

SymptomsSymptoms FeverFever ChillsChills MalaiseMalaise Foul-smelling vaginal dischargeFoul-smelling vaginal discharge BackacheBackache Painful, tender abdomenPainful, tender abdomen



DiagnosisDiagnosis There is tenderness during vaginal examThere is tenderness during vaginal exam Signs include elevated WBC and fever Signs include elevated WBC and fever Ultrasonography may be used to identify abcess Ultrasonography may be used to identify abcess

formationformation Laparoscopy is helpful to confirm diagnosisLaparoscopy is helpful to confirm diagnosis



TreatmentTreatment Aggressive antibiotic therapy to treat disease and Aggressive antibiotic therapy to treat disease and

help prevent complicationshelp prevent complications AnalgesicsAnalgesics Bed restBed rest

Without effective treatment, serious and life-Without effective treatment, serious and life-threatening complications can developthreatening complications can develop


Leiomyomas (fibroids)Leiomyomas (fibroids)

Leiomyomas are benign tumors of the smooth Leiomyomas are benign tumors of the smooth muscle within the uterusmuscle within the uterus


Leiomyomas (fibroids) Leiomyomas (fibroids) (cont’d.)(cont’d.)

SymptomsSymptoms Most do not cause any symptomsMost do not cause any symptoms If present, they often include: If present, they often include:

• Heavy and prolonged periodsHeavy and prolonged periods

• Pelvic pain and pressurePelvic pain and pressure

• ConstipationConstipation

• Frequent urinationFrequent urination

• Abnormal bleedingAbnormal bleeding


Leiomyomas (fibroids) Leiomyomas (fibroids) (cont’d.)(cont’d.)

TreatmentTreatment Depends on:Depends on:

• Severity of symptomSeverity of symptom

• Age of patientAge of patient

• Desire to bear childrenDesire to bear children

Treatment options:Treatment options: Surgery to remove tumors (childbearing age)Surgery to remove tumors (childbearing age) Hysterectomy (if bleeding continues)Hysterectomy (if bleeding continues) Ultrasound ablationUltrasound ablation Uterine artery embolizationUterine artery embolization


VaginitisVaginitis

The inflammation and/or infection of the vaginal The inflammation and/or infection of the vaginal tissuestissues

Fungal infection most common cause; or may be Fungal infection most common cause; or may be bacterial or protozoanbacterial or protozoan

Cervical infections may be mistaken for vaginitisCervical infections may be mistaken for vaginitis Postmenopausal women are also at greater riskPostmenopausal women are also at greater risk


Vaginitis Vaginitis (cont’d.)(cont’d.)

SymptomsSymptoms Vaginal dischargeVaginal discharge Itching/burning sensation of the vulvaItching/burning sensation of the vulva Fever may be presentFever may be present


Vaginitis Vaginitis (cont’d.)(cont’d.)

TreatmentTreatment Hormone therapyHormone therapy Antibiotic therapyAntibiotic therapy Vaginal antifungal/steroid creamVaginal antifungal/steroid cream

If vaginitis is contracted by sexual contact, If vaginitis is contracted by sexual contact, both partners must be treatedboth partners must be treated


Toxic Shock SyndromeToxic Shock Syndrome

An acute, systemic infection that has been An acute, systemic infection that has been associated with menstruating females who associated with menstruating females who use vaginal tamponsuse vaginal tampons


Toxic Shock Syndrome Toxic Shock Syndrome ((cont’d.)cont’d.)

CauseCause Fibers of super-absorbent tampon create an ideal Fibers of super-absorbent tampon create an ideal

environment for bacteria to produce toxinsenvironment for bacteria to produce toxins Staphylococcal infection is responsible for TSSStaphylococcal infection is responsible for TSS Can also occur in women using contraceptive Can also occur in women using contraceptive

sponges or diaphramssponges or diaphrams


Toxic Shock Syndrome Toxic Shock Syndrome (cont’d.)(cont’d.)

SymptomsSymptoms Sudden onset of high feverSudden onset of high fever HeadacheHeadache Sore throatSore throat RashRash Low blood pressure (hypotension)Low blood pressure (hypotension) ShockShock


Toxic Shock Syndrome Toxic Shock Syndrome (cont’d.)(cont’d.)

TreatmentTreatment Replacement of fluids to counteract shockReplacement of fluids to counteract shock Antibiotic therapyAntibiotic therapy

Without prompt treatment, condition can Without prompt treatment, condition can result in neurological, renal, and respiratory result in neurological, renal, and respiratory complications and deathcomplications and death


MenopauseMenopause

Represents the cessation of menstrual Represents the cessation of menstrual periodsperiods

Menstruation discontinues due to ovaries Menstruation discontinues due to ovaries producing less estrogen, which inhibits producing less estrogen, which inhibits ovulationovulation

Changes in pituitary hormone levels bring Changes in pituitary hormone levels bring physical and psychological changesphysical and psychological changes


Menopause Menopause (cont’d.)(cont’d.)

SymptomsSymptoms Fluctuations in menstrual cycleFluctuations in menstrual cycle Periods become lighter and less frequentPeriods become lighter and less frequent Hot flashes/night sweatsHot flashes/night sweats Vaginal dryness/skin changesVaginal dryness/skin changes



TreatmentTreatment Consists of management of symptomsConsists of management of symptoms Recent research links HRT with increased rates Recent research links HRT with increased rates

of:of:• Breast cancerBreast cancer

• Heart diseaseHeart disease

• StrokeStroke

• Blood clotsBlood clots



Alternate symptom management is Alternate symptom management is suggested:suggested: Consumption of soy products to replace missing Consumption of soy products to replace missing

hormones (high in isoflavones)hormones (high in isoflavones) Medications to strengthen bones, lower Medications to strengthen bones, lower

cholesterol, and help relieve vaginal drynesscholesterol, and help relieve vaginal dryness


Uterine ProlapseUterine Prolapse

Prolapse of the uterus is a downward Prolapse of the uterus is a downward displacement of the uterus from its normal displacement of the uterus from its normal location in the bodylocation in the body

The uterus becomes prolapsed when the The uterus becomes prolapsed when the pelvic floor muscles and ligaments become pelvic floor muscles and ligaments become extremely overstretched or weakenedextremely overstretched or weakened


Uterine Prolapse Uterine Prolapse (cont’d.)(cont’d.)


Uterine Prolapse Uterine Prolapse (cont’d.)(cont’d.)

TreatmentTreatment Kegel exercise to strengthen the pelvic floor Kegel exercise to strengthen the pelvic floor

musclesmuscles Weight lossWeight loss High-fiber diet High-fiber diet Insertion of supportive uterine device (pessary)Insertion of supportive uterine device (pessary) Surgery (for serious prolapse)Surgery (for serious prolapse)


RectoceleRectocele

Protrusion of the rectum into the posterior Protrusion of the rectum into the posterior portion of the vaginaportion of the vagina

Occurs when the posterior wall of the vagina Occurs when the posterior wall of the vagina is weakenedis weakened

Could result from trauma to the area during Could result from trauma to the area during childbirthchildbirth


Rectocele Rectocele (cont’d.)(cont’d.)

SymptomsSymptoms A bearing-down feelingA bearing-down feeling ConstipationConstipation Incontinence of gas/fecesIncontinence of gas/feces Difficulty with eliminating fecesDifficulty with eliminating feces


Rectocele Rectocele (cont’d.)(cont’d.)

TreatmentTreatment Surgical repair of the posterior wall of the vaginaSurgical repair of the posterior wall of the vagina Prognosis is good with surgical repairPrognosis is good with surgical repair


Cervical CancerCervical Cancer

Malignant cell growth that is located in the Malignant cell growth that is located in the cervix regioncervix region

Most cervical cancers are squamous cell Most cervical cancers are squamous cell carcinomas and occur in the area between carcinomas and occur in the area between the uterus and vagina.the uterus and vagina.


Cervical Cancer Cervical Cancer (cont’d.)(cont’d.)

SymptomsSymptoms Abnormal Pap smear test resultAbnormal Pap smear test result Watery, bloody vaginal dischargeWatery, bloody vaginal discharge Bleeding between menstrual periods and/or after Bleeding between menstrual periods and/or after

intercourse or after menopauseintercourse or after menopause



Advanced stage symptoms include:Advanced stage symptoms include:• Pelvic and lower back painPelvic and lower back pain

• Blood in urineBlood in urine

• Painful urinationPainful urination

• Rectal bleedingRectal bleeding



Risk factorsRisk factors Not having routine Pap smearsNot having routine Pap smears Exposure to human papilloma virus (HPV) most Exposure to human papilloma virus (HPV) most

often through unprotected sexual contactoften through unprotected sexual contact SmokingSmoking Low socioeconomic statusLow socioeconomic status



TreatmentTreatment Early stage:Early stage:

• Laser therapyLaser therapy

• Cryoablation (removal by freezing)Cryoablation (removal by freezing)

• Electrocoagulation (high-frequency electric current that Electrocoagulation (high-frequency electric current that destroys tissue)destroys tissue)

Later stage:Later stage:• The above plus radiation therapy and chemotherapyThe above plus radiation therapy and chemotherapy



PreventionPrevention Sexually active women should obtain annual Pap Sexually active women should obtain annual Pap

smear and pelvic examinationsmear and pelvic examination After three consecutive normal Pap smears, After three consecutive normal Pap smears,

screening can be less frequent as determined by screening can be less frequent as determined by doctordoctor

Screening can cease at age 65-70 for women with Screening can cease at age 65-70 for women with no risk factors no risk factors


Vaginal CancerVaginal Cancer

Malignancy found typically on the vaginal wallMalignancy found typically on the vaginal wall Vaginal cancer is rare and thought to be Vaginal cancer is rare and thought to be

related to:related to: HPV infectionHPV infection Prior history of gynecological malignancyPrior history of gynecological malignancy Advanced ageAdvanced age Multiple lifetime sexual partners Multiple lifetime sexual partners Early age at first intercourse Early age at first intercourse Cigarette smokingCigarette smoking


Vaginal Cancer Vaginal Cancer (cont’d.)(cont’d.)

SymptomsSymptoms Vaginal bleeding following sex or postmenopausalVaginal bleeding following sex or postmenopausal Foul-smelling or watery vaginal dischargeFoul-smelling or watery vaginal discharge Painful urinationPainful urination ConstipationConstipation Black, tarry stool Black, tarry stool Vaginal massVaginal mass



TreatmentTreatment Surgery – usually includes:Surgery – usually includes:

• HysterectomyHysterectomy

• Partial or complete removal of vaginaPartial or complete removal of vagina

• Partial or complete removal of lymph glands in the pelvic Partial or complete removal of lymph glands in the pelvic regionregion

Radiotherapy (may be used with surgery or may Radiotherapy (may be used with surgery or may be sufficient alone to treat early-stage vaginal be sufficient alone to treat early-stage vaginal cancers)cancers)



PreventionPrevention Regular Pap smearsRegular Pap smears Using barrier contraceptivesUsing barrier contraceptives Limiting the number of sexual partnersLimiting the number of sexual partners


Labial or Vulvar CancerLabial or Vulvar Cancer

Malignancy of the area external to the female Malignancy of the area external to the female genitalia (vulva) which includes the labium genitalia (vulva) which includes the labium (any of four folds of tissue on the outer (any of four folds of tissue on the outer portion)portion)


Labial or Vulvar Cancer Labial or Vulvar Cancer (cont’d.)(cont’d.)

SymptomsSymptoms Presence of a nodule or ulcer on:Presence of a nodule or ulcer on:

• Labia major and/or labia minorLabia major and/or labia minor

• ClitorisClitoris

Vulvar bleedingVulvar bleeding DischargeDischarge Painful urinationPainful urination Enlarged lymph node in the groinEnlarged lymph node in the groin



Risk factorsRisk factors Cigarette smokingCigarette smoking Presence of HPV, HIV, or herpes simplex virus Presence of HPV, HIV, or herpes simplex virus

type 2type 2 Prior history of cervical, endometrial, or breast Prior history of cervical, endometrial, or breast

cancercancer Northern European ancestryNorthern European ancestry



DiagnosisDiagnosis Requires excision biopsy of lesionRequires excision biopsy of lesion Examination of regional lymph nodes is mandatory Examination of regional lymph nodes is mandatory

to determine whether tumor has metastasized and to determine whether tumor has metastasized and may also include other tests to examine related may also include other tests to examine related areasareas



TreatmentTreatment Surgical removal of the growth and surrounding Surgical removal of the growth and surrounding

skin or complete or partial removal of the vulva skin or complete or partial removal of the vulva itself (vulvectomy)itself (vulvectomy)

Radiation and chemotherapy may be used in Radiation and chemotherapy may be used in combination with surgery for advanced-stage combination with surgery for advanced-stage cancercancer


Ovarian CancerOvarian Cancer

Malignancy of one or both ovariesMalignancy of one or both ovaries Ovarian cancer accounts for more deaths Ovarian cancer accounts for more deaths

than any other gynecological malignancy, than any other gynecological malignancy, because ovaries are located deep within the because ovaries are located deep within the pelvis and disease is often asymptomatic until pelvis and disease is often asymptomatic until the advanced stagethe advanced stage


Ovarian Cancer Ovarian Cancer (cont’d.)(cont’d.)

SymptomsSymptoms Enlargement of abdomen caused by accumulated Enlargement of abdomen caused by accumulated

fluidfluid Lower abdominal discomfortLower abdominal discomfort Lower back painLower back pain Irregular menstrual cyclesIrregular menstrual cycles Frequent urinationFrequent urination Painful intercoursePainful intercourse Persistent, vague digestive disturbancePersistent, vague digestive disturbance



Risk factorsRisk factors Age (most diagnosed between ages of 40 and 65)Age (most diagnosed between ages of 40 and 65) History of breast or ovarian cancerHistory of breast or ovarian cancer

Factors that may reduce riskFactors that may reduce risk PregnancyPregnancy Breast feedingBreast feeding Prolonged use of oral contraceptivesProlonged use of oral contraceptives Tubal ligationTubal ligation



DiagnosisDiagnosis Sometimes, but rarely, mass is discovered during Sometimes, but rarely, mass is discovered during

routine pelvic examroutine pelvic exam Laparotomy is indicated once mass is found to Laparotomy is indicated once mass is found to

confirm diagnosisconfirm diagnosis Abdominal or pelvic CT scans may be used to Abdominal or pelvic CT scans may be used to

identify degree of metastasisidentify degree of metastasis



TreatmentTreatment Early stage Early stage

• Removal of the ovaries, fallopian tubes, and uterusRemoval of the ovaries, fallopian tubes, and uterus

Advanced stageAdvanced stage• Removal of the above organs in combination with Removal of the above organs in combination with

chemotherapychemotherapy


Endometrial CancerEndometrial Cancer

Malignancy of the lining of the uterusMalignancy of the lining of the uterus It is the most common gynecological It is the most common gynecological

malignancymalignancy


Endometrial Cancer Endometrial Cancer (cont’d.)(cont’d.)

SymptomsSymptoms Abnormal uterine bleeding at the onset of or Abnormal uterine bleeding at the onset of or

following menopausefollowing menopause Abdominal pain (in advanced stage)Abdominal pain (in advanced stage)



DiagnosisDiagnosis Endometrial biopsyEndometrial biopsy Dilation and curettage (usually performed when Dilation and curettage (usually performed when

biopsy is inconclusive)biopsy is inconclusive)



TreatmentTreatment Early stage:Early stage:

• SurgerySurgery

Advanced stage:Advanced stage:• Radiation therapy in combination with surgeryRadiation therapy in combination with surgery


Complications in pregnancy can arise at any Complications in pregnancy can arise at any point in the gestational periodpoint in the gestational period

This further emphasizes the need for early This further emphasizes the need for early and continual prenatal care and patient and continual prenatal care and patient educationeducation

Condition and Complications of Condition and Complications of PregnancyPregnancy


Morning SicknessMorning Sickness

Temporary nausea and vomiting experienced Temporary nausea and vomiting experienced with the onset of pregnancy through the12th with the onset of pregnancy through the12th to 16to 16thth week week

Generally occurs during the dayGenerally occurs during the day


Morning Sickness Morning Sickness (cont’d.)(cont’d.)

CauseCause Elevated: Elevated:

• EstrogenEstrogen

• hCG levels (hormone produced early in pregnancy by hCG levels (hormone produced early in pregnancy by the placenta)the placenta)

Emotions may also trigger episodesEmotions may also trigger episodes


Morning Sickness Morning Sickness (cont’d.)(cont’d.)

TreatmentTreatment Eating smaller amounts of food and simple Eating smaller amounts of food and simple

hydrationhydration Rest, ginger, wrist bands, and vitamins B6 & B1 Rest, ginger, wrist bands, and vitamins B6 & B1

may helpmay help


Hyperemesis GravidarumHyperemesis Gravidarum

Severe nausea and excessive vomiting that Severe nausea and excessive vomiting that cause starvation during pregnancycause starvation during pregnancy The severity of episodes causes:The severity of episodes causes:

• Weight lossWeight loss

• DehydrationDehydration

• Fluid and electrolyte imbalanceFluid and electrolyte imbalance


Hyperemesis Gravidarum Hyperemesis Gravidarum (cont’d.)(cont’d.)

TreatmentTreatment Hospitalization (in severe cases)Hospitalization (in severe cases) Intravenous fluids and electrolyte replacementIntravenous fluids and electrolyte replacement IV antiemeticsIV antiemetics


Naturally occurring loss of a fetus before the Naturally occurring loss of a fetus before the 2020thth week of pregnancy week of pregnancy

About 10-15 percent of all pregnancies About 10-15 percent of all pregnancies terminate in spontaneous abortionterminate in spontaneous abortion

Majority are the result of a fetus with Majority are the result of a fetus with abnormal chromosomes abnormal chromosomes

Spontaneous Abortion (Miscarriage)Spontaneous Abortion (Miscarriage)


Spontaneous Abortion Spontaneous Abortion (cont’d.)(cont’d.)

SymptomsSymptoms Presents with vaginal bleedingPresents with vaginal bleeding Cramping pelvic painCramping pelvic pain Positive pregnancy testPositive pregnancy test Possible shock (pulse rate increases/blood Possible shock (pulse rate increases/blood

pressure decreases)pressure decreases)


Spontaneous Abortion Spontaneous Abortion (cont’d.)(cont’d.)

TreatmentTreatment If bleeding is not severe, the mother is treated If bleeding is not severe, the mother is treated

conservativelyconservatively Cervical suture (cerclage) to keep the cervix Cervical suture (cerclage) to keep the cervix

closedclosed Severe bleeding or partial expulsion of the Severe bleeding or partial expulsion of the

contents of thecontents of the uterus requires surgical uterus requires surgical intervention (D & C)intervention (D & C)


Ectopic PregnancyEctopic Pregnancy

Occurs when the fertilized ovum implants and Occurs when the fertilized ovum implants and grows in a structure outside the uterus, most grows in a structure outside the uterus, most often the fallopian tubeoften the fallopian tube

Ectopic pregnancies can develop when the Ectopic pregnancies can develop when the fertilized ovum is unable to enter the uterus fertilized ovum is unable to enter the uterus and is unable to implant and growand is unable to implant and grow


Ectopic Pregnancy Ectopic Pregnancy (cont’d.)(cont’d.)



SymptomsSymptoms Sudden onset of severe lower abdominal painSudden onset of severe lower abdominal pain Evidence of vaginal bleedingEvidence of vaginal bleeding No pain or pain on one sideNo pain or pain on one side Positive pregnancy testPositive pregnancy test Possible shock and deathPossible shock and death



TreatmentTreatment Laparoscopic surgery to terminate the pregnancy Laparoscopic surgery to terminate the pregnancy

and remove fetus and placentaand remove fetus and placenta Replace lost bloodReplace lost blood Methotrexate (instead of surgery) may be used to Methotrexate (instead of surgery) may be used to

terminate ectopic pregnancy that has not rupturedterminate ectopic pregnancy that has not ruptured


Premature LaborPremature Labor

Premature labor occurs before the 37th week Premature labor occurs before the 37th week of gestation (late second or early third of gestation (late second or early third trimester), or before the fetus has reached a trimester), or before the fetus has reached a viable weightviable weight

Symptoms include:Symptoms include: Contractions with cervical changeContractions with cervical change Increased vaginal dischargeIncreased vaginal discharge


Premature Labor Premature Labor (cont’d.)(cont’d.)

Predisposing conditionsPredisposing conditions Maternal infectionMaternal infection Uterine abnormalitiesUterine abnormalities Uterine fibroidsUterine fibroids Incompetent cervixIncompetent cervix

Certain risk factorsCertain risk factors Maternal ageMaternal age Gum diseaseGum disease InfectionInfection


Premature Labor Premature Labor (cont’d.)(cont’d.)

There is no effective treatmentThere is no effective treatment Medical management includes drug therapyMedical management includes drug therapy

MonitoringMonitoring• PatientPatient

• Fetal heartFetal heart

• Fetal movementFetal movement


Preeclampsia is a serious Preeclampsia is a serious disease characterized disease characterized by:by:

HypertensionHypertension Edema (in some cases)Edema (in some cases) Proteinuria (protein in Proteinuria (protein in

urine)urine)

Eclampsia is Eclampsia is characterized by:characterized by:

Grand mal seizure in a Grand mal seizure in a patient with patient with preeclampsiapreeclampsia

Preeclampsia (Toxemia) and EclampsiaPreeclampsia (Toxemia) and Eclampsia


Symptoms – PreeclampsiaSymptoms – Preeclampsia Sudden weight gainSudden weight gain Edema (primarily in face, hands, and feet)Edema (primarily in face, hands, and feet) Headaches Headaches Epigastric painEpigastric pain Blood pressure greater than 140/90Blood pressure greater than 140/90 Visual disturbancesVisual disturbances Elevated protein in urineElevated protein in urine Clonus Clonus

Preeclampsia (Toxemia) and Eclampsia Preeclampsia (Toxemia) and Eclampsia (cont’d.)(cont’d.)


Etiology – EclampsiaEtiology – Eclampsia UnknownUnknown More common in first pregnancyMore common in first pregnancy Improves after placenta is deliveredImproves after placenta is delivered



TreatmentTreatment Bed rest when symptoms are mildBed rest when symptoms are mild Frequent monitoring of baby and motherFrequent monitoring of baby and mother Monitoring of blood testsMonitoring of blood tests If symptoms are severe the patient may be If symptoms are severe the patient may be

hospitalized and monitoredhospitalized and monitored• Dark and quiet room (to prevent convulsions)Dark and quiet room (to prevent convulsions)

• Medications (to reduce blood pressure)Medications (to reduce blood pressure)



Abruptio PlacentaeAbruptio Placentae

The premature detachment of a normally The premature detachment of a normally positioned placenta occurring during positioned placenta occurring during pregnancypregnancy

When the placenta separates from the uterine When the placenta separates from the uterine wall too early during pregnancy, it causes the wall too early during pregnancy, it causes the mother to hemorrhage and fetal distressmother to hemorrhage and fetal distress


Abruptio Placentae Abruptio Placentae (cont’d.)(cont’d.)

SymptomsSymptoms Variable bleeding to hemorrhageVariable bleeding to hemorrhage Painful contractionsPainful contractions Abdominal painAbdominal pain Fetal distressFetal distress Fetal heart rate abnormalitiesFetal heart rate abnormalities Fetal deathFetal death



CauseCause In many cases cause is unknownIn many cases cause is unknown Trauma, infection, maternal vascular disease and Trauma, infection, maternal vascular disease and

multiple gestation are predisposing factorsmultiple gestation are predisposing factors Women with preeclampsia or who use Women with preeclampsia or who use

cocaine are at higher riskcocaine are at higher risk



TreatmentTreatment Hospitalization Hospitalization Bed restBed rest Labor may be induced if near term or bleeding is Labor may be induced if near term or bleeding is

excessiveexcessive Surgery if fetal heart rate declines or maternal Surgery if fetal heart rate declines or maternal

shock is indicatedshock is indicated Blood replacement may also be neededBlood replacement may also be needed


Placenta PreviaPlacenta Previa

Condition in which the placenta that is Condition in which the placenta that is implanted in the lower uterine segment implanted in the lower uterine segment encroaches on the internal cervical opening, encroaches on the internal cervical opening, causing bleedingcausing bleeding


Placenta Previa Placenta Previa (cont’d.)(cont’d.)

SymptomsSymptoms Painless, bright vaginal bleedingPainless, bright vaginal bleeding Abdomen is soft and not tenderAbdomen is soft and not tender Vital signs may indicate shockVital signs may indicate shock Fetal blood supply may be compromisedFetal blood supply may be compromised

Prior cesarean delivery and multiple gestation Prior cesarean delivery and multiple gestation increase riskincrease risk


Placenta Previa Placenta Previa (cont’d.)(cont’d.)

TreatmentTreatment Partial PP: Close observation and monitoring in Partial PP: Close observation and monitoring in

hospital settinghospital setting• Surgery is indicated when fetus is near term or bleeding Surgery is indicated when fetus is near term or bleeding

is profuseis profuse

Complete PP: Immediate surgical termination of Complete PP: Immediate surgical termination of the pregnancy (by cesarean section) to save both the pregnancy (by cesarean section) to save both mother and babymother and baby


Hydatidiform MoleHydatidiform Mole

An intrauterine tumorous growth that results An intrauterine tumorous growth that results from a genetic anomaly during fertilizationfrom a genetic anomaly during fertilization

The patient experiences symptoms that mimic The patient experiences symptoms that mimic pregnancy but usually no fetus developspregnancy but usually no fetus develops

What does develop is a mass of clear What does develop is a mass of clear grapelike vesiclesgrapelike vesicles


Hydatidiform Mole Hydatidiform Mole (cont’d.)(cont’d.)



SymptomsSymptoms Abnormalities noted on ultrasoundAbnormalities noted on ultrasound Uterus increases in size disproportionately to Uterus increases in size disproportionately to

gestational agegestational age Nausea and vomitingNausea and vomiting Greatly elevated hCG levelsGreatly elevated hCG levels



TreatmentTreatment Surgical intervention (D & C)Surgical intervention (D & C) Observation for hemorrhageObservation for hemorrhage If mole is found to be cancerous, patient may If mole is found to be cancerous, patient may

receive chemotherapyreceive chemotherapy


Diseases of the BreastDiseases of the Breast

Diseases of the breast can range from mild to Diseases of the breast can range from mild to fatal and necessitate frequent screening, fatal and necessitate frequent screening, monthly self-examinations, and routine monthly self-examinations, and routine mammograms mammograms

Although most diseases of the breast are Although most diseases of the breast are most common in women, men do experience most common in women, men do experience diseases of the breastdiseases of the breast


Cystic Disease of the BreastCystic Disease of the Breast

Common, benign breast disorder where Common, benign breast disorder where lumps and cysts develop in one or both lumps and cysts develop in one or both breastbreast

The most common female breast diseaseThe most common female breast disease The breasts are tender when pressure is The breasts are tender when pressure is

applied and some women may experience applied and some women may experience shooting pains in the breast tissueshooting pains in the breast tissue


Cystic Disease of the Breast Cystic Disease of the Breast (cont’d.)(cont’d.)

DiagnosisDiagnosis Physical examinationPhysical examination MammogramMammogram Ultrasonography may be used to determine Ultrasonography may be used to determine

whether lump is hollow or solidwhether lump is hollow or solid


Cystic Disease of the Breast Cystic Disease of the Breast (cont’d.)(cont’d.)

TreatmentTreatment No specific treatmentNo specific treatment Some physicians remove fluid (aspirate) from the Some physicians remove fluid (aspirate) from the

cysts with a needlecysts with a needle Other recommendations:Other recommendations:

• Wearing a firm, supporting braWearing a firm, supporting bra

• Avoid caffeineAvoid caffeine

• Avoid smokingAvoid smoking


MastitisMastitis

Inflammation of the breast tissue that occurs Inflammation of the breast tissue that occurs during lactation following birthduring lactation following birth

Often caused by a strep or staph infection Often caused by a strep or staph infection that invades the milk ducts and creates that invades the milk ducts and creates inflammation and blockageinflammation and blockage

Milk stagnates due to blockage and produces Milk stagnates due to blockage and produces a dull paina dull pain


Mastitis Mastitis (cont’d.)(cont’d.)

Symptoms found in breast post delivery:Symptoms found in breast post delivery: Sudden painSudden pain RednessRedness Sensation of heat (at either beginning or end of Sensation of heat (at either beginning or end of

lactation period)lactation period) Feels hot, doughy, and tough Feels hot, doughy, and tough Discharge from nippleDischarge from nipple


Mastitis Mastitis (cont’d.)(cont’d.)

TreatmentTreatment Firm, supportive braFirm, supportive bra Heat applied to the painful areaHeat applied to the painful area Progesterone creamProgesterone cream AntibioticsAntibiotics RestRest AnalgesicsAnalgesics Warm soaksWarm soaks


Fibroadenoma of the BreastFibroadenoma of the Breast

Non-tender benign tumor of the breast tissue Non-tender benign tumor of the breast tissue that is firm, round, and encapsulatedthat is firm, round, and encapsulated

Occurs most often in late adolescence or Occurs most often in late adolescence or early 20searly 20s


Fibroadenoma of the Breast Fibroadenoma of the Breast (cont’d.)(cont’d.)

TreatmentTreatment Surgical removal of the tumor under local Surgical removal of the tumor under local

anesthesiaanesthesia


Cancer of the BreastCancer of the Breast

Malignancy of the breast tissueMalignancy of the breast tissue The most common cancer and the second The most common cancer and the second

leading cause of cancer death among womenleading cause of cancer death among women


Cancer of the Breast Cancer of the Breast (cont’d.)(cont’d.)

Symptoms in breast:Symptoms in breast: LumpLump Swelling Swelling Tenderness of breastTenderness of breast Irritation or dimpling of breast skinIrritation or dimpling of breast skin Pain, ulceration, or retraction of nipplePain, ulceration, or retraction of nipple Asymmetrical appearanceAsymmetrical appearance



Risk factors include:Risk factors include: Increased ageIncreased age Female (100 times more frequent in women than Female (100 times more frequent in women than

men)men) Prolonged exposure to endogenous (from within) Prolonged exposure to endogenous (from within)

estrogenestrogen Long-term use (>5 years) of Long-term use (>5 years) of

estrogen/progesterone hormone replacement estrogen/progesterone hormone replacement therapytherapy

Prior history of breast cancerPrior history of breast cancer Alcohol usageAlcohol usage



DiagnosisDiagnosis 90 percent of cases are diagnosed through 90 percent of cases are diagnosed through

abnormal mammogram findingsabnormal mammogram findings Remainder detected by physical examinationRemainder detected by physical examination



If warranted, the following may also be used to If warranted, the following may also be used to confirm or clarify diagnosis:confirm or clarify diagnosis:• BiopsyBiopsy

• UltrasoundUltrasound

• MRI (contrast-enhanced)MRI (contrast-enhanced)

• Blood testsBlood tests

• Chest x-rayChest x-ray

• CT scan of the abdomen, pelvis, and boneCT scan of the abdomen, pelvis, and bone



Treatment options:Treatment options: Lumpectomy (removal of tumor and some Lumpectomy (removal of tumor and some

surrounding tissue)surrounding tissue) Mastectomy (removal of breast and nearby lymph Mastectomy (removal of breast and nearby lymph

modes)modes) Radiation therapyRadiation therapy Hormone therapyHormone therapy ChemotherapyChemotherapy



Lifestyle factors that may reduce risk:Lifestyle factors that may reduce risk:• Having a baby before the age of 25Having a baby before the age of 25

• Breast feeding for at least six monthsBreast feeding for at least six months

• Avoiding weight gainAvoiding weight gain

• Limiting alcohol consumptionLimiting alcohol consumption

• Taking tamoxifen for five yearsTaking tamoxifen for five years

• Regular mammogram screeningRegular mammogram screening

• Monthly self-examinationMonthly self-examination


Paget Disease of the BreastPaget Disease of the Breast

A breast lesion on the nipple that signifies the A breast lesion on the nipple that signifies the presence of malignant cellspresence of malignant cells

Advanced disease symptoms include:Advanced disease symptoms include: Crusting, serum, or bloody discharge from the Crusting, serum, or bloody discharge from the

nipplenipple Nipple retractionNipple retraction


Paget Disease of the Breast Paget Disease of the Breast (cont’d.)(cont’d.)

TreatmentTreatment Past conventional treatment has been a simple Past conventional treatment has been a simple

mastectomy but breast-saving procedures are mastectomy but breast-saving procedures are used with Paget disease.used with Paget disease.

Whole breast irradiation may be performed in Whole breast irradiation may be performed in addition to surgery.addition to surgery.

Essentials of Human Diseases and Conditions 4 th edition

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