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Reproductive System --Structure & Function
Terms in this set (279)
Differentiation of female & male genitalia begins
In the 8th week of embryonic development, when the gonads of genetically male embryos begin to secrete male sex hormones, primarily testosterone. Until that time, the primitive reproductive organs of males and females are homologous ( the same).
The structure and function of both male and female reproductive systems are controlled by
the hypothalamic-pituitary-ovarian axis, a set of complex neurologic & hormonal interactions that accelerate at puberty, causing sexual maturation and making reproduction possible.
Extra hypothalamic factors cause
the hypothalamus to secrete gonadotropin-releasing hormone (GnRh), which stimulates the anterior pituitary to secrete gonadotropin-follicle-stimulating hormone (FSH) & luteinizing hormone (LH)--which stimulate the gonads (ovaries or testes) to secrete female or male sex hormones.
Production of primitive female gametes (ova)
Occurs solely during fetal life. From puberty to menopause, one female gamete matures per menstrual cycle.
Production of the male gametes (sperm)
Begins at puberty; after that, millions are produced daily, normally for life.
THE FEMALE REPRODUCTIVE SYSTEM
The function of the reproductive system is to
Produce mature ova and, when they are fertilized, to protect and nourish them through embryonic and feal life and expel them at birtd.
the external female genitalia are
The mons pubis, labia majora, labia minora, clitoris, vestibule (urinary & vaginal openings), Bartholin glands, and Skene glands.
The internal female genitalia are
The vagina, uterus, fallopian tubes, & ovaries. All these organs are necessaty for reproduction; the ovaries are most essential because they produce the female gametes and female sex hormones.
A fibromuscular canal that receives the penis during sexual intercourse and is the exit route for menstrual fluids and products of conception. The vagina leads from the introitus (its external opening) to the cervical portion of the uterus.
is the hollow, muscular organ in which a fertilized ovum develops until birth.
the uterine walls have three layers:
The Endometrium (lining)
Myometrium (muscular layer)
Perimetrium (outer covering which is continuous with the pelvic peritoneum).
The endometrium proliferates (thickens & sloughs off in response to cyclic changes in levels of female sex hormones.
Narrow. lower portion of the uterus that opens into the vagina.
The two fallopian tubes
Extends from the uterus to the ovaries. Their function is to conduct ova from the spaces around the ovaries to the uterus. fertilization normally occurs in the fallopian tubes.
From puberty to menopause the ovaries are the site of:
(a) ovum maturation and release
(b) production of female sex hormones (estrogen & progesterone) and androgens.
The female sex hormones are involved in
sexual differentiation and development, the menstrual cycle, pregnancy, and lactation.
Are primarily male sex hormones but in women contribute to the pre pubertal growth spurt, pubic and axillary hair growth, and activation of sebaceous glands.
Estrogen (primarily estradiol) is produced by
Cells in the developing ovarian follicle (structure that encloses the ovum).
Progesterone is produced by
Cells of the corpus luteum, the structure that develops from the ruptured ovarian follicle after ovulation (ovum release).
Androgens are produced
Within the ovarian follicle, adrenal glands and adipose tissue.
The average menstrual takes 37 to 30 days & consists of three phases
follicular/proliferative phase, luteal/secretory phase, and menstruation. Named for endometrial changes.
Ovarian events of the menstrual cycle are controlled by
gonadotropins. High FSH levels stimulate follicle and ovum maturation (follicular phase); then a surge of LSH causes ovulation, which is followed by development of the corpus luteum (luteal phase).
Uterine (endometrial) events of the menstrual cycle are caused by
ovarian hormones. During the follicular phase of the ovarian cycle, estrogen produced by the follicle causes the endometrium to proliferate (proliferative phase). During the luteal phase, estrogen maintains the thickened endometrium, while progesterone causes it to develop blood vessels and secretory glands (secretory phase). As the corpus luteum degenerates, production of both hormones drops sharply, and the "starved" endometrium degenerates and sloughs off, causing menstruation.
Cyclic changes in hormone levels also cause thinning and thickening of the vaginal epithelium,
thinning and thickening of cervical secretions, and changes in basal body temperature.
THE MALE REPRODUCTIVE SYSTEM
The function ofthe male reproductive system is to
Produce male gametes (sperm) and deliver them to the female reproductive tract.
The external male genitalia are
The testes, epididymides, scrotum, and penis.
The internal genitalia are
The vas deferens, ejaculatory duct, prostatic and membranous sections of the urethra, seminal vessicles, prostate gland, and Cowper glands.
The testes (male gonads) are paired glands suspended within the scrotum. They have two functions
Spermatogenesis (sperm production) and production of male sex hormones (androgens, chiefly testosterone).
The epididymis is
a long coiled tube arranged in a comma-shapedcompartment that curves over the top and rear of the testis.
Receives sperm from the testis and stores them while they develop further. sperm travel the length of the epididymis and then are ejaculated into the vas deferens.
is a skin-covered fibromuscular sac that encloses the testes and epididymides, which are suspended within the scrotum by the spermatic cord.
keeps these organs at optimal temperatures for sperm survival (about1 to 2 degrees centigrade lower than body temperature) by contracting in cold environments and relaxing in warm environments.
A cylindrical organ consisting of three longitudinal compartments.
The male____ system is composed of the paired gonads, or testes, genital ducts,
accessory organs, and penis.
The testicular cells of a male embryo produce an____ , which prevents development of the uterus and fallopian tubes in the
male, and testosterone.
____stimulates the wolfﬁan ducts to develop into the epididymis, vas deferens, and seminal vesicles.
After descent of the testes, the___ closes almost completely.
The male___ consist of the seminal vesicles, the prostate gland, and the bulbourethral glands.
The____ is a ﬁbromuscular and glandular organ lying just inferior to the bladder.
___refers to the generation of spermatozoa or sperm.
____is produced and secreted by the interstitial Leydig's cells in the testes.
All or almost all of the actions of testosterone and other androgens result from increased
______in target tissues.
The term____ has been used to describe an ill-defined collection of symptoms in aging men, typically those older than
50 years, who have a relative or absolute hypogonadism associated with aging.
Expulsion of the sperm from the
Sperm move from the epididymis to the urethra
Persistent inability to achieve and maintain an erection
Initiation of spermatogenesis
Follicle stimulating hormone
Controls production of testosterone
Becomes engorged with blood during erection
Site of sperm production
region of the Y chromosome
1 . What are the endocrine changes that occur to
stimulate male puberty? 237
At approximately 10 or 11 years of age, the adenohypophysis, or anterior pituitary, under the control of the hypothalamus begins to secrete the gonadotropins that stimulate testicu-
lar function and cause the interstitial cells of Leydig to begin producing testosterone. Approximately the same time, hormonal stimulation induces mitotic activity of the germ cells
that develop in sperm. After cell maturation has begun, the testes begin to enlarge rapidly as the individual tubules grow. Full maturity
and spermatogenesis usually are attained by 15 or 16 years of age.
2. Describe the process of spermatogenesis.
In the ﬁrst stage of spermatogenesis, small and unspecialized diploid germinal cells located immediately adjacent to the tubular wall,
called the spermatogonia, undergo rapid mitotic division and provide a continuous source of new germinal cells. As these cells multiply,
the more mature spermatogonia divide into two daughter cells, which grow and become the primary spermatocytes—the precursors of
sperm. Over several weeks, large primary spermatocytes divide by a process called meiosis to form two smaller secondary spermatocytes.
The spermatid elongates into a spermatozoon, or mature sperm cell, with a head and tail.
3. What are the side effects of excess synthetic
Among the undesired or harmful effects of supraphysiologic doses of androgens are acne, decreased testicular size, and azoospermia.
These effects may persist for months after use of the agents has ceased. Because testosterone can be aromatized to estradiol in the periph-
eral tissues, androgens can also produce gynecomastia.
4. How does the penis become erect?
Erection involves the shunting of blood into the corpus cavernosum. It is controlled by the sympathetic, parasympathetic, and nonadren-
ergic-noncholinergic systems. Nitric oxide is the released locally as a mediator that produces relaxation of vascular smooth muscle. In the ﬂaccid state, sympathetic discharge
through -adrenergic receptors maintains contraction of the arteries that supply the penis and vascular sinuses of the corpora cavernosa
and corpus spongiosum. Parasympathetic stimulation produces erection by inhibiting sympathetic neurons that cause detumescence
and by stimulating the release of nitric oxide to effect a rapid relaxation of the smooth muscle in the sinusoidal spaces of the corpus cavernosum.
Sperm production by the testes is optimal at 2°C to 3°C below body temperature. Two sys-
tems of the body maintain the temperature of the testes at a level that allows sperm produc-
tion. What is the system that assists in maintaining the testes at a temperature that allows
Spermatozoa are produced in the seminiferous tubules of the testes and are moved through
the genital ducts to be stored in the ampulla of the vas deferens before ejaculation through the penis. Unlike the female egg, which remains brieﬂy fertile, spermatozoa can remain fertile for up to 42 days. Where are the spermatozoa stored so they maintain their fertility?
The ﬂuid from both the vas deferens and the vagina are acidic. From where do the alkaline secretions that allow mobilization of sperm come?
The penis is a soft, cylindrical shaft that is outside the body. When sexual stimulation
occurs the penis becomes ﬁrm and elongated due to blood being trapped in what?
a. Corpus spongiosum
c. Corpora cavernosa
Spermatogenesis, or generation of spermatozoa or sperm, begins at approximately 13
years of age and continues as long as a man remains fertile. It is in the seminiferous tubules that spermatogenesis takes place. Of what is the inner lining of the seminiferous tubules composed?
The male reproductive system is controlled by the hypothalamus and the anterior pituitary
gonadotropic hormones regulated by a negative feedback loop. What gonadotropic hormones regulate control of the male reproductive system?
a. Follicle-stimulating hormone and luteinizing hormone
The practice among some athletes of taking synthetic androgens to improve their performance in their sport can be physiologically harmful. What are the undesired effects of
the androgens taken by athletes in supraphysiologic doses? Mark all that apply.
a. Gynecomastia b. Azoospermia
Sperm begin their life in the Sertoli cells. What factor functions in releasing mature
spermatozoa from the Sertoli cells?
What can cause erectile dysfunction?
Dysfunction of pudendal nerves
The male reproductive system undergoes changes as aging occurs. What is the term
used to describe a relative or absolute hypogonadism associated with aging?
______and ____ are congenital
disorders of the penis resulting from embryologic defects in the development of the urethral groove and penile urethra.
What involves a localized and progressive ﬁbrosis of unknown origin that affects the tunica albuginea.
The manifestations of what disease include painful erection, bent erection, and the presence of a hard mass at the site of
Erection is under the control of ___ nervous system, and ejaculation and detumescence (penile relaxation) are under
the ____ nervous system control.
. Parasympathetic stimulation results in release
of ____, which causes relaxation of trabecular smooth muscle of the corpora cavernosa, permitting inﬂow of blood into the sinuses of the cavernosa at pressures approach-
ing those of the ______system?.
nitric oxide, arterial erectile dysfunction.
____is commonly classiﬁed as psychogenic, organic, or mixed psychogenic and organic.
Erectile dysfunction, now recognized as a marker for____ disease, is now considered a component of the____syndrome.
____is caused by impaired blood
ﬂow in the corpora cavernosa of the penis.
Several risk factors for___ have been suggested, including increasing age, poor hygiene, smoking, human papillo-
mavirus infections, ultraviolet radiation exposure, and immunodeﬁciency states.
The consequences of ___include
infertility, malignancy, testicular torsion, and the possible psychological effects of an empty
Sperm concentration and____ are
decreased in men with varicocele.
____is an inﬂammation of the epididymis, the elongated cordlike structure that
lies along the posterior border of the testis, whose function is the storage, transport, and maturation of spermatozoa.
___refers to a variety of inﬂammatory disorders of the prostate gland, some
bacterial and some not.
The manifestations of____include
fever and chills, malaise, myalgia, arthralgia,frequent and urgent urination, dysuria, and urethral discharge.
Acute bacterial prostatitis
As with other cancers, it appears that the development of___ cancer is a multi-step process involving genes that control cell
differentiation and growth.
Men with____ typically have recurrent urinary tract infections with persistence of the same strain of pathogenic bacteria in
prostatic ﬂuid and urine.
Chronic bacterial prostatitis
The cause of noninﬂammatory prostatitis is unknown, but because of the absence of
inﬂammation, the search for the cause of symptoms has been directed toward______sources.
Inﬂammation of the
the phimotic foreskin
Excess ﬂuid collects be-
tween the layers of the
Infection of the testes
Inﬂammation of the
Tightening of the pe-
Opening of the urethra
is on the dorsal surface
of the penis
abnormal, and painful
An age-related, non-
of the prostate gland
Benign prostatic hyperplasia.
What are some of the known causes of erectile
Neurogenic disorders, such as Parkinson disease, stroke, and cerebral trauma, often contribute to erectile dysfunction by decreasing
libido or preventing the initiation of erection. In spinal cord injury, the extent of neural impairment depends on the level, location, and extent of the lesion. Hormonal causes of erec-
tile dysfunction include a decrease in androgen levels owing to both primary and secondary hypogonadism. Common risk
factors for generalized penile arterial insufﬁciency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation.
How do drugs like Viagra treat erectile
Sildenaﬁl (Viagra) is a selective inhibitor of phosphodiesterase type 5 (PDE-5), the enzyme that inactivates cyclic guanosine monophos-
phate (cGMP). This acts by facilitating corporeal smooth muscle relaxation in response to sexual stimulation.
What is testicular torsion? What are the
Testicular torsion is a twisting of the spermatic cord that suspends the testis. Extravaginal torsion, which occurs almost exclusively in neonates, is the less common form. It occurs
when the testicle and the fascial tunicae that surround it rotate around the spermatic cord at a level well above the tunica vaginalis. The
torsion probably occurs during fetal or neonatal descent of the testes before the tunica adheres to the scrotal wall. Intravaginal torsion is considerably more common than
extravaginal torsion. It occurs when the testis rotates on the long axis in the tunica vaginalis. In most cases, congenital abnormalities of the tunica vaginalis or spermatic cord exist. The tunica vaginalis normally surrounds the testes and epididymis, allowing
the testicle to rotate freely in the tunica. Patients usually present in severe distress within hours of onset and often have nausea, vomit-
ing, and tachycardia. The affected testis is large and tender, with pain radiating to the inguinal area.
How are testicular cancers staged?
The clinical staging for testicular cancer is as follows:
stage I, tumor conﬁned to testes, epididymis, or spermatic cord;
stage II, tumor spread to retroperitoneal lymph nodes below
and stage III, metastases outside the retroperitoneal nodes or above the diaphragm.
How does benign prostatic hyperplasia cause
obstruction of the urethra?
The anatomic location of the prostate at the bladder neck contributes to the pathophysiology and symptomatology of benign prostatic hyperplasia (BPH). The two prostatic components to the obstructive properties of BPH and
development of lower urinary tract symptoms are dynamic and static. The static component of BPH is related to an increase in prostatic
size; it gives rise to symptoms such as a weak urinary stream, postvoid dribbling, frequency of urination, and nocturia. The dynamic component of BPH is related to prostatic smooth
muscle tone. 1-Adrenergic receptors are the main receptors for the smooth muscle component of the prostate.
How is prostate cancer diagnosed?
The diagnosis of prostate cancer is based on history and physical examination and conﬁrmed through biopsy methods. Transrectal ultrasonography is used to guide a biopsy needle and document the exact location of the biopsied tissue. Radiologic examination of the
bones of the skull, ribs, spine, and pelvis can be used to reveal metastases. Prostatic-speciﬁc
antigen (PSA) levels are important in the staging and management of prostatic cancer. In untreated cases, the level of PSA correlates with the volume and stage of disease.
In hypospadias, the treatment of choice is surgery to repair the defect. What inﬂuences the timing of the surgical repair? Mark all
Penile size, Psychological effects on a child, Aesthetic risk
Factors that influence the
timing of surgical repair include anesthetic risk, penile size, and the psychological effects of the surgery on the child. In mild cases, the surgery is done for cosmetic reasons only. In more severe cases, repair becomes essential for normal sexual functioning and to prevent the psychological sequelae of having malformed genitalia. Testicular involvement and presence of an abdominal hernia have no bearing on the timing of the surgery.
A 75-year-old man presents at the clinic complaining of pain during intercourse and an
upward bowing of his penis during erection. His history includes an inﬂammation of the
penis that was treated 3 months ago. The physician's physical examination of him notes beads of scar tissue along the dorsal
midline of the penile shaft. What would be the suggested diagnosis for this patient?
Peyronie disease involves a localized and progressive ﬁbrosis of unknown origin that affects the tunica albuginea (i.e., the tough, ﬁbrous sheath that surrounds the corpora cavernosa) of the penis The disorder is characterized initially by an inﬂammatory process that results in dense ﬁbrous plaque formation. The plaque usually is on the dorsal midline of the shaft, causing upward bowing of the shaft during erection. The other
answers are incorrect.
3. Priaprism (a prolonged painful erection not associated with sexual excitement) can occur
at any age. In boys, ages 5 to 10 years, what are the most common causes of priapism?
Sickle cell disease or neoplasms.
Priapism can occur at any age, in newborn the as well as other age groups. Sickle cell disease or neoplasms are the most common cause in boys between 5 and 10
years of age. Hemophilia and hypospadias are not linked to priapism in any age group.
4.Cryptorchidism, left untreated, is a high risk for testicular cancer and infertility. What are the treatment goals for boys with cryptorchidism?
Easier cancer detection.
The treatment goals for the boys with cryptorchidism include measures to enhance future fertility potential, placement of the gonad in a favorable place for cancer detection, and improved cosmetic
5. The mother of a 5-year-old boy brings him into the clinic because of a ﬁrm swelling
around one of his testes. What diagnosis is suggested?
Hydroceles are palpated as cystic masses that may attain massive proportions. With sufﬁcient ﬂuid, the mass may be mistaken for a solid tumor. Transillumination of the scrotum (i.e., shining a light through the scrotum to visualize its internal structures) or ultra-sonography can help to determine whether the mass is solid or cystic and whether the testicle
6. In the neonatal and pediatric population, there can be many physiologic problems with the male genitourinary system. What is the most common acute scrotal disorder
in the pediatric population?
common acute scrotal disorder in the
pediatric population is testicular torsion.
7. Epididymitis can be sexually transmitted, or it can be caused by a variety of other reasons,
including abnormalities in the genitourinary tract. What are the most common causes of epididymitis in young men without underlying
b. Chlamydia trachomatis and Neisseria gonorrhoeae.
Sexually transmitted acute epididymitis occurs mainly in young men without underlying genitourinary disease and ismost commonly caused by Chlamydia trachomatis and Neisseria gonorrhoeae. Candida
albicans and Escherichia coli are not the most common causes of epidiymitis in young men
without underlying genitourinary disease.
8. Testicular cancer is highly curable if found and treated early. What are signs of metasta-
tic spread of testicular cancer? Mark all that apply.
b. Back pain
c. Neck mass
Signs of metastatic spread
include swelling of the lower extremities, back pain, neck mass, cough, hemoptysis, or dizziness. Gynecomastia (breast enlargement)
may result from human chorionic go-
nadotropin (hCG)-producing tumors and occurs in about 5% of men with germ cell tumors. The other answers are not signs of metastatic spread of a testicular cancer.
9. A 40-year-old man presents at the clinic complaining of painful urination and rectal pain.
His vital signs are as follows: temperature
101.7F; blood pressure 105/74 mm Hg; pulse98; respiratory rate 22. While taking a history, you note that the patient has had chills, malaise, and myalgia. What would you suspect as a diagnosis?
c. Acute bacterial prostatitis.
The manifestations of acute bacterial prostatitis include fever and chills, malaise, myalgia, arthralgia, frequent and urgent urination, dysuria, and urethral discharge. Dull, aching pain often is present in the perineum, rectum, or sacrococcygeal region. The other answers are incorrect.
10. Although the cause of benign prostatic hyperplasia (BPH) is unknown, its incidence increases with age. In which ethnic group is BPH
d. African American.
The incidence of benign prostatic hyperplasia increases with advanced age and is highest in African Americans and lowest in native
The__is a rounded, skin-covered
fat pad located anterior to the symphysis pubis
The___are analogous to the male scrotum.
The____ begin anteriorly at the
hood of the clitoris and end posteriorly at the base of the vagina.
The female___is an erectile organ, rich in vascular and nervous supply.
The____functions as a route for
discharge of menses and other secretions.
The____is a thick-walled muscular organ, located between the bladder and the
The uterus is supported on both sides by four sets of ligaments: the ____ ligaments,which run laterally from the body of the
uterus to the pelvic sidewalls; the____ligaments, which run from the fundus laterally into each labium majus;
the_____ligaments, which run from the uterocervical junction to the sacrum; and the____ cervical ligaments.
BROAD, ROUND, UTEROSACRAL, TRANSVERSE
The___forms the major portion of the uterine wall.
The superﬁcial layer of the ____ is shed during menstruation and regenerated by cells of the basal layer.
The end of the____nearest the ovary forms a funnel-like opening with fringed, ﬁnger-like projections, called ﬁmbriae, which pick up the ovum after its release into the peritoneal cavity after ovulation.
The ovaries have a dual function: they store the female germ cells, or ova, and produce the female sex hormones,____and_____ .
Growth, prepubertal maturation, the reproductive cycle, and sex hormone secretion are regulated by___and___from the anterior pituitary gland.
The steroid____hormones enter
cells by passive diffusion, bind to speciﬁc receptor proteins in the cytoplasm, and then
move to the nucleus, where they bind to speciﬁc sites on the chromosomes.
Androgens can be converted to estrogens peripherally, especially in____.
Observational studies indicate a possible preventative role of estrogen in the development of Alzheimer disease through ___ mechanisms to prevent vascular injury, increased cerebral blood ﬂow, and altered brain activation.
The corpus luteum of the ovary secretes large amounts of____after
The local effects of progesterone on reproductive organs include the glandular development of the lobular and alveolar tissue of the breasts and the cyclic glandular development
of the _____.
As estrogen suppresses FSH, the actions of LH predominate, and the mature follicle bursts;the ____, with the corona radiata, is ejected from the
If fertilization does not take place, the corpus luteum atrophies and is replaced by white scar tissue called the___; the hormonal support of the endometrium is withdrawn and _____
Corpus albicans, Menstruation
In the event of fertilization, ____ is produced by the trophoblastic cells in the blastocyst and prevents luteal
Human chorionic gonadotropin
The functional layer of the _____
arises from the basal layer and undergoes proliferative changes and
The absence of ______ of cervical
mucus can indicate inadequate estrogen stimulation of the endocervical glands or inhibition of the endocervical glands by increased secretion of progesterone.
________ results from the gradual cessation of ovarian function and the resultant
diminished levels of estrogen.
Problems that can arise from menopause are a result of_____ and include vaginal dryness, urinary stress incontinence, urgency, nocturia, vaginitis, and urinary tract infection.
Consequences of long-term estrogen deprivation include ____ due to an imbalance in bone remodeling, and an increased risk for ____ disease, which is the leading cause of death for women after menopause.
The ______are specialized glandular structures that have an abundant shared nervous, vascular, and lymphatic supply.
____ stimulates increased vascularity of the breasts and the growth and extension of the ductile structures, causing "heaviness" of the breasts.
____ causes marked budding and growth of the alveolar structures.
Technique to examine properties of cervical mucus
Cessation of menstrual cycles
Pain accompanying the contractions associated with menses
Sebaceous glands that keep the nipple area soft and elastic
Generation of ova by
How and why is the vagina kept at an
Vaginal tissue usually is moist, with a pH maintained within the bacteriostatic range of 3.8 to 4.2. Glycogen is fermented to lactic acid
by the lactobacilli (i.e., Döderlein's bacilli) that are part of the normal vaginal ﬂora, accounting for the mildly acid pH of vaginal ﬂuid.
2. What relationship is there between body composition and a normal
Evidence indicates that a certain
minimal body weight (48 kg) and fat content (16%-24%) are necessary for menarche to occur and for the menstrual cycle to be maintained. This is supported by the observation of
amenorrhea in women with anorexia nervosa, chronic disease, and malnutrition and in those
who are long-distance runners. In women with anorexia nervosa, gonadotropin and estradiol secretion, including LH release and responsiveness to the hypothalamic
gonadotropin-releasing hormone (GnRH), can revert to prepubertal levels.
3. What is the cardioprotective effect of estrogen?
Estrogens have additional cardioprotective actions, including direct antiatherosclerotic effects on the arterial wall (augmentation of
vasodilating and antiplatelet aggregation factors such as nitric oxide and prostacyclin), vasodilation through endothelium-independent
mechanisms, antioxidant activity, reduced levels of angiotensin converting enzyme and
renin, reduction of homocysteine levels, improved peripheral glucose metabolism with subsequent decreased circulating insulin lev-
els, and direct effects on cardiac
4. What is the normal role of estrogen in female
Estrogens are necessary for normal female physical maturation. In concert with other hormones, estrogens provide for the reproductive processes of ovulation, implantation of the products of conception, pregnancy, parturition, and lactation by stimulating the development and maintaining the growth of the
accessory organs. In the absence of androgens, estrogens stimulate the intrauterine development of the vagina, uterus, and uterine tubes
from the embryonic müllerian system. They also stimulate the stromal development and ductal growth of the breasts at puberty. Estrogens are responsible for the accelerated puber-
tal skeletal growth phase and for closure of the epiphyses of the long bones; they contributeto the growth of axillary and pubic hair, and alter the distribution of body fat to produce
the typical female body contours, including the accumulation of body fat around the hips and breasts. Larger quantities of estrogen stimulate
pigmentation of the skin in the nipple,
areolar, and genital regions.
What were the posited beneﬁts of hormone replacement therapy? How has it been shown
to be incorrect?
Over the past four to ﬁve decades, hormone therapy (HT) became increasingly prescribed for postmenopausal women. Initially, HT was used only for symptom management and later for prevention of osteoporosis. During the 1990s, HT evolved to the status of replacement
for a vital hormone lost because of an endocrine organ failure (menopause). It was routinely offered to all postmenopausal women based on mounting evidence of preventive
beneﬁts in numerous areas. During this time, data from observational studies demonstrated a 50% reduction in coronary artery disease (CAD) mortality rates in women using HT.
Other demonstrated advantages of HT included a reduced risk of Alzheimer disease, decreased risk of colon cancer, less tooth loss, and lower incidence of macular degeneration.
Unopposed estrogen can lead to the development of endometrial hyperplasia which, in some cases, can increase a woman's risk for endometrial cancer. The Women's Health Initiative study to investigate the potential effects of HT was stopped after 5.2 years of data analysis when it was found that the risk of breast cancer crossed the predetermined safety boundary and it was determined that the risks of HT
outweighed its beneﬁts. In addition to breast cancer risk, CAD, stroke, and venous thromboembolic disease were all increased. On the
positive side, a reduction was noted in colorectal cancer and hip fractures among the women using HT.
How does lactation occur?
During lactation, milk is secreted by
alveolar cells, which are under the inﬂuence of the anterior pituitary hormone prolactin. Milk ejection from the ductile system occurs in response to the release of oxytocin from the
posterior pituitary. The suckling of the infant provides the stimulus for milk ejection. Suckling produces feedback to the hypothalamus, stimulating the release of oxytocin from the posterior pituitary. Oxytocin causes contraction of the myoepithelial cells lining the alveoli and ejection of milk into the
1. The female external genitalia are made up of several components. What is in the vestibule of the female external genitalia?
a. Bartholin glands
b. Skene glands
c. Cowper glands
d. Bulbourethral glands
a. Bartholin glands.
The area between labia minora is
called the vestibule. Located in the vestibule are the urethral and vaginal openings and Bartholin's lubricating glands. The other an-
swers are incorrect.
2. Estrogen stimulates the vaginal wall to
thicken and increase the secretion of glyco-
gen. What causes the glycogen in the vagina
to ferment to lactic acid?
a. Escherichia coli
b. Döderlein's bacilli
c. Candida albicans
d. Staphylococcus aureus
The glycogen is fermented to lactic acid by the lactobacilli (i.e., Döderlein's
bacilli), which are part of the normal vaginal ﬂora, accounting for the mildly acid pH of vaginal ﬂuid. The other answers are incorrect.
3. The perimetrium reﬂects over the bladder wall and forms what?
a. Opening to fallopian tubes
b. The external cervical os
c. The pouch of Douglas
d. Bartholin's pouch
c. The pouch of Douglas.
Anteriorly, the perimetrium is reﬂected over the bladder wall, forming the
vesicouterine pouch; posteriorly, it extends to form the cul-de-sac, or pouch of Douglas.
The other answers are incorrect.
4. The fallopian tubes are narrow tubes that attach bilaterally to the uterus. Within the fal-
lopian tube, fertilization of the ovum takes place. The end of the fallopian tube nearest the ovary is funnel-like. What are the fringed, ﬁnger-like projections around the funnel-
shaped opening of the fallopian tube called?
a. Fallopian ﬁngers
The end of the fallopian tube nearest the ovary forms a funnel-like opening with fringed, ﬁnger-like projections called
ﬁmbriae, which pick up the ovum after its release into the peritoneal cavity after ovulation. The other answers are incorrect
5. The ovarian follicle becomes luteinized once ovulation has taken place. As the corpus lu-
teum, the now empty follicle produces what?
a. Estrogen and progesterone
b. Follicle-stimulating hormone and luteiniz-
c. Testosterone and estrogen
d. Glycogen and testosterone
a. Estrogen & progesterone.
After ovulation, the follicle becomes luteinized; as the corpus luteum, it produces estrogen and progesterone to support the endometrium until conception occurs or the cycle begins again. The other
answers are incorrect.
6. The ovaries secrete both
estrogen and progesterone. What is one function of progesterone in the body?
a. Causes moderate retention of sodium and water
b. Increases body temperature at ovulation
c. Reduces levels or rennin
d. Enhances the coagulability of
b. Increases body temp at ovulation.
Although the mechanism is un-
certain, progesterone increases basal body
temperature and is responsible for the in-
crease in body temperature that occurs with
ovulation. The other answers are effects of
7. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) produce profound effects on the ovaries. What do high levels of estrogen do to FSH and LH?
a. cFSH and TLH
b. cLH and Testradiol
c. c LH and T FSH
d. c FSH and T renin
c. LH & T FSH.
High levels of estrogen exert a negative feedback effect on FSH, inhibiting multiple follicular development and causing an increase in LH
levels. The other answers are incorrect.
8. Menopause signals the end of
the menstrual cycle. It is caused by the end of ovarian function and the decreased levels of estrogen this
brings to the body. What are problems that can arise from the onset of menopause? Mark all that apply.
b. Urinary stress incontinence
c. Upper respiratory infection
e. Urinary retention
a, Nocturia b, Urinary stress incontinence, d. Vaginitis.
Problems that can arise as a result of urogenital atrophy include vaginal dryness, urinary stress incontinence, urgency, nocturia, vaginitis, and urinary tract infection. URI, an upper respiratory infection, has nothing to do with menopause and urinary retention is not a problem that arises from menopause.
9. What are the small bumps or projections on the areolar surface called?
a. Cowper cells
b. Bartholin gland
c. Climacteric glands
d. Montgomery tubercles
d. Montgomery tubercles.
The small bumps or projections on the areolar surface known as Montgomery's tubercles are sebaceous glands that keep the nipple area soft and elastic. The other answers are
10. Lactation occurs under the control of the anterior pituitary hormone prolactin. What causes the ejection of milk from the ductile system in the breast?
Milk ejection from the ductile system occurs in response to the release of oxytocin from the posterior
pituitary. The other answers are incorrect.
. Diseases of the external genitalia are similar to those that affect ______skin else-where in the body.
. The ___is particularly susceptible to skin infections because it is constantly being
exposed to secretions and moisture.
A ______is a ﬂuid-ﬁlled sac that results from occlusion of the duct system in Bartholin's gland
Bartholin gland cyst.
______ presents as thickened, gray-white plaques with an irregular surface.
The normal vaginal ____depends on the delicate balance of hormones and bacterial ﬂora.
_______represents an inﬂammation of the vagina that is characterized by vaginal
discharge and burning, itching, redness, and swelling of vaginal tissues.
The most common symptom of vaginal carcinoma is abnormal______.
During ______, the newly developed squamous epithelial cells of the cervix are vulnerable to development of dysplasia
and genetic change if exposed to cancer producing agents
_______cancer is readily detected and, if detected early, is the most easily cured of all the cancers of the female
Untreated ______may extend to include the development of pelvic cellulitis, low back pain, dyspareunia, cervical stenosis, dysmenorrhea, and ascending infection of the uterus or fallopian tubes.
______are the most common lesions of the cervix.
A preponderance of evidence suggests a causal link between _____infection and cervical cancer.
______is the condition in which functional endometrial tissue is found in ectopic sites outside the uterus.
____is the condition in which en-
dometrial glands and stroma are found within the myometrium, interspersed between the smooth muscle ﬁbers.
_____and _____, which con-
sists of dilating the cervix and scraping the uterine cavity, is the deﬁnitive procedure for diagnosis of endometrial cancer because it provides a more thorough evaluation.
Dilation , curettage
Uterine ____are benign neoplasms of smooth muscle origin.
_____is a polymicrobial infection of the upper reproductive tract associated with sexually transmitted and endogenous organisms.
Pelvic inflammatory disease
_____occurs when a fertilized ovum
implants outside the uterine cavity, the most common site being the fallopian tube.
Disorders of the ovaries frequently
cause ______and _____problems.
______syndrome is characterized by varying degrees of menstrual irregularity, signs of hyperandrogenism, and
Most women with polycystic ovary syndrome (PCOS) have elevated ____levels with normal estrogen and follicle-stimulating hormone (FSH) production.
_________tumors are common, most are benign, but malignant tumors are the leading cause of death from reproductive cancers.
The most signiﬁcant risk factor for ovarian cancer appears to be ________ -the length of time during a woman's life when
her ovarian cycle is not suppressed by pregnancy, lactation, or oral contraceptive use.
The breast cancer susceptibility genes, BRACA1 and BRCA2, which are ____ genes, are incriminated in approximately 10% of hereditary ovarian cancers despite being
identiﬁed as breast cancer genes.
________is the herniation of the rectum into the vagina.
Uterine prolapse is the bulging of the uterus into the vagina that occurs when the____________
ligaments are stretched.
Removal of the uterus through the vagina with appropriate repair of the vaginal wall
often is done when ________is accompanied by cystocele or rectocele.
Primary ______is the failure to menstruate by 15 years of age or by 13 years of age if failure to menstruate is accompanied by absence of secondary sex characteristics.
____is the secretion of breast milk in a nonlactating breast.
_________is inﬂammation of the breast.
_______are ﬁrm, rubbery, sharply deﬁned round masses in breast tissue.
________changes usually present as nodular granular breast masses that are more
prominent and painful during the luteal or progesterone-dominant portion of the menstrual cycle.
________disease presents as an eczemoid lesion of the nipple and areola.
_________is the inability to conceive a child after 1 year of unprotected intercourse.
Insertion of radioactive materials
into the body .
Commonly called ﬁbroids.
Unexplained vulvar pain
Herniation of the bladder into the vagina .
Inﬂammation of the vagina that
occurs after menopause
Surgical procedure used to scrape out the surface of the
Inﬂammation of the cervix
Excessive menstrual bleeding.
Vaginal cytology to detect vaginal or cervical cancer.
Inﬂammatory disease of the vulva.
Bleeding between periods
Absence of menstruation
Heavy bleeding during and between menstrual periods.
What measures should be taken to avoid vaginal infections?
The prevention and treatment of vaginal infections depend on proper health habits and accurate diagnosis and treatment of ongoing infections. Measures to prevent infection include those that keep the genital area clean
and dry, maintenance of normal vaginal ﬂora and healthy vaginal mucosa, and avoidance of contact with organisms known to cause vaginal infections. Perfumed products, such as feminine deodorant sprays, douches, bath powders, soaps, and even toilet paper, can be irritating and may alter the normal vaginal ﬂora. Tight clothing prevents the dissipation of body heat and evaporation of skin moisture and promotes favorable conditions for irritation and the growth of pathogens.
Cotton undergarments that can withstand hot water and bleach (a fungicide) may be preferable for
women to prevent such infections.
What is the only approved vaccine for cervical cancer and how does it work?
A quadrivalent vaccine (Gardisil) to prevent infection with the HPV subtypes 6, 11, 16, and 18 was licensed by the US Food and Drug Ad-
ministration (FDA) in June 2006. The vaccine targets the two strains of HPV (HPV 16 and18), which are responsible for 70% of cervical
cancer, and the two most common benign strains (HPV 6 and 11), which account for up to 90% of genital warts. The vaccine is targeted
for females between the ages of 9 to 26 years, optimally before initiating sexual activity. Clinical studies provided to the FDA have conﬁrmed that the vaccine appears safe and effective in inducing long-term immunity to HPV.
What is the normal method of detecting/diagnosis cervical cancer?
Diagnosis of cervical cancer requires pathologic conﬁrmation. Papanicolaou smear results
demonstrating squamous intraepithelial lesion (SIL) often require further evaluation by colposcopy during which a biopsy sample may be obtained from suspect areas and examined microscopically. An alternate diagnostic tool in
areas where colposcopy is not readily available is a noninvasive photographic technique, in which a cervicography camera is used to pho-tograph the cervix. The projected cervicogram (a slide made from the ﬁlm) is then sent for expert evaluation. In one study, the cer-
vicogram was found to give a greater yield of cervical intraepithelial neoplasia (CIN) than Papanicolaou smear alone in patients with previous abnormal Papanicolaou smears.
What are the three most prominent theories of the pathogenesis of endometriosis?
4. The ﬁrst theory, the regurgitation/implantation theory suggests that menstrual blood con-
taining fragments of endometrium is forced upward through the fallopian tubes into the peritoneal cavity. Retrograde menstruation is not an uncommon phenomenon, and it is unknown why endometrial cells implant and grow in some women but not in others. A second theory, the metaplastic theory, proposes that dormant, immature cellular elements,
spread over a wide area during embryonic development, persist into adult life and then differentiate into endometrial tissue. A third theory, the vascular/lymphatic theory, suggests that the endometrial tissue may metastasize through the lymphatics or vascular system. Genetic and immune factors also have been studied as contributing factors to the development of endometriosis.
What is the mechanism of infection in pelvic inﬂammatory disease?
The organisms ascend through the endocervical canal to the endometrial cavity, and then to the tubes and ovaries. The endocervical canal is slightly dilated during menstruation,
allowing bacteria to gain entrance to the uterus and other pelvic structures. After entering the upper reproductive tract, the organsms multiply rapidly in the favorable environment of the sloughing endometrium and ascend to the fallopian tube.
Why should you be concerned about the future of your patient with polycystic ovarian
There is also concern that women with PCOS who are anovulatory do not produce signiﬁcant amounts of progesterone. This, in turn, may subject the uterine lining to an unop-posed estrogen environment, which is a signiﬁcant risk factor for development of endometrial cancer. Although an association with breast cancer and ovarian cancer has been reported, PCOS has not been conclu-
sively shown to be an independent risk factor for either malignancy.
Describe the functional anatomy of normal pelvic support.
The uterus and the pelvic structures are maintained in proper position by the uterosacral, round, broad, and cardinal ligaments. The two cardinal ligaments maintain the cervix in its
normal position. The uterosacral ligaments hold the uterus in a forward position and the broad ligaments suspend the uterus, fallopian tubes, and ovaries in the pelvis. The vagina is encased in the semirigid structure of the strong supporting fascia. The muscular ﬂoor
of the pelvis is a strong, slinglike structure that supports the uterus, vagina, urinary bladder, and rectum.
Describe the alterations in a normal period and name the hormone thought to be responsible.
Dysfunctional menstrual cycles are related to alterations in the hormones that support normal cyclic endometrial changes. Estrogen
deprivation causes retrogression of a previously built-up endometrium and bleeding. Such bleeding often is irregular in amount and duration, with the flow varying with the time and degree of estrogen stimulation and with the degree of estrogen withdrawal. A lack of progesterone can cause abnormal menstrual bleeding; in its absence, estrogen
induces development of a much thicker endometrial layer with a richer blood supply.
The absence of progesterone results from the failure of any of the developing ovarian follicles to mature to the point of ovulation, with the subsequent formation of the corpus luteum and production and secretion of progesterone.
What is the genetic component of breast cancer?
Approximately 5% to 10% of all breast cancers are hereditary, with genetic mutations causing up to 80% of breast cancers in women under age 50. Two breast cancer susceptibility
genes—BRCA1 on chromosome 17 and BRCA2 on chromosome 13—may account for most inherited forms of breast cancer. BRCA1 is known to be involved in tumor suppression. A woman with known mutations in BRCA1 has a lifetime risk of 60% to 85% for breast cancer and an increased risk of ovarian cancer. BRCA2 is another susceptibility gene that carries an elevated cancer risk similar to that with BRCA1.
Bartholin gland obstruction of the ductal system will cause a cyst. Sometimes the cyst becomes infected and an abscess occurs. What is
the surgical procedure to remove a Bartholin cyst or abscess when a wedge of vulvar skin is removed along with the cyst wall?
Marsupialization. Rationale: Surgical treatment of a Bartholin cyst that has abscessed or blocks the entroitis
is called marsupialization, aprocedure that involves removal of a wedge of vulvar skin and the cyst wall.
There are two types of vulvar cancer. One type is found in older women, and one type is
found in younger women, generally younger than 40 years of age. The type found in younger women thought to be caused by which of the following?
Human papillomavirus (HPV). Rationale: One-third to one-half of vulvar intraepithelial neoplasm (VIN) cases appear to be caused by the cancer-promoting potential of certain strains (subtypes 16 and 18) of HPV
that are sexually transmitted and are associated with the type of vulvar cancer found in younger women. The other answers are not thought to be associated with vulvar cancer
in younger women.
3. Vaginal infections can occur in young girls before menarche. These infections generally have nonspeciﬁc causes. What are some of the causes of vaginal infections in premenarchal girls?
Presence of foreign bodies; Intestinal parasites; Poor hygiene. Rationale: In premenarchal girls, most vaginal infections have nonspeciﬁc causes,
such as poor hygiene, intestinal parasites, or the presence of foreign bodies. Vaginal deodorants and tampons are not associated.
The endocervix is covered with large branched mucous secreting glands. During
the menstrual cycle, they undergo functional changes, and the amount and properties of the mucus that they secret varies according to the stage of the cycle. When one of these
glands gets blocked, what kind of cyst forms within the cervix?
Nabothian cysts. Rationale: Blockage of the mucosal glands results in trapping of mucus in the deeper glands leading to the formation of dilated cysts within the cervix, called nabothian cysts.
Endometriosis is the condition where endometrial tissue is found growing outside of the uterus in the pelvic cavity. What are risk factors for endometriosis?
Periods longer than 7 days and increased menstrual pain. Rationale: Risk factors for endometriosis may include early menarche; regular periods with shorter cycles (<27 days), longer duration (>7 days), or heavier ﬂow; increased menstrual pain; and other ﬁrst-degree relatives with the condition. Late menarche, light ﬂow, and periods shorter than 7 days are not risk factors for endometriosis.
Leiomyomas, or intrauterine ﬁbroids, are the most common form of pelvic tumor.
Approximately half the time leiomyomas are asymptomatic. What are the symptoms of
leiomyomas that are not asymptomatic?
Anemia and urinary frequency. Rationale: Leiomyomas are asymptomatic approximately half of the time and may be discovered during a routine pelvic examina-
tion, or they may cause menorrhagia (excessive menstrual bleeding), anemia, urinary frequency, rectal pressure/constipation, abdominal distention, and, infrequently, pain.
Diarrhea and urinary retention are not symptoms of leiomyomas.
An 18-year-old woman presents at the clinic complaining new onset breakthrough bleeding, even though she is on contraceptives.
What contraceptive use, along with new-onset breakthrough bleeding, has been associ-
ated with pelvic inﬂammatory disease.
Depo-Provera. New-onset breakthrough bleeding in women who are on oral contraceptives or medroxyprogesterone contraceptive injection (Depo-Provera) has been associated with pelvic inﬂammatory disease (PID). The other forms of contraception have not been associ-
ated with PID.
Ectopic pregnancies are true gynecologic emergencies and are considered the leading
cause of maternal death in the ﬁrst trimester.What diagnostic test would you expect to have
ordered for a suspected ectopic pregnancy?
Ultrasonography followed by serial hCG tests. Rationale: Diagnostic tests for ectopic pregnancy include a urine pregnancy test, ultrasonography, and B-human chorionic gonadotropin (hCG), the hormone produced
by placental cells) levels. Serial - hCG tests may detect lower-than-normal hCG production. Transvaginal ultrasound studies after 5 weeks' gestation may demonstrate an
empty uterine cavity or presence of the gestational sac outside the uterus. In a comparison of various protocols for diagnosing ectopic pregnancy, ultrasound followed by serial hCG levels was found to yield the best re-
Polycystic ovary syndrome is an endocrine disorder and a common cause of chronic anovulation. In addition to the clinical manifestations of PCOS, long-term health problems, including cardiovascular disease and diabetes, have been
linked to PCOS. What drug has emerged as an important part of PCOS treatment?
Metformin.: Metformin, an insulin-sensitizing drug, used with or without ovulation-inducing medications, is emerging as an important component of polycystic ovary syndrome
(PCOS) treatment. Dehydroepiandrosterone
(DHEAS) is often found in the blood of
women with PCOS; Methotrexate is used in ectopic pregnancies; Spironalactone, an an timineralocorticoid, is used in treating PCOS, not mineralocorticoids.
Ovarian cancer, once thought to be asymptomatic, has now been shown to produce nonspeciﬁc symptoms, which makes the diagnosis of ovarian cancer difﬁcult. What symptoms
are believed to have a strong association to ovarian cancer?
Difﬁculty eating, Bloating Abdominal or pelvic pain : Symptoms believed to have a strong correlation with ovarian cancer include abdominal or pelvic pain, increased abdominal size or bloating, and difﬁculty eating
or feeling full quickly after ingesting food. Increased intestinal gas and an increased appetite are not highly correlated with ovarian cancer.
Uterine prolapse is a disorder of pelvic support and uterine position. It can range in
severity from a slight descent of the uterus into the vagina, all the way to the entire uterus protruding through the vaginal opening. In women who want to have children or in older women who are at signiﬁcant risk if
surgery is performed, what device is inserted to hold the uterus in place?
A pessary. pessary can be inserted to hold the uterus in place and it may stave off surgical intervention in women who want to have children or in older women for whom the surgery may pose a signiﬁcant health risk.
In primary dysmenorrheal when contraception is not desired, what is the treatment of choice?
Ibuprofen : Although analgesic agents, such as aspirin and acetaminophen, may relieve
minor uterine cramping or low back pain, prostaglandin synthetase inhibitors (e.g., ibuprofen, naproxen, mefenamic acid, in-
domethacin) are more speciﬁc for dysmenorrhea and the treatment of choice, if contraception is not desired.
Mastitis is an inﬂammation of the breast that can occur at any time. What is the treatment
Application of heat or cold. Rationale: Treatment for mastitis symptoms
include application of heat or cold, excision, aspiration, mild analgesics, antibiotics, and asupportive brassiere or breast binder.
Fibrocystic changes in the breast are not uncommon. How is the diagnosis of ﬁbrocystic
Ultrasonography and mammography Rationale: Diagnosis of ﬁbrocystic changes is made by physical examination, mammography, ultrasonography, and biopsy (i.e., as-
piration or tissue sample). Patient history and galactography are not used to diagnose ﬁbrocystic changes in the breast.
Cancer of the breast is the most common cancer in women. Many breast cancers are found
by women themselves while doing breast self examination. When should postmenopausal
women perform breast self-examination?
Any day of the month. Rationale: Postmenopausal women and women who have had a hysterectomy can
perform the examination any day of the month.
The causes of infertility can be in either the male or the female. Male tests for infertility require a specimen of ejaculate that is collected when?
After 3 days of abstinence. Rationale: The specimen is best collected by masturbation into a sterile container after 3 days of abstinence.
Couples who are being treated for infertility often choose to try in vitro fertilization (IVF). When using this technique, the eggs are inseminated with sperm in a culture dish. After a period of time, the ova are evaluated for
signs of fertilization. If signs of fertilization are present, when are the fertilized eggs placed in the woman's uterus?
48 to 72 hours after egg retrieval. Rationale: Between 12 and 24 hours after insemination, the ova are evaluated for signs of fertilization. If signs are present, the ova are returned to the incubator, and 48 to 72 hours after egg retrieval, the fertilized eggs are placed into the woman's uterus by means
of a transcervical catheter.
STIs can selectively infect the ____ tissues of the external genitalia, primarily cause vaginitis in women, or they can produce both genitourinary and systemic effects.
STIs can be transmitted by an infected mother to a___ , causing congenital defects or death of the child.
Fetus or newborn
______are caused by the human papillomavirus (HPV).
Genital warts typically present as soft, raised, ﬂeshy lesions on the ______, including the penis, vulva, scrotum, perineum, and
_____is one of the most common causes of genital ulcers in patients in the
6. Herpes simplex virus type-1 and herpes simplex virus type-2 are _______viruses, meaning that they grow in neurons and share
the biologic property of latency.
Herpes simplex virus _____is responsible for greater than 90% of recurrent genital herpes infections.
The initial symptoms _____of infections include tingling, itching, and pain in the genital area, followed by eruption of
small pustules and vesicles
Primary Genital Herpes
______is a common viral disease of the skin that gives rise to multiple umbilicated papules.
Candida albicans is the most commonly identiﬁed organism in vaginal ______infections, but other Candida species, such as
Candida glabrata and Candida tropicalis may also be present.
______can reside in the paraurethral glands of both sexes.
_____ vaginosis is the most prevalent form of vaginal infection seen by health care
_______ exist in two forms: elementary bodies, which are the infectious particles capable of entering uninfected cells, and the initiator or reticulate bodies, which multiply by binary ﬁssion to produce the inclusions
identiﬁed in stained cells.
Untreated chlamydial infection results in _____ damage in female patients.
The ______is a pyogenic (i.e., pus-forming) gram-negative diplococcus that evokes inﬂammatory reactions characterized by purulent exudates.
_____is spread by direct contact with an infectious moist lesion, usually through sexual intercourse.
Anaerobic protozoan that can be
transmitted sexually .
Development of large, tender, and sometimes ﬂuctuant
inguinal lymph nodes called buboes.
Excess of lactobacilli
Disease of the external genitalia and lymph nodes
Large mononuclear cells ﬁlled with intracytoplasmic gram-negative rods.
Spirochete responsible for syphilitic infection
Obligate intracellular bacterial pathogen that resembles a virus
but, as does bacteria, has RNA and DNA and is susceptible to
In late stages, it is associated with the development of
enlarged and elephantoid external genitalia
1 . What are the risk factors for acquiring the human papillomavirus (HPV) and how is it spread?
Risk factors for acquiring the human papillomavirus (HPV) include young age (<25 years), early age of ﬁrst intercourse (<16 years), increasing numbers of sex partners,and having
a male partner with multiple sex partners. HPV infection can occur with any type of vaginal or anal penetration and is common in men having sex with men and women having sex with women. Oral-genital and manual-genital contact are less likely means of spreading this infection.
2. How do herpes simplex virus (HSV)-1 and HSV-
2 spread, and where do they reside in the body?
Herpes simplex virus (HSV) is transmitted by contact with infectious lesions or secretions. Herpes simplex virus type-1 is transmitted by oral secretions, and infections frequently
occur in childhood. Herpes simplex virus type-1 can be spread to the genital area by autoinoculation after poor handwashing or through oral-genital contact. Herpes simplex
virus type-2 usually is transmitted by sexual contact but can be passed to an infant during childbirth if the virus is actively being shed from the genital tract. In genital herpes, the virus ascends through the peripheral nerves to the sacral dorsal root ganglia. The virus can remain dormant in the dorsal root ganglia, or it can reactivate, in which case the viral particles are transported back down the nerve root to the skin, where they multiply and cause a lesion to develop.
3. What are the risk factors for developing a candidiasis infection?
Reported risk factors for the overgrowth of Candida albicans include recent antibiotic therapy,
which suppresses the normal protective bacterial ﬂora; high hormone levels owing to preg-
nancy or the use of oral contraceptives, which cause an increase in vaginal glycogen stores; and uncontrolled diabetes mellitus or human immunodeﬁciency virus (HIV) infection, because they compromise the immune system.
4. What are the potential complications of trichomoniasis in male and female patients?
Trichomoniasis is a risk factor for HIV transmission and infectivity in both men and women. In women, it increases the risk of tubal infertility and atypical pelvic inﬂammatory disease, and it is associated with adverse outcomes, such as premature birth in pregnant women.Trichomonads attach easily to mucous membrane. They can serve as vectors for the spread of other organisms, carrying pathogens attached to their surface into the fallopian tubes. In men, it is a common cause of non-gonococcal urethritis and is a risk factor for in-
fertility, altering sperm motility and viability. It has also been associated with chronic prostatitis.
What are the sex-speciﬁc manifestations of gonorrhea?
Men are more likely to be symptomatic than women. In men, the initial symptoms include urethral pain and a creamy yellow, sometimes
bloody, discharge. The disorder may become chronic and affect the prostate, epididymis, and periurethral glands. Rectal infections are common in homosexual men. In women, rec-
ognizable symptoms include unusual genital or urinary discharge, dysuria, dyspareunia, pelvic pain or tenderness, unusual vaginal bleeding
(including bleeding after intercourse), fever, and proctitis. Symptoms can occur or increase during or immediately after menses because
the bacterium is an intracellular diplococcus that thrives in menstrual blood but cannot survive long outside the human body. There may be infections of the uterus and development of acute or chronic infection of the fallopian tubes, with ultimate scarring and sterility.
6. What is the clinical course of syphilis6. What is the clinical course of syphilis?
The clinical disease is divided into three stages: primary, secondary, and tertiary. Primary syphilis is characterized by the appearance of a chancre at the site of exposure. These
lesions usually are painless and located at the site of sexual contact. The timing of the second stage of syphilis varies even more than that of the ﬁrst, lasting from 1 week to 6
months. The symptoms of a rash, fever, sore throat, stomatitis, nausea, loss of appetite, and inﬂamed eyes may come and go for a year but
usually last for 3 to 6 months. Secondary manifestations can include alopecia and genital condylomata latum. Condylomata latum are
elevated, red-brown lesions that can ulcerate and produce a foul discharge. They are 2 to
3 cm in diameter, contain many spirochetes, and are highly infectious. Tertiary syphilis is a delayed response of the untreated disease. It can occur as long as 20 years after the initial
infection. When syphilis does progress to the symptomatic tertiary stage, it commonly takes one of three forms: development of localized
destructive lesions called gummas, development of cardiovascular lesions, or development of central nervous system lesions.
1 . After inoculation with human papilloma virus (HPV), genital warts may begin to grow.They usually manifest as soft, raised ﬂeshy lesions on the external genitalia of either a male or female patient. What is the incubation period for HPV induced genital warts?
6 weeks to 8 months.
The incubation period for HPV-
induced genital warts ranges from 6 weeks to 8 months, with a mean of 2 to 3 months.
Primary genital herpes is a sexually transmitted infection (STI) caused by either the herpes
simplex virus type 1 (HSV-1) or the herpes simplex virus type 2 (HSV-2). What are the initial symptoms of primary genital herpes infections?
Itching; Genital pain; Small pustules.
The initial symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Chancres and eczema like lesions are
not indicative of genital herpes.
There is no known cure for genital herpes and methods of treatment are often symptomatic. Pharmacologic treatment of genital herpes includes which drugs?
The antiviral drugs acyclovir, valacyclovir, and famciclovir have become the cornerstone for the treatment of genital herpes.
Chancroid or soft chancre is a highly contagious STI usually found in the Southeast Asian and North African populations. What is the recommended treatment for chancroid?
Erythromycin. Rationale: Chancroid organisms have shown resistance to treatment with sulfamethoxazole alone and to tetracycline. The
Centers for Disease Control and Prevention (CDC) recommends treatment with azithromycin, erythromycin, or ceftriaxone.
A male patient presents at the clinic with ﬂu-like symptoms, weight loss of 10 pounds
without trying. On physical examination, he is found to have splenomegaly and large, tender, ﬂuctuant inguinal lymph nodes. While taking the nursing history, it is discovered that the patient prefers male sexual partners, and 2 weeks ago he had small, painless papules. What disease would the nurse suspect the client has?
Lymphogranuloma venereum (LGV).
An important characteristic of Lymphogranuloma venereum (LGV) is the early (1 to 4 weeks later) development of large, tender, and sometimes ﬂuctuant inguinal lymph nodes called buboes.
Candidiasis is a leading cause of vaginal infections. Which antifungal agent is not available
without prescription to treat candidiasis?
Antifungal agents, such as clotrimazole, miconazole, butaconazole, and ter-
conazole, in various forms, are effective in treating candidiasis. These drugs, with the exception of terconazole, are available without
prescription for use by women who have had a previously conﬁrmed diagnosis of candidiasis.
Trichomoniasis is an STI that can occur in either sex. Men carry the protozoan in the ure-
thra and prostate and remain asymptomatic. This anerobic protozoan can cause a number
of complications. What is a risk factor for trichomoniasis in both men and women?
Trichomoniasis can cause a number of complications. It is a risk factor for HIV transmission and infectivity in both men and women. In women, it increases the risk tubal infertility and atypical pelvic inﬂammatory disease, and it is associated with adverse outcomes, such as premature birth, in preg-
Bacterial vaginosis is the most common vaginal infection seen by health care providers.
What is the predominant symptom of bacterial vaginosis?
Grayish white discharge with a ﬁshy odor.
:* The predominant symptom of bacterial vaginosis is a thin, grayish-white discharge that has a foul, ﬁshy odor.
Gonorrhea is an STI that affects both men and women. When diagnosing gonorrhea,
specimens should be collected from the appropriate site and inoculated onto the correct
medium. From what sites can specimens be collected when diagnosing gonorrhea?
Oropharynx; Urethra; Anal canal.
A specimen should be col-
lected from the appropriate site (i.e., endo-cervix, urethra, anal canal, or oropharynx), inoculated onto a suitable medium, and transported under appropriate conditions.
The nasal passages and the exocervix are not sites that would be used for the collection of Neisseria gonorrhoeae.
Tertiary syphilis is a delayed response of untreated primary syphilis that can occur as long
as 20 years after the primary disease. When tertiary syphilis progresses to a symptomatic
stage, it can produce localized necrotic lesions. What are these lesions called?
The syphilitic gumma is a peculiar, rubbery, necrotic lesion that is caused by noninﬂammatory tissue necrosis. Gummas can occur singly or multiply and vary in size from microscopic lesions to large, tumorous masses. They most commonly are found in
the liver, testes, and bone. Chancres occur in primary syphilis. Chancroid is a sexually transmitted infection (STI).
Sets found in the same folder
Male Reproductive System (parts/functions)
Anatomy of the Reproductive System
Chapter 54 Disorders of the Female Reproductive Sy…
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