Those disorders which involve the structures of the human female and male reproductive systems.
Female system
Disorders of the female reproductive system may involve the ovaries, Fallopian tubes, uterus, cervix, vagina, or vulva.
Failure of the ovaries to form normally results in short stature, sterility, and lack of development of female secondary sex characteristics, such as breast growth, fat deposition in buttocks and thighs and mons pubis, and female escutcheon. Destruction of the ovaries after puberty results in loss of fertility, cessation of menses, loss of secondary sex characteristics, and osteoporosis. See also Osteoporosis.
Neoplastic enlargement of the ovary can be cystic or solid, benign or malignant. Malignant ovarian tumors are commonly asymptomatic in their early stages, and may be quite widely spread in the pelvic and abdominal cavity before they are discovered. See also Ovarian disorders; Ovary.
Endometriosis, which is a condition involving the presence of ectopic endometrial tissue, can affect the ovaries. Endometriosis can be found as large “chocolate” cysts of the ovary, called endometriomas, or small “blue domed” cysts; both are filled with old, dark brown blood. Tiny implants of endometriosis commonly called powder burns also occur on the surface of the ovaries, on other pelvic peritoneum, and over the Fallopian tubes and uterus as well. Endometriomas of the ovary may be painful, or may rupture and cause diffuse pelvic pain, while the smaller endometrial implants may cause severe pain with menstrual periods, generalized pelvic pain, pain with intercourse, and infertility.
Inflammation is the most common disorder of the Fallopian tubes, and if it is repeated or severe, destruction of the tubal lining with closure of the outer ends of the tubes can occur. This inflammation can be caused by several organisms. Sterility commonly results because the tube is permanently closed to passage of egg and sperm. The second most common problem involving the tube is pregnancy. The egg is fertilized in the outer portion of the tube and descends to implant in the uterus, but in some cases the passage is delayed and the conceptus attaches to the wall of the tube. The tube has a small lumen and thin wall, and the growing pregnancy quickly enlarges and grows through the tube, leading usually to rupture and hemorrhage into the peritoneal cavity. See also Pregnancy disorders.
Developmental abnormalities can occur during formation of the uterus. The Fallopian tubes might not join at all, or might join partially from the cervical end upward. Septae or walls in the vagina and uterus can also occur. These abnormalities are more common in females who are exposed to diethylstilbesterol (DES) during the mother's pregnancy. The muscle (myometrium) and lining (endometrium) of the uterus are susceptible to various problems, including tumors, infections, and hormonal derangements. Benign tumors of the myometrium (fibroids) are a common disorder, producing irregular enlargement of the uterus and sometimes causing pain, obstruction of the urinary tract, and heavy vaginal bleeding. The uterus can be one site of a significant infection which produces fever and pain and usually involves other organs, such as ovaries and tubes. Hormonal abnormalities resulting in anovul can lead to overgrowth and irregular shedding of the endometrium. Pregnancy usually proceeds uneventfully, but certain accidents of pregnancy, such as threatened, incomplete, or missed abortion, can produce irregular bleeding and some uterine discomfort. See also Pregnancy; Uterus.
Infection of the endocervical glands with gonococcus or chlamydia trachomatis agent can occur. This may be asymptomatic, except for producing a mucopurulent discharge, or it may cause pain when the cervix is manipulated, particularly during intercourse. The infection can ascend from this area into the internal genital organs and adjacent structures. The cervix can be affected by malignant tumors which can be adenocarcinomas, or tumors of the glandular cells, or more commonly squamous tumors. Cervical cancer is associated with several factors, including early age at first coitus, multiple sex partners, especially at an early age, smoking, and infection with certain subtypes of human papilloma virus. There is no single factor that “causes” this cancer, but rather a combination of these factors is critical. Papanicolaou smears are used to detect early changes suggestive of this cancer. Further evaluation is by low-power magnification, called colposcopy, and biopsy. See also Gonorrhea.
Developmental abnormalities of the vagina may include imperforate hymen, septae, both vertical and horizontal, and complete failure of development. Inflammation of the lining of the vagina can be due to several common organisms. Specific chemical treatment is available for each of these entities. Postmenopausal women can experience atrophy or shrinkage of the vagina and mucosa secondary to estrogen deprivation. This produces itching, bleeding, and pain with intercourse. Estrogen therapy can relieve these symptoms. The vaginal support can be weakened through childbirth, or may simply be naturally poor, allowing the bladder and rectum to bulge inward, and the cervix and uterus to protrude from the introitus. This condition can cause a variety of symptoms, including involuntary loss of urine with a cough or laugh, inability to move the bowels without mechanically pushing the stool out, and a sensation of pelvic heaviness. Intravaginal devices called pessaries may improve support, but surgical correction may be necessary. Vaginal cancer can occur, but it is rare, and cervical cancer can also involve the vagina. Treatment is usually surgical. Vaginal trauma can lead to significant bleeding. Penetrating straddle injuries can occur, and trauma with intercourse or childbirth can produce lacerations. Surgical repair is usually undertaken. Vaginismus, or painful spasm of the muscular sidewalls of the vagina, can occur, making intercourse painful.
Infection of the female external genitalia can be diffuse or localized, involving bacteria, viruses, or fungal agents. Inflammation can be caused by allergic reactions to soap, powders, semen, lubricant, or even clothing.
Male system
The principal organs of the male reproductive system are the testicles, epididymis, vas deferens and seminal vesicles, prostate gland, urethra, and penis.
During fetal life the testicles form in the abdominal cavity near the kidneys and migrate down into the scrotum. Failure of descent permanently damages the sperm-producing cells, but allows the interstitial cells which produce hormones to survive. Other causes of male infertility are organic problems which block passage of seminal fluid or interfere with sperm production. The testes are sites of malignant tumors which carry a high mortality rate. Undescended testicles are more susceptible to malignant transformation, and for that reason should be removed when discovered, and appropriate hormonal replacement instituted. The membranes covering the testicle can become filled with fluid, a condition known as hydrocele.
The major disorder of the epididymis is infection and inflammation, which can lead to scarring and permanent blockage of the ducts.
The vas deferens and seminal vesicles are rarely afflicted by disease, although the network of veins surrounding the vas deferens can become engorged and tortuous, and is called a variococoele.
Inflammation and development of small calculi are relatively minor ailments of the prostate. Benign overgrowth of this gland is the most common and troublesome complaint. This enlargement results in constriction of the urethra, which obstructs urinary outflow and leads to an increasing residual of urine in the bladder. Cancer of the prostate is another relatively frequent problem in older males. This tumor spreads primarily to bones, where it is markedly painful.
Inflammation is the chief disorder of the urethra, causing dysuria and a discharge.
Inflammation (balanitis) or narrowing (phimosis) of the foreskin, which covers the glans penis, can occur and may interfere with urination. Viral infections can produce warty growths (condyloma acuminata) or painful ulcers (herpetic lesions) of the glans or shaft of the penis, and a syphilitic infection can result in the firm, painless ulcer known as a chancre. See also Herpes; Syphilis.
Disorders of erectile capability range from tumescence unaccompanied by sexual desire (Peyronie's disease, priapism) to impotence, both psychologic and secondary to old age. Carcinoma can arise from the surface epithelium of the penis and spread both locally and via the lymphatic system to the nodes of the groin. This disease is virtually unknown in populations where males are circumcised at birth. See also Infertility; Oncology; Reproductive system; Reproductive technology.
