Female Reproductive System Review

Female Reproductive System

• The uterus is a muscular organ where a fertilized ovum may implant and develop.
• The cervix is the opening into the uterus and the neck of the uterus.
• The external os is the opening from the vagina, filled with thick mucus, which prevents vaginal flora from ascending into the uterus.
• The internal os is the opening of the fallopian tubes (oviducts) from the ovaries to the uterus.
• Ovaries produce ova and estrogen and progesterone hormones.
• Breasts consist of glands that produce colostrum and milk for newborns, and adipose tissue.

Structural Abnormalities

• Uterine displacement or prolapse occurs when the cervix or uterus drops into the vagina.
• First-degree prolapse: cervix drops into the vagina.
• Second-degree prolapse: cervix lies at the opening to the vagina.
• Third-degree prolapse: uterus and cervix protrude through the vaginal orifice.
• Early stages of prolapse may be asymptomatic, while advanced stages cause discomfort, infection, and decreased mobility.

Menstrual Disorders

• Amenorrhea: absence of menstruation, which may be primary or secondary.
• Primary form may be genetic.
• Menstrual abnormalities include:
  • Dysmenorrhea: painful menstruation caused by excessive release of prostaglandins.
  • Premenstrual syndrome (PMS): symptoms include breast tenderness, weight gain, abdominal distension, irritability, emotional liability, sleep disturbances, depression, headache, and fatigue.
  • Abnormal bleeding: menorrhagia, metrorrhagia, polymenorrhea, and oligomenorrhea.

Carcinoma of the Breast

• Incidence increases after age 20 years.
• Most cases occur in women between ages 50 and 69 years.
• Can metastasize quickly to brain, lungs, bone, and liver.
• Most tumors are unilateral and occur in the upper outer quadrant.
• Types of carcinoma:
  • Ductal carcinoma: most common type, arising from ductal epithelial cells.
  • Lobular carcinoma: arising from lobular epithelial cells.
• Predisposing factors:
  • First-degree relative with the disease.
  • Strong genetic predisposition (BRCA1 and BRCA2).
  • Longer and higher exposure to estrogen.
  • Nulliparous or late first pregnancy.
  • Lack of exercise.
  • Smoking.
  • High-fat diet.
  • Radiation therapy to the chest.
  • Cancer of the uterus, ovaries, or pancreas.

Carcinoma of the Cervix

• Most cases are caused by human papillomavirus (HPV) infection.
• Vaccines now exist against the causative strains of HPV.
• Routine Pap smears of cervical cells are important in identifying early, treatable stages of the disease.
• Development of carcinoma:
  • In situ: non-invasive stage.
  • Cervical intraepithelial neoplasia (CIN): stage 3.

Carcinoma of the Uterus

• Most common in postmenopausal women.
• Early indicator is painless vaginal bleeding or spotting.
• Risk factors:
  • Age > 50 years.
  • High-dose estrogen hormone treatment without progesterone.
  • Obesity.
  • Diabetes.
• Pap smear does not detect this cancer.
• Types of carcinoma:
  • Adenocarcinomas: arising from glandular epithelium.
  • Leiomyosarcomas: arising from connective tissue or muscle, with a poor prognosis.

Endometriosis

• Endometrial tissue occurs outside the uterus.
• Ectopic endometrium responds to cyclical hormone changes.
• Bleeding leads to inflammation and pain.
• Fibrous tissue may cause adhesions and obstructions of the involved structures.
• Treatment:
  • Hormonal suppression.
  • Surgical removal of ectopic tissue.

Infections

• Candidiasis (vaginitis): causes red and swollen, intensely pruritic mucous membranes and a thick, white, curdlike discharge.
• Pelvic inflammatory disease (PID):
  • Infection of uterus, fallopian tubes, and/or ovaries.
  • May be acute or chronic.
  • Infection usually originates as an ascending infection from the lower reproductive tract.
  • Most infections arise from sexually transmitted diseases, nonsterile abortions, or childbirth.
• Signs and symptoms:
  • Pelvic pain (lower abdominal).
  • Increased temperature.
  • Pain increases with walking.
  • Guarding (tensing the abdominal wall).
  • Nausea and vomiting.
  • Leukocytosis.
  • Purulent discharge may be present.

Ovarian Cysts

• A variety of types occur.
• Physiological type lasts about 8 to 12 weeks and disappears without complications.
• Usually multiple, small, fluid-filled sacs.
• Go away on their own usually.
• If bleeding occurs, more serious inflammation occurs.
• Requires surgical intervention.
• Ultrasound or laparoscopy for identification.

Ovarian Cancer

• No reliable screening available.
• Large mass detected by pelvic examination.
• Transvaginal ultrasound.
• Only 25% are diagnosed in early stage.
• Considered a silent tumor.
• Few diagnosed in the early stage.
• Research is ongoing to identify markers for serum diagnosis.
• Types of carcinoma:
  • Serous: most common type.
  • Mucinous: second most common type.
  • Endometrioid: third most common type.
• Risk factors:
  • Obesity.
  • BRCA1 gene.
  • Early menarche.
  • Nulliparous or late first pregnancy.
  • Use of fertility drugs.
  • Oral contraceptives containing progesterone are somewhat protective.

Infertility

• Cause may be a female condition, male condition, or a combination of both.
• Associated with hormonal imbalances.
• Age of parents.
• Structural abnormalities-small or divided uterus.
• Infections (STDs for example).
• Chemotherapy-can reduce viability of sperm or egg.
• Change in vaginal pH due to too much douching, thick cervical mucus, antibodies against sperm.
• Idiopathic (no known cause).
• Smoking/secondhand smoke.

Bacterial Infections

• Chlamydial infections:
  • Caused by Chlamydia trachomatis.
  • Treatment is doxycycline and azithromycin.
  • Males-urethritis and epididymitis.
  • Females-often asymptomatic until PID or infertility develops.
  • Newborns may be infected during birth.
• Gonorrhea:
  • Caused by Neisseria gonorrhoeae.
  • Many strains have become resistant to penicillin and tetracycline.
  • Males-most common site is urethra, which is inflamed.
  • Females-frequently asymptomatic (infects endocervical canal).
  • PID and infertility are serious complications.
  • May infect the eyes of the newborn, causing irreversible damage and blindness.
• Syphilis:
  • Caused by Treponema pallidum, a spirochete.
  • Primary stage-presence of chancre at site of infection.
  • Genital region, anus, oral cavity.
  • Painless, firm, ulcerated nodule.
  • Occurs about 3 weeks after exposure.
  • Lesion heals spontaneously but client is still contagious.
  • Secondary stage-if untreated, a flulike illness occurs, with a widespread symmetrical rash.
  • Latent stage-may persist for years.
  • Transmission may occur in the first few years of this stage.
  • Tertiary syphilis-irreversible changes.
  • Gummas in organs and major blood vessels.
  • Dementia, blindness, motor disabilities.

Viral Infections

• Genital herpes:
  • Caused by HSV-2 or HSV-1.
  • HSV-1 possible with oral sex.
  • Lesions similar to HSV-1.
  • Recurrent outbreaks of blister-like vesicles on the genitalia.
  • Preceded by tingling or itching sensation.
  • Lesions are extremely painful.
  • After acute stage, virus migrates back to dorsal root ganglion.
  • Infectivity greater when symptoms are present.
  • Reactivation is common and may be associated with stress, illness, menstruation.
  • Antiviral drugs are used for treatment and prevention of transmission.
  • Infection is considered lifelong.
• Condylomata acuminata (genital warts):
  • Caused by HPV.
  • Incubation period may be up to 6 months.
  • Disease may be asymptomatic.
  • Warts vary in appearance.
  • Warts can appear wherever contact with virus has occurred.
  • Warts can be removed by different methods.
  • May predispose to cervical or vulvar cancer.
  • Most common STD and can be spread in non-sexual ways.
• Trichomoniasis:
  • Caused by Trichomonas vaginalis, a protozoan parasite.
  • Localized infection.
  • Men-usually asymptomatic.
  • Women-may be subclinical.
  • Flares up when microbial balance in vagina shifts.
  • Causes intense itching.
  • Yellow/green discharge, foul smelling.
  • Systemic treatment necessary for both partners.