Male Reproductive System Disorders

Male Reproductive System Disorders

Inflammations and Infections

• Prostatitis refers to the infection or inflammation of the prostate gland.
• Prostatitis is categorized into acute bacterial, chronic bacterial, nonbacterial, and asymptomatic inflammatory types.
• Prostatitis can occur in young men with UTIs, older men with prostatic hypertrophy, with STDs, catheterization, or through bacteremia.
• The signs and symptoms of prostatitis include dysuria, urinary frequency and urgency, decreased urinary stream, and fever with chills in the acute form.
• Additional signs and symptoms include lower back pain, muscle aches, leukocytosis, abdominal discomfort, and anorexia.

Benign Prostatic Hypertrophy (BPH)

• BPH affects up to 50% of men over 65 years and is characterized by hyperplasia of prostatic tissue with compression of the urethra.
• BPH is related to an estrogen-testosterone imbalance.
• BPH does not predispose individuals to prostatic carcinoma.
• An enlarged prostate gland can be palpated on digital rectal examination.
• BPH may lead to frequent infections.
• Progression can cause distended bladder, dilated ureters, hydronephrosis, and renal failure if BPH is left untreated.
• Signs and symptoms of BPH include obstructed urinary flow, difficulty initiating flow, decreased flow strength, increased frequency/urgency, nocturia, and dysuria if infection is present.

Prostate Cancer

• Prostate cancer is the most common cancer in men over 50 and the third leading cause of cancer death in men.
• Prostate cancer is both invasive and metastatic; some forms are aggressive while others are not.
• More undifferentiated tumors are more aggressive.
• High androgen levels, increased insulin-like growth factor, and a history of recurrent prostatitis are potential causes.
• Signs and symptoms include a hard nodule, hesitancy in urination, decreased urine stream, frequent urination, recurrent UTI, and pelvic/groin pain.
• Metastatic prostate cancer signs and symptoms include new onset dull pain, fractures, unexplained weight loss, fatigue, and increasing SOB.

Testicular Cancer

• Most testicular tumors are malignant and are the most common solid tumor cancer in young men.
• The number of cases is increasing.
• Some malignant tumors secrete hCG (human chorionic gonadotropin) or AFP (alpha-fetoprotein), which can be be used as markers for diagnosis.
• Testicular cancer typically spreads to common iliac and para-aortic lymph nodes, then to mediastinal and supraclavicular lymph nodes, and the lungs, liver, bone, and brain.
• Tumors are hard, painless, and usually unilateral.
• Testes may be enlarged or feel heavy
• Other signs and symptoms include a dull aching scrotum and pelvis, hydrocele or epididymitis, and gynecomastia if the tumor is hormone-secreting.

Female Reproductive System Disorders

Structural Abnormalities of the Uterus

• The normal position of the uterus is slightly anteverted and anteflexed with the cervix downward and posterior. Retroflexion of the uterus involves the uterus being tipped posteriorly and may be excessively curved or bent.
• Marked retroversion may cause back pain, dysmenorrhea, dyspareunia, and in some cases, infertility.
• Uterine displacement or prolapse involves the cervix dropping into the vagina as a 1st-degree prolapse.
• In 2nd-degree prolapse, the cervix lies at the opening to the vagina, with the body of the uterus in the vagina.
• 3rd-degree prolapse involves the uterus and cervix protruding through the vaginal orifice.
• Early stages of prolapse may be asymptomatic, while advanced stages cause discomfort.

Menstrual disorders

• Endometriosis is characterized by endometrial tissue occurring 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.
• The cause of endometriosis has not been established but is thought to be congenital in some cases.
• Symptoms of endometriosis include pain in the lower abdomen, lower back, pelvis, rectum, or vagina, and is often cyclical
• Other symptoms include painful intercourse, abnormal menstruation, constipation or nausea, abdominal fullness or cramping, difficulty defecating and infertility.

Infections: Pelvic Inflammatory Disease

• Infections can occur in the uterus, fallopian tubes, and/or ovaries and may be acute or chronic.
• Infections may occur because of bacteremia but arise from sexually transmitted diseases, nonsterile abortions, or childbirth most commonly.
• Scarring of tubes increases the risk of infertility and ectopic pregnancy.
• Potential acute complications include peritonitis, pelvic abscesses, and septic shock.
• Pelvic pain is usually the first sign, and treatment usually requires aggressive antibiotic therapy in the hospital.
• Additional signs include increased temperature, guarding, nausea and vomiting, leukocytosis, and purulent discharge.

Benign Tumors

• Leiomyomas (fibroids) are benign tumors of the myometrium, common during the reproductive years.
• Fibroids are usually multiple well-defined, unencapsulated masses that often cause abnormal bleeding and may interfere with implantation.
• Fibroids are often asymptomatic until large growth occurs, and can cause LBP.
• Fibrocystic breast disease includes a broad range of breast changes and increased density of breast tissue.
• Fibrocystic breast disease demonstrates a cyclic occurrence of nodules or masses in breast tissue.
• Increased risk of breast cancer occurs if atypical cells are present.
• Increased density makes breast self-examination difficult.
• Increased cystic masses may occur with caffeine intake.

Malignant Tumors

• Breast cancer incidence increases after age 20, most commonly in women between the ages of 50 and 69 years.
• Most tumors are unilateral, and metastasis occurs via lymph nodes relatively early in the course of the disease.
• Younger onset breast cancer is associated with more aggressive forms.
• Predisposing factors include a first-degree relative with the disease, strong genetic predisposition (BRCA1 and BRCA2), longer/higher exposure to estrogen, nulliparous or late first pregnancy, lack of exercise, smoking, high-fat diet, radiation therapy to the chest, and cancer of the uterus, ovaries, or pancreas.
• The initial sign of breast cancer is a single, small, hard, painless nodule, and later signs include distortion of breast tissue, dimpled skin, discharge from the nipple, and axillary lymph node involvement.
• Metastasis often occurs by the time the tumor is 1-2 cm in diameter and secondary tumors can occur in the bone, lung, brain, and liver.
• Risk factors for cervical cancer include age < 40 years, HPV viral infection (STD), multiple partners, sexual intercourse beginning in early teenage years, smoking, and a history of prior STDs.
• Possible signs and symptoms include atypical vaginal bleeding, unusual vaginal discharge, pelvic pain, dyspareunia, and postcoital bleeding.
• Uterine cancer is most common in postmenopausal women.
• An early indicator is painless vaginal bleeding or spotting.
• Risk factors include age > 50 years, obesity, diabetes, reproductive factors, and genetic predisposition.
• Ovarian cancer has no reliable screening available, and few cases are diagnosed early.
• Risk factors include obesity, BRCA1 gene, early menarche, nulliparous or late first pregnancy, and use of fertility drugs.
• Oral contraceptives containing progesterone are somewhat protective.
• Symptoms are often vague in early stages and may include atypical vaginal bleeding, pain or pressure in the pelvic area, abdominal or back pain, bloating, feeling full quickly or difficulty eating, a more frequent or urgent need to urinate, and constipation.

Key Points

• Low back, SI/sacral, hip, and/or groin pain can all be referred to from the male or female reproductive systems.