chapter 17 the reproductive system replacement & repair

Chapter 17Chapter 17The Reproductive SystemThe Reproductive System

Replacement & RepairReplacement & Repair

IntroductionIntroductionPurpose of ReproductionPurpose of Reproduction

Mitosis Mitosis or or Asexual reproduction: Asexual reproduction: Tissue ReplacementTissue Replacement Regeneration of Tissues Regeneration of Tissues Cells & tissues get damaged or simply wear out.Cells & tissues get damaged or simply wear out. The process by which cells make exact copies of The process by which cells make exact copies of

themselves, & is essential to maintain a healthy themselves, & is essential to maintain a healthy body.body.

Meiosis:Meiosis: To reproduce human lifeTo reproduce human life

MitosisMitosis vsvs Meiosis Meiosis

MitosisMitosis:: Cells make identical copies of themselvesCells make identical copies of themselves Human cells are called Human cells are called EukaryoticEukaryotic cells cells Contain Contain bundles of chromatinbundles of chromatin (chromosomes) (chromosomes) #46#46 Bacteria are single-cell Bacteria are single-cell ProkaryoticProkaryotic cells & divide cells & divide

via via Binary FissionBinary Fission..

Prophase Metaphase Anaphase Telophase & CytokinesisProphase Metaphase Anaphase Telophase & Cytokinesis

MeiosisMeiosisGametes:Gametes: Sex cellsSex cells; female eggs & male sperm for human or ; female eggs & male sperm for human or

animal reproduction.animal reproduction. Formed in GonadsFormed in Gonads: Ovaries & Testes: Ovaries & Testes Total number of chromosomes needed is Total number of chromosomes needed is 4646, , 23 23 from from

mother & mother & 2323 from father. from father. Daughter CellsDaughter Cells: produced at : produced at endend of meiosis have of meiosis have halfhalf

as many chromosomes (as many chromosomes (2323) as original.) as original. Chromosomes are matchedChromosomes are matched based on based on sizesize, , shapshape, & e, &

genesgenes they carry & numbered 1-23. they carry & numbered 1-23.

MeiosisMeiosis

2323rdrd pair pair: is sex chromosome determines sex of : is sex chromosome determines sex of baby.baby.

XX XX is femaleis female, , XYXY is maleis male; thus the ; thus the fatherfather determines sex of the baby because the mother determines sex of the baby because the mother can can onlyonly contribute “contribute “X”X” chromosomes. chromosomes.

Sexual ReproductionSexual Reproduction

FertilizationFertilization: both male & female : both male & female gametesgametes unite unite & combine their genetic material; thus & combine their genetic material; thus fertilizationfertilization..

ZygoteZygote ( (fertilized eggfertilized egg), has ), has 4646 chromosomes; chromosomes; reproduces millions of times via mitosis & reproduces millions of times via mitosis & develops within female to change from embryo develops within female to change from embryo to to fetusfetus..

The Early Stages of the Human Life CycleThe Early Stages of the Human Life Cycle

Day 1Day 1: Fertilization in Fallopian tube: Fertilization in Fallopian tube Week 1-3Week 1-3: : ZygoteZygote in Fallopian tube in Fallopian tube Weeks 3-9Weeks 3-9: : EmbryoEmbryo implantation in uterus implantation in uterus Week 10Week 10: : FetusFetus placenta with umbilicus formed placenta with umbilicus formed Month 9Month 9: : InfantInfant birth birth

The Human Reproduction SystemThe Human Reproduction SystemFemale AnatomyFemale Anatomy

Reproductive organs called Reproductive organs called genitaliagenitalia

Divided intoDivided into:: Primary genitaliaPrimary genitalia: gonads (: gonads (OvariesOvaries) that produce ) that produce

gametes.gametes. Secondary genitaliaSecondary genitalia: other structures that aid in : other structures that aid in

reproductive process; fallopian tubes, uterus, reproductive process; fallopian tubes, uterus, vagina, & external genitalia called vulva.vagina, & external genitalia called vulva.

The OvaryThe Ovary

Covered byCovered by fibrous capsule called fibrous capsule called tunica tunica albugineaalbuginea made of made of cuboidal epitheliumcuboidal epithelium..

CortexCortex: contains eggs (: contains eggs (gamatesgamates)) MedullaMedulla: contains blood vessels, nerves, & : contains blood vessels, nerves, &

lymphatic tissue surrounded by loose connective lymphatic tissue surrounded by loose connective tissue.tissue.

The Uterine TubesThe Uterine Tubes CalledCalled oviductsoviducts or or fallopian fallopian tubes, are tubes, are 4 inch4 inch

passageways for eggs to get to uterus.passageways for eggs to get to uterus. InfundibulumInfundibulum: : large funnel, surrounded by ciliated large funnel, surrounded by ciliated

projections called projections called fimbriafimbria.. Connected toConnected to superior portion of uterus superior portion of uterus Made ofMade of smooth muscle, ciliated simple columnar smooth muscle, ciliated simple columnar

epithelium tissue.epithelium tissue. Covered byCovered by visceral peritoneum & visceral peritoneum &

suspended by mesentery known suspended by mesentery known

as as mesosalpinxmesosalpinx, , Latin for tubaLatin for tuba!!!!!!

The UterusThe Uterus Found in pelvic cavityFound in pelvic cavity posterior and superior to posterior and superior to

urinary bladder & anterior to rectum.urinary bladder & anterior to rectum. Major portionMajor portion called “ called “bodybody.”.” FundusFundus: rounded superior portion between uterine : rounded superior portion between uterine

tubes.tubes. IsthmusIsthmus: narrow inferior portion: narrow inferior portion CervixCervix: “: “valve-likevalve-like” ” portion of uterus portion of uterus

that protrudes into vagina.that protrudes into vagina. Cervical CanalCervical Canal: communicates with vagina: communicates with vagina

Uterine LayersUterine Layers

PerimetriumPerimetrium: outermost layer: outermost layer MyometriumMyometrium: smooth muscle : smooth muscle EndometriumEndometrium: : highly vascularhighly vascular inner lining is inner lining is

mucosal layer of columnar epithelium & secretory mucosal layer of columnar epithelium & secretory cells with two divisions;cells with two divisions;

1. 1. BasalBasal: responsible for regenerating uterine lining : responsible for regenerating uterine lining each month.each month.

2. 2. FunctionalFunctional: sheds about every : sheds about every 28 days28 days during during

menses. menses.

Pathology Connection: Pathology Connection: EndometriosisEndometriosis

EtiologyEtiology: endometrial tissue escapes uterus & : endometrial tissue escapes uterus & implants in abdominal cavity. Builds up & decays implants in abdominal cavity. Builds up & decays each month with hormonal changes.each month with hormonal changes.

S/SS/S: : Chronic pelvic painChronic pelvic pain dysmenorrhea: pain during menstruation dysmenorrhea: pain during menstruation dyspareunia: painful sexual intercoursedyspareunia: painful sexual intercourse Dysuria: Dysuria:

painful urination painful urination

Endometriosis Endometriosis con’tcon’t

DXDX:: history & physical examhistory & physical exam ultrasoundultrasound laparoscopic surgery laparoscopic surgery

RxRx:: NSAIDsNSAIDs surgical removal of tumorssurgical removal of tumors Hormones: progesterone, GnRH agonists, Hormones: progesterone, GnRH agonists,

androgens (testosterone).androgens (testosterone). HysterectomyHysterectomy

The VaginaThe Vagina

10 cm10 cm ( (4 inches4 inches) long running from uterus to outside ) long running from uterus to outside of body.of body.

Purpose:Purpose: To receive penis during intercourse To receive penis during intercourse Allow for passage of Allow for passage of menstrual menstrual fluid out of uterusfluid out of uterus Also called Also called birth canalbirth canal, to allow movement of baby out , to allow movement of baby out

of uterus during childbirth.of uterus during childbirth. Opening may be covered a perforated membrane, the Opening may be covered a perforated membrane, the

hymenhymen..

The The External GenitaliaExternal Genitalia (Vulva) (Vulva)

Labia majoraLabia majora: : rounded fat deposits that meet & protect rest of rounded fat deposits that meet & protect rest of

external genitalia.external genitalia. meet anteriorly to form “meet anteriorly to form “mons pubismons pubis””

Pudendal cleftPudendal cleft:: Open area between the Open area between the 22 labia majora labia majora

The The External GenitaliaExternal Genitalia (Vulva) con’t (Vulva) con’t

PerineumPerineum:: Area between vagina & rectumArea between vagina & rectum

Labia minoraLabia minora: (: (prepuceprepuce)) Meet anteriorly to form the prepuceMeet anteriorly to form the prepuce Clitoris Clitoris contains erectile tissue 2cm in diametercontains erectile tissue 2cm in diameter

Mammary GlandsMammary Glands

Milk production glandsMilk production glands housed in breasts housed in breasts In young childrenIn young children virtually virtually identicalidentical in boys & girls in boys & girls At pubertyAt puberty estrogen & progesterone stimulate estrogen & progesterone stimulate

breast development in girls.breast development in girls.

LactationLactation In adult femalesIn adult females, breast consists of , breast consists of 15-2015-20 glandular glandular

lobes & “lobes & “adipose”adipose” tissue. tissue. Each lobe dividedEach lobe divided into smaller lobules which house into smaller lobules which house

milk secreting sacs called milk secreting sacs called alveolialveoli when woman is when woman is ““lactatinglactating.”.”

Milk travelsMilk travels through series of ducts & sinuses, through series of ducts & sinuses, eventually reaching eventually reaching areolaareola or nipple. or nipple.

Milk production controlled byMilk production controlled by hormone “ hormone “prolactinprolactin””

The The MenstrualMenstrual Cycle Cycle

Organized aroundOrganized around approximately approximately 28 days28 days, involves , involves ovaries & uterus.ovaries & uterus.

Ovarian cycleOvarian cycle involves monthly maturation & involves monthly maturation & release of eggs from ovary.release of eggs from ovary.

Uterine cycleUterine cycle consists of monthly buildup, decaying, consists of monthly buildup, decaying, & shedding of uterine lining.& shedding of uterine lining.

The The MenstrualMenstrual Cycle con’t Cycle con’t

Cycles beginCycles begin in in teen yearsteen years during puberty, & end during puberty, & end during her during her 40s40s or or 50s50s in in menopause.menopause.

Goal isGoal is to to releaserelease egg for fertilization, prepare egg for fertilization, prepare uterus to uterus to receivereceive fertilized egg, & fertilized egg, & nourishnourish fertilized fertilized egg should pregnancy result.egg should pregnancy result.

If pregnancy doesn’t resultIf pregnancy doesn’t result, uterine lining will , uterine lining will shedshed & cycle will begin & cycle will begin againagain!!

The The 28-day28-day MenstrualMenstrual Cycle Cycle

BeginsBegins with first day of menses with first day of menses MenstruationMenstruation refers to actual shedding of refers to actual shedding of

endometrium, endometrium, ““periodperiod” itself.” itself. Menses usually lastsMenses usually lasts 4–5 days4–5 days, but can be longer , but can be longer

or shorter in different women, can vary month to or shorter in different women, can vary month to month.month.

The The 28-day28-day MenstrualMenstrual Cycle Cycle

The The 11stst of 4 of 4 StagesStages of Menses of Menses Follicle StageFollicle Stage:: 1010 days long days long FSHFSH released released Follicle & ovum Follicle & ovum maturemature EstrogenEstrogen released (ovary) released (ovary) Uterine lining Uterine lining preparedprepared

The The 22ndnd of 4 of 4 StagesStages of Menses of Menses

Ovulation StageOvulation Stage: : FSHFSH stops stops LHLH starts: triggers starts: triggers ovulation ovulation

Day 14Day 14 FollicleFollicle ruptures ruptures OvumOvum released released

The The 33rdrd of 4 of 4 StagesStages of Menses of Menses

Corpus Luteum StageCorpus Luteum Stage:: ProgesteroneProgesterone released (ovary & endometrium) released (ovary & endometrium) If egg fertilizedIf egg fertilized, progesterone cont, progesterone cont 1414 days long days long

The The 4th of 4 4th of 4 StagesStages of Menses of Menses

Menstruation StageMenstruation Stage:: If no egg fertilizedIf no egg fertilized, , 3-63-6 days of diminished days of diminished

production of production of progesteroneprogesterone.. Uterine liningUterine lining broken down broken down

Oogenesis, Follicle Development, & Oogenesis, Follicle Development, & OvulationOvulation

OogenesisOogenesis:: Process of egg productionProcess of egg production Begins with birth of Begins with birth of OogoniaOogonia, or egg , or egg stem cellsstem cells, in , in

ovary.ovary. OogoniaOogonia undergoes undergoes mitosismitosis, producing millions of , producing millions of

““primary oocytesprimary oocytes””.. Women will have all eggs they will ever have Women will have all eggs they will ever have 5 5

monthsmonths before they are born. before they are born.

Primary Primary OocytesOocytes

Born via mitosisBorn via mitosis: still have : still have 46 chromosomes46 chromosomes Must undergo Must undergo meiosismeiosis to become to become gametesgametes, with only , with only

23 23 chromosomes, allowing them to combine with chromosomes, allowing them to combine with another gamete (another gamete (spermsperm) & ending with total of ) & ending with total of 46 46 chromosomeschromosomes..

Primary oocytes stayPrimary oocytes stay in kind of in kind of suspended animationsuspended animation until puberty, when they finish developing.until puberty, when they finish developing.

Follicle DevelopmentFollicle Development

Primary oocytes eventually surroundedPrimary oocytes eventually surrounded by helper by helper cells, called cells, called granulosa cellsgranulosa cells; at this point they are ; at this point they are called called primordial folliclesprimordial follicles, ,

& stay “& stay “dormant”dormant” until puberty. until puberty.

Hormonal signals during pubertyHormonal signals during puberty

cause some primordial follicles to enlarge & cause some primordial follicles to enlarge & increase number of increase number of granulosa cellsgranulosa cells..

Enlarged cells called “Enlarged cells called “primary folliclesprimary follicles””

OvulationOvulation

@ puberty@ puberty, one primary follicle will become , one primary follicle will become ““secondarysecondary” follicle.” follicle.

Secondary follicleSecondary follicle: will not complete development : will not complete development unless it is unless it is ovulatedovulated & & fertilizedfertilized..

Just before ovulationJust before ovulation: secondary follicle : secondary follicle fills with fills with fluidfluid & moves toward surface of ovary, where it & moves toward surface of ovary, where it becomes a becomes a visible lumpvisible lump..

Ovulation Ovulation con’tcon’t

Fimbria of uterine tubesFimbria of uterine tubes brush surface of ovary, brush surface of ovary, causing follicle to causing follicle to rupturerupture..

When follicle rupturesWhen follicle ruptures: egg (: egg (actually an oocyteactually an oocyte) is ) is released into released into peritoneal cavityperitoneal cavity & fimbria pull it & fimbria pull it toward funnel, drawing it into uterine tube. (toward funnel, drawing it into uterine tube. (WowWow!!!)!!!)

Ovulation Ovulation con’tcon’t

Ova travels down Ova travels down Fallopian tubeFallopian tube If sperm present in uterine tubeIf sperm present in uterine tube & all conditions are & all conditions are

right, sperm will penetrate egg, fertilizing it & right, sperm will penetrate egg, fertilizing it & triggering rest of egg development.triggering rest of egg development.

If If ovaova is is fertilized…fertilized…

Now calledNow called “ “zygotezygote” with ” with 4646 chromosomes chromosomes Zygote enters uterusZygote enters uterus & implants into proliferated & implants into proliferated

““endometriumendometrium,” ,” stoppingstopping woman from experiencing woman from experiencing mensesmenses..

Ruptured follicle left behind in ovaryRuptured follicle left behind in ovary will become will become ““corpus luteumcorpus luteum” and secrete ” and secrete hormoneshormones to help to help maintain thickened maintain thickened endometrium endometrium to nourish embryo.to nourish embryo.

If ova is If ova is NOTNOT fertilized fertilized……

zygotezygote will will notnot implant in uterus implant in uterus Within few daysWithin few days, uterine lining will begin to , uterine lining will begin to

degeneratedegenerate & woman will have her period, with egg & woman will have her period, with egg swept outswept out in menstrual flow. in menstrual flow.

Corpus luteumCorpus luteum will become will become corpus albicanscorpus albicans & & eventually eventually disappeardisappear..

Hormonal ControlHormonal Control Hormones from Hormones from hypothalamushypothalamus, , pituitarypituitary, & , & ovaryovary

control female cycle.control female cycle. Generally controlled byGenerally controlled by negative feedbacknegative feedback loop. loop. Released as part of hierarchyReleased as part of hierarchy, with hypothalamus , with hypothalamus

releasing hormone that controls pituitary, which releasing hormone that controls pituitary, which then releases hormone that controls another then releases hormone that controls another organ.organ.

The The 4 hormones4 hormones that control menstrual cycle that control menstrual cycle

OvaryOvary: Estrogen & Progesterone : Estrogen & Progesterone PituitaryPituitary: Luteinizing hormone (: Luteinizing hormone (LHLH) & Follicle ) & Follicle

Stimulation Hormone (Stimulation Hormone (FSHFSH).). Estrogen & progesterone levelsEstrogen & progesterone levels: increase at : increase at

puberty.puberty. Gonadotropin releasing hormoneGonadotropin releasing hormone ( (GnRHGnRH) from ) from

hypothalamus causes increase in secretion of hypothalamus causes increase in secretion of LHLH & & FSHFSH from from pituitarypituitary..

Hormonal ControlHormonal Control con’t con’t

During Follicular stageDuring Follicular stage: : FSHFSH initiates development initiates development of of primary folliclesprimary follicles each month, while each month, while LHLH triggers triggers ovulationovulation..

Estrogen levelsEstrogen levels continue to continue to riserise as more & more as more & more is secreted by developing follicle, stimulating is secreted by developing follicle, stimulating proliferation of uterine liningproliferation of uterine lining..

EstrogenEstrogen exerts exerts positivepositive influence on influence on hypothalamushypothalamus, increasing secretion of, increasing secretion of GnRH GnRH, , thus increasing thus increasing LHLH & & FSHFSH..

+ feedback loop+ feedback loop continues, raising hormone levels continues, raising hormone levels until until ovulation occursovulation occurs..


Once ovulation occurs, Once ovulation occurs, feedback feedback loop loop reversesreverses itself. itself.

Corpus luteum beginsCorpus luteum begins to secrete to secrete progesterone, as well as a little progesterone, as well as a little estrogen.estrogen.

Estrogen under influence of Estrogen under influence of progesteroneprogesterone, exerts neg. feedback , exerts neg. feedback on hypothalamus & pituitary, on hypothalamus & pituitary, decreasing GnRH, LH, & FSH decreasing GnRH, LH, & FSH secretion.secretion.


ProgesteroneProgesterone also exerts negative feedback on also exerts negative feedback on hypothalamus & pituitary.hypothalamus & pituitary.

ThusThus, LH, FSH, & estrogen levels drop while , LH, FSH, & estrogen levels drop while progesterone levels rise.progesterone levels rise.

Hormonal changesHormonal changes preventprevent another egg from another egg from maturing.maturing.


For about 10 days after ovulationFor about 10 days after ovulation, , progesterone levels remain high as progesterone levels remain high as corpus luteumcorpus luteum continues to secretecontinues to secrete hormone.hormone.

Progesterone's effect on uterusProgesterone's effect on uterus is to is to maintainmaintain buildup of endometrium & buildup of endometrium &

to to decreasedecrease uterine contractionsuterine contractions.. If no pregnancy resultsIf no pregnancy results, corpus luteum , corpus luteum

degeneratesdegenerates & progesterone will & progesterone will no no longer be produced.longer be produced.


Decreasing progesterone Decreasing progesterone levelslevels cause cause degeneration of degeneration of endometriumendometrium, followed by , followed by menstruationmenstruation..

Decreased progesterone Decreased progesterone levelslevels release hypothalamus release hypothalamus & pituitary from its inhibitory & pituitary from its inhibitory effects, & FSH & LH levels effects, & FSH & LH levels begin to rise & begin to rise & cycle begins cycle begins againagain..

If pregnancy occursIf pregnancy occurs…… Implanted fertilized egg secretes hormoneImplanted fertilized egg secretes hormone called called

human chorionic gonadotropinhuman chorionic gonadotropin ( (HCGHCG).). HCG stimulatesHCG stimulates corpus luteum to keep secreting corpus luteum to keep secreting

progesterone & little estrogen to maintain uterine progesterone & little estrogen to maintain uterine lining.lining.

@ about three month’s gestation@ about three month’s gestation, , placenta placenta begins begins to secrete its to secrete its own progesterone & estrogenown progesterone & estrogen, thus , thus becoming endocrine organbecoming endocrine organ!!!!!!

If pregnancy occursIf pregnancy occurs… con’t…… con’t…

ProlactinProlactin: produced by anterior Pituitary : produced by anterior Pituitary stimulates milk production by breasts.stimulates milk production by breasts.

OxytocinOxytocin: produced by posterior Pituitary : produced by posterior Pituitary stimulates uterine contractions & milk production.stimulates uterine contractions & milk production.

Pathology ConnectionPathology Connection: : Menstrual DisordersMenstrual Disorders

Premenstrual SyndromePremenstrual Syndrome:: EtiologyEtiology: central-nervous-system neurotransmitter : central-nervous-system neurotransmitter

interactions with sex hormones affectedinteractions with sex hormones affected??????

S/SS/S: depression, anger, irritability, anxiety, confusion, : depression, anger, irritability, anxiety, confusion, withdrawal, breast tenderness, bloating, swelling withdrawal, breast tenderness, bloating, swelling extremities, headache.extremities, headache.

D/XD/X: must start : must start 5 days5 days prior to menses, cease prior to menses, cease 4 days4 days into menses, & not recur until following cycle; into menses, & not recur until following cycle; X 3 X 3 cyclescycles..

Premenstrual Syndrome Premenstrual Syndrome con’tcon’t

RxRx: : Mild/moderateMild/moderate: good nutrition, regular exercise, : good nutrition, regular exercise,

complex carbohydrates, calcium supplements.complex carbohydrates, calcium supplements. NSAIDNSAID or or hormonal suppressionhormonal suppression SevereSevere: psychiatric medications: psychiatric medications

Polycystic Ovarian SyndromePolycystic Ovarian Syndrome

EtiologyEtiology: : Ovaries produce too muchOvaries produce too much testosterone testosterone & & estrogenestrogen, but too little , but too little progesteroneprogesterone,,

effects effects 5-10 %5-10 % women. women.

S/SS/S: : • FailureFailure to ovulate to ovulate• Excess Excess facial hairfacial hair• Male pattern baldnessMale pattern baldness• IrregularIrregular menstrual cycles menstrual cycles• Formation of Formation of multiple cysts multiple cysts on ovarieson ovaries• HormonalHormonal abnormalities abnormalities• InfertilityInfertility• ObesityObesity• Insulin resistance (Insulin resistance (Type II DMType II DM))

Polycystic Ovarian Syndrome Polycystic Ovarian Syndrome con’tcon’t

D/XD/X: : Serum analysisSerum analysis; looking for elevated levels of ; looking for elevated levels of LH,LH,

testosteronetestosterone, , prolactinprolactin, , insulininsulin. . UltrasoundUltrasound: looking for large ovaries : looking for large ovaries

RxRx: consists mainly of : consists mainly of symptom reliefsymptom relief• Weight lossWeight loss• Birth control pillsBirth control pills: can regulate menstrual cycle: can regulate menstrual cycle• DrugsDrugs: can treat : can treat hyperlipidemia & & DM• Infertility drugs Infertility drugs &/or &/or surgical repair surgical repair of damaged of damaged

ovaries.ovaries.

Polycystic Ovarian DiseasePolycystic Ovarian Disease

Breast Cancer Breast Cancer

EtiologyEtiology: most common malignancy of American : most common malignancy of American women and leading cause of death between women and leading cause of death between ages 40-55; familial historyages 40-55; familial history

S/SS/S: bloody, brown, or serous nipple discharge, : bloody, brown, or serous nipple discharge, noticeable lump, changes in breast tissuenoticeable lump, changes in breast tissue

DXDX: mammogram, Imaging, biopsy: mammogram, Imaging, biopsy TXTX: lumpectomy, mastectomy, chemotherapy, : lumpectomy, mastectomy, chemotherapy,

radiation, etcradiation, etc

Cervical Cancer Cervical Cancer

DXDX: PAP smears with microscopic : PAP smears with microscopic examination, patient history and exam.examination, patient history and exam.

TXTX: cryotherapy (freezing) or laser : cryotherapy (freezing) or laser surgery, hysterectomy (removal of uterus); surgery, hysterectomy (removal of uterus); radiationradiation

Male AnatomyMale AnatomyTestesTestes:: primary genitaliaprimary genitalia: producing male gamete, sperm: producing male gamete, sperm secondary genitaliasecondary genitalia: penis (sperm delivery organ), : penis (sperm delivery organ),

epididymis, vas deferens, urethra, prostate gland, epididymis, vas deferens, urethra, prostate gland, seminal vesicles, & bulbourethral glands.seminal vesicles, & bulbourethral glands.

The Testes The Testes con’tcon’t

Paired organsPaired organs: suspended in sac called : suspended in sac called scrotumscrotum, , hanging on either side of penis.hanging on either side of penis.

During fetal developmentDuring fetal development, testes formed in , testes formed in abdomenabdomen; in last ; in last 3 months3 months of development, of development, migratemigrate to normal position in scrotum.to normal position in scrotum.

Pathology Connection:Pathology Connection: CryptorchidismCryptorchidism

Testes fail to descend into scrotal sacTestes fail to descend into scrotal sac Requires surgical intervention: Requires surgical intervention: OrchiopexyOrchiopexy May become sterile as abdominal temp too warmMay become sterile as abdominal temp too warm

Cryptorchidism Orchiopexy

Pathology Connection:Pathology Connection: Hydrocele Hydrocele

EtiologyEtiology: abnormal collection of : abnormal collection of fluidfluid around testes via around testes via inguinal herniainguinal hernia..

S/SS/S: scrotal edema, : scrotal edema, possiblepossible pain, deformity pain, deformity

DxDx: transillumination, ultrasound: transillumination, ultrasound

RxRx: Hydrocelectomy : Hydrocelectomy

Pediatric Hydrocele

Ultrasound

Pathology Connection:Pathology Connection: Testicular Torsion Testicular Torsion

EtiologyEtiology: twisting of the vas deferens, which cuts off : twisting of the vas deferens, which cuts off the blood supply to the testicle.the blood supply to the testicle.

S/SS/S: sudden onset of pain, edema, N/V, rise in level : sudden onset of pain, edema, N/V, rise in level of affected testicle.of affected testicle.

DxDx: H/P, ultrasound: H/P, ultrasound

RxRx: emergency : emergency OrchiopexyOrchiopexy

ProgProg: good : good ifif surgery done within surgery done within 6 hours6 hours of pain of pain

The PenisThe Penis Latin word for “Latin word for “tailtail”” Sperm delivery organSperm delivery organ that that

transfers sperm from male transfers sperm from male to female.to female.

Attached portionAttached portion called called rootroot, while freely moving , while freely moving part called part called shaft or bodyshaft or body..

Glans penisGlans penis (tip) is covered (tip) is covered by loose section of skin by loose section of skin called called foreskinforeskin or or prepuceprepuce unless man has been unless man has been circumcised.circumcised.

The Penis The Penis cont.cont.

Contains urethraContains urethra, a transport , a transport

passage for both sperm & urine.passage for both sperm & urine.

Has 3 erectile bodiesHas 3 erectile bodies, tubes with , tubes with

sponge-like network of blood sinuses.sponge-like network of blood sinuses. GlansGlans: Head of penis: Head of penis Corpus cavernosumCorpus cavernosum: : 22 columns of tissue running columns of tissue running

along the sides of the penis. Blood fills this tissue to along the sides of the penis. Blood fills this tissue to cause an cause an erectionerection..

Corpus spongiosumCorpus spongiosum: column of : column of sponge-likesponge-like tissue tissue running along front of penis ending at glans penis; running along front of penis ending at glans penis; fills with blood during fills with blood during erectionerection..

The EpididymisThe Epididymis

Comma shaped duct on posterior and Comma shaped duct on posterior and lateral part of testeslateral part of testes

Tube is highly coiled, if unraveled, would Tube is highly coiled, if unraveled, would measure six meters longmeasure six meters long

Sperm mature hereSperm mature here

The Vas DeferensThe Vas Deferens

Short tube: 45 cm longShort tube: 45 cm long Runs from anterior part of scrotum as pair Runs from anterior part of scrotum as pair

of tubes, one on each side, into abdominal of tubes, one on each side, into abdominal wall and pelvic cavity, medially over wall and pelvic cavity, medially over urethra, and along posterior bladder wallurethra, and along posterior bladder wall

Posterior to bladder, joins seminal vesicle Posterior to bladder, joins seminal vesicle to form ejaculatory duct, which then to form ejaculatory duct, which then passes through prostate gland and passes through prostate gland and empties into urethraempties into urethra

Three Accessory GlandsThree Accessory Glands

Seminal vesiclesSeminal vesicles: highly coiled, posterior : highly coiled, posterior to bladderto bladder

Prostate glandProstate gland: chestnut-sized gland : chestnut-sized gland surrounding urethra just inferior to bladdersurrounding urethra just inferior to bladder

Bulbourethral glandsBulbourethral glands: pea sized glands : pea sized glands inferior to prostateinferior to prostate

Pathology Connection: Pathology Connection: Male Male Reproductive Diseases Reproductive Diseases

Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH) EtiologyEtiology: Non-cancerous enlargement of : Non-cancerous enlargement of

prostateprostate S/SS/S: enlarged prostate impinges upon urethra, : enlarged prostate impinges upon urethra,

causing causing • Weak urine streamWeak urine stream• Incomplete voidingIncomplete voiding• Urinary frequencyUrinary frequency• Night time urinationNight time urination• Urinary urgencyUrinary urgency

Benign Prostatic Hyperplasia (BPH) Benign Prostatic Hyperplasia (BPH) cont.cont.

DX:DX:• History and physical exam (including exam History and physical exam (including exam

of prostate)of prostate)• Prostate specific antigen (PSA) blood Prostate specific antigen (PSA) blood

levelslevels• Rule out other urinary conditions (like Rule out other urinary conditions (like

infection, etc.)infection, etc.)

Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH)cont.cont.

TXTX• Drug tx: Drug tx: decrease testosterone and shrink decrease testosterone and shrink

prostate; relax smooth muscle in prostate, prostate; relax smooth muscle in prostate, improving urine streamimproving urine stream

• Surgical txSurgical tx: minimally invasive laser or : minimally invasive laser or microwave ablation. placement of stent in microwave ablation. placement of stent in urethra, removal of part or all of prostateurethra, removal of part or all of prostate

Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia

Prostate CancerProstate Cancer

EtiologyEtiology: cancer cells forming in prostate; most : cancer cells forming in prostate; most common non-skin cancer affecting American common non-skin cancer affecting American menmen

S/S: S/S: same as BPHsame as BPH DXDX: Physical exam and prostate specific antigen : Physical exam and prostate specific antigen

(PSA) blood test can be used to screen for it(PSA) blood test can be used to screen for it TXTX: chemo, radiation, surgery: chemo, radiation, surgery

SpermatogenesisSpermatogenesis

Produced in testes beginning when boy Produced in testes beginning when boy reaches puberty and continuing until deathreaches puberty and continuing until death

Sperm stem cells, undergo mitosis to form Sperm stem cells, undergo mitosis to form primary spermatocytesprimary spermatocytes

Primary spermatocytes form two Primary spermatocytes form two secondary spermatocytessecondary spermatocytes

Spermatocytes complete meiosis to form Spermatocytes complete meiosis to form spermatidsspermatids

Spermatogenesis cont.Spermatogenesis cont.

Spermatids go through period of Spermatids go through period of development to form immature development to form immature spermatozoa (sperm)spermatozoa (sperm)

All of this takes place in testes in All of this takes place in testes in seminiferous tubulesseminiferous tubules

Sperm then travel from seminiferous Sperm then travel from seminiferous tubules to epididymis where sperm spend tubules to epididymis where sperm spend about two weeks maturing and gaining about two weeks maturing and gaining ability to swimability to swim

SpermatogenesisSpermatogenesis

Hormonal Control of Male Hormonal Control of Male ReproductionReproduction

At puberty, two hormonal changes occurAt puberty, two hormonal changes occur

First, testosterone secretion by testes First, testosterone secretion by testes increasesincreases

Second, testosterone inhibits GnRH, FSH Second, testosterone inhibits GnRH, FSH and LH, further enhancing testosterone and LH, further enhancing testosterone production, creating major positive production, creating major positive feedback loopfeedback loop

Hormonal Control of Male Hormonal Control of Male Reproduction cont.Reproduction cont.

Testosterone secretion at puberty brings Testosterone secretion at puberty brings about male secondary sexual about male secondary sexual characteristics development including:characteristics development including: Body, facial, and pubic hair growthBody, facial, and pubic hair growth Deepening of the voiceDeepening of the voice Increased muscle and bone massIncreased muscle and bone mass

Erection and EjaculationErection and Ejaculation

Erectile bodies in penis become engorged Erectile bodies in penis become engorged with blood, producing erectionwith blood, producing erection

During ejaculation sperm is propelled from During ejaculation sperm is propelled from epididymis into vas deferens, and into epididymis into vas deferens, and into pelvic cavitypelvic cavity

As sperm passes seminal vesicles sugar As sperm passes seminal vesicles sugar and chemicals addedand chemicals added

Erection and Ejaculation cont.Erection and Ejaculation cont.

Sperm and chemicals enter ejaculatory Sperm and chemicals enter ejaculatory duct, pass through prostate gland, where duct, pass through prostate gland, where fluid is added, liquefying semen and fluid is added, liquefying semen and protecting sperm from acid environment of protecting sperm from acid environment of vagina by secreting alkaline substancevagina by secreting alkaline substance

Semen passes by bulbourethral gland, Semen passes by bulbourethral gland, adding mucus to semenadding mucus to semen

Finally, semen enters urethra and is Finally, semen enters urethra and is carried outside bodycarried outside body

PregnancyPregnancy

Period of time when developing baby Period of time when developing baby grows within uterus called gestation grows within uterus called gestation period, approximately 40 weeksperiod, approximately 40 weeks

Baby born before 37 weeks gestation Baby born before 37 weeks gestation considered prematureconsidered premature

First eight weeks of gestation developing First eight weeks of gestation developing fertilized egg called embryo; organs and fertilized egg called embryo; organs and systems are fundamentally formedsystems are fundamentally formed

Pregnancy cont.Pregnancy cont.

After eight weeks is called fetusAfter eight weeks is called fetus fetus nourished by spongy structure called fetus nourished by spongy structure called

placenta, attached to fetus and mother by placenta, attached to fetus and mother by umbilical cordumbilical cord

Fetus is encased in membranous sac, Fetus is encased in membranous sac, called the amnion, containing amniotic called the amnion, containing amniotic fluidfluid

AmniocentesisAmniocentesis

Stages of LaborStages of Labor

Stage 1: dilationStage 1: dilation- uterine smooth muscles begin - uterine smooth muscles begin to contract, moving fetus down uterus and to contract, moving fetus down uterus and causing cervix to begin to dilate.causing cervix to begin to dilate.

Stage 2: expulsionStage 2: expulsion- begins when cervix fully - begins when cervix fully dilated to 10 cm and fetus actually delivered; dilated to 10 cm and fetus actually delivered; breech presentation is when buttocks or foot breech presentation is when buttocks or foot appear first instead of head.appear first instead of head.

Stage 3: placental-Stage 3: placental- delivery of placenta from delivery of placenta from final uterine contractions.final uterine contractions.

Stages of LaborStages of Labor

Pregnancy/Delivery complications: Pregnancy/Delivery complications: Abruptio Placenta Abruptio Placenta

EtiologyEtiology: placenta separates from uterus: placenta separates from uterus

S/SS/S: bleeding, pain, preterm labor: bleeding, pain, preterm labor

DXDX: ultrasound: ultrasound

TX:TX: depends on severity: ranges from nothing to depends on severity: ranges from nothing to emergency caesarian sectionemergency caesarian section

Placenta Previa Placenta Previa

EtiologyEtiology: placenta grows over cervix; causes : placenta grows over cervix; causes unknownunknown

S/SS/S: bleeding late in pregnancy, pain: bleeding late in pregnancy, pain

DXDX: ultrasound: ultrasound

TXTX: transfusions, medication, caesarian: transfusions, medication, caesarian

Ectopic (tubal) pregnancyEctopic (tubal) pregnancy

embryo implants in uterine tubeembryo implants in uterine tube EtiologyEtiology: scarring, endometriosis: scarring, endometriosis S/SS/S: bleeding, abdominal pain, nausea, : bleeding, abdominal pain, nausea,

unconsciousness and shock if tube rupturesunconsciousness and shock if tube ruptures DXDX: ultrasound, exploratory surgery, blood tests, : ultrasound, exploratory surgery, blood tests,

pregnancy testpregnancy test TXTX: termination of pregnancy, treatment of : termination of pregnancy, treatment of

symptomssymptoms

Postpartum Depression Postpartum Depression EtiologyEtiology: changes in hormone levels after : changes in hormone levels after

pregnancypregnancy

S/SS/S: fatigue, anxiety, worthlessness: fatigue, anxiety, worthlessness

DXDX: exam: exam

TXTX: counseling, medication: counseling, medication

chapter 17 the reproductive system replacement & repair

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