The organs that form the reproductive
system allow humans to reproduce. Men and women have different reproductive
systems that work in unison to create new life. If something goes awry with the
components of the female or male reproductive system, it can affect not only
the ability to have children but may also cause
serious disorders warranting early detection and treatment.
The
reproductive and genital organs of a fetus form during the fourth week of
pregnancy. At that time, nerve, blood vessel, and tissue bundles form in
patterns that distinguish males from females when they are fully developed.
Development of these organs in the fetus ends during the first trimester. (See
Fig.
Many
of the anatomic structures in one sex correspond to those in the other. For
instance, The female clitoris and the male penis are
derived from the same structures, contain the same number of nerves, and are
the site of intense sensitivity during sexual activity.
A
child is born with male or female reproductive organs, but these organs remain
undeveloped until puberty. Then a spurt of hormones causes rapid growth and
development of reproductive organs, changing body structure and function and
making a person capable of reproduction.
Females
usually mature sexually between the ages of
Males
develop sexually a little later than females. At puberty, the hormone
testosterone causes an increase in height, muscle development, and the growth
of the sex organs, which then produce sperm. Boys may have nocturnal emissions
of semen, or wet dreams, at puberty. Around age
The Female Reproductive System
A
woman's external genital area is called the vulva. It is made up of the labia
minora -- the inner lips enclosing the opening to the vagina -- and the labia
majora -- the outer, hair-bearing lips surrounding the opening of the vagina
and the urethra, the opening to the bladder. The clitoris is a small bud-shaped
organ, located just above the urethra. It is the most sensitive area of the
external female genitals. Bartholin's glands are located on either side of the
vaginal opening.
The
vagina is a muscular tube leading from the external genital organs to the uterus.
The opening of the uterus, the cervix, projects into the upper end of the
vagina. (See Fig.
The
uterus is a hollow, muscular organ, about the size of a pear, in which the
fetus grows during pregnancy. (See Fig.
A
woman is born with
Estrogen
is secreted by the ovaries throughout a woman's reproductive years, affecting
all the cells of the body. Special estrogen receptors are located in the
breasts, the lining of the uterus, the cervix, and the upper vagina. Cells with
estrogen receptors grow when estrogen is in the blood, whether it is secreted
from the ovaries or taken in pill form. The lining of the uterus has the
greatest number of receptors, and it thickens on a monthly basis. Each month,
when estrogen levels decline, the lining is broken down and results in a
menstrual period.
Progesterone
is a hormone secreted by the ovaries after ovulation. It causes the uterine
lining cells to stop growing and to simply prepare to nourish an egg should it
be fertilized and become implanted in the uterus. At menopause, when ovulation
ceases, no more progesterone can be made by the ovaries.
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Hormones Of the Reproductive
System The
reproductive systems of both women and men are regulated by hormones produced
by glands that are part of the endocrine system. At the onset of puberty, the
hypothalamus gland sends a signal to the pituitary gland to secrete hormones
that cause the development of sexual organs. The
hypothalamus is cells in the brain that secrete peptides to signal the
pituitary. This area regulates eating, drinking, sleeping, waking, body
temperature, chemical balances, heart rate, hormones, sex, and emotions. The
pituitary, a small, gray, rounded gland attached to the base of the brain, is
an endocrine gland secreting a number of hormones. The pituitary is often
referred to as the master gland of the body. Gonads
(sex glands) are the testes in the male and the ovaries in the female. These
glands produce the male and female hormones that regulate reproduction:
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The
menstrual cycle is an average of
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Anabolic Steroids Androgens
are male sex hormones, one of which is testosterone. Anabolic steroids are
synthetic androgens that have been designed to enhance the growth-promoting
effects of androgens. Anabolic steriods are occasionally used, under a
doctor's supervision, to treat skeletal and growth disorders and certain
types of anemia. Steroids are also used illegally, mainly by athletes who
want to quickly build muscle tissue. They have many potentially serious side
effects: reduced sperm production, decreased size of the testes, and reduced
natural sex hormone production, resulting in a diminished sex drive. Steroids
can also lead to liver damage and cardiovascular disease and, if taken in
early puberty, result in short stature. |
The Male Reproductive System
Like
that of females, the reproductive system of males is regulated by hormones,
which have an effect through birth, puberty, maturity, and aging (see
"Hormones of the Reproductive System"). The male genital organs
(testes) produce sperm cells and transport them through a series of ducts to
the female reproductive system. (See Fig.
Each
day a male produces about
The
penis, a rod-shaped organ, also transports urine (see Fig.
The
testes are two egg-shaped organs contained in a pouch of skin called the
scrotum that hangs behind the penis. In each of the testicles there is a
tightly packed mass of tubes surrounded by a protective capsule. Leydig cells
in the testes produce the hormone testosterone, and the tubes in the testes
produce sperm. The production of sperm requires a temperature that is lower
than the body's internal temperature. Spermatic cords suspend the testicles
within the scrotum and help to maintain the correct temperature for sperm production.
When the outside temperature is low, the cords draw the testicles upward,
nearer to the warm body.
The
epididymis is a cordlike structure beside and behind the testes that transports
sperm cells from the testicles to the seminal vesicles. Lying behind the
bladder, the seminal vesicles store sperm. The sperm are mingled in a fluid
that forms part of the semen that is released during ejaculation.
The
vas deferens is a thick muscular tube, which is about
The
prostate is a walnut-shaped gland located below the bladder, surrounding the
urethra. Its main function is to produce a fluid that nourishes sperm and helps
transport sperm through the urethra during ejaculation.
Cowper's
glands, also known as bulbourethral glands, are two teardrop-shaped structures
each the size of a pea. They are situated on either side of the urethra and
provide mucus and chemicals during sexual excitement. The mucus washes the
urethra in preparation for ejaculation and serves as a lubricant.
Semen
is the fluid that is ejaculated during the male sexual act. An ejaculation may
contain as many as
Erection
of the penis is provoked by sexual stimulation. Impulses are transmitted from
the brain down the spinal cord to the penis by parasympathetic nerves. The
messages signal the corpora cavernosa, two rod- shaped bundles of muscle in the
penis on either side, to relax and fill with blood. As they fill, the corpora
cavernosa expand and press against the veins that would normally drain blood
from the penis. The penis becomes firm and erect, allowing penetration into the
female vagina during sexual intercourse.
Sensations
on the skin of the penis that occur during intercourse stimulate the organ's
numerous nerve endings. These impulses are carried back to the brain. The
sexual stimulation gradually builds in intensity until it causes a reflex
action. Impulses travel down the nerves, passing through the genital organs,
and trigger ejaculation, the rhythmic contractions of the smooth muscle of the
testicles which expel their contents, the semen, into the urethra. The
bulbourethral glands discharge additional amounts of mucus at this time. The act of ejaculation, and the feelings of intense pleasure associated
with it, are the male orgasm or climax.
Understanding
and monitoring your own reproductive system is key to
keeping it healthy. Health maintenance involves routine self-examinations,
regular checkups, prevention of problems, and being alert to signs of problems so
they can be treated early. A number of practitioners treat the reproductive
system (see "Health Care Practitioners").
The
reproductive systems of both women and men are vulnerable to sexually
transmitted diseases (STDs), such as syphilis, gonorrhea, herpes, chlamydia,
human papillomavirus (HPV), and AIDS. To protect against STDs, you should limit
your sexual partners and always use a condom during sexual intercourse. A woman
having sex with another woman should be careful not to have contact with her partner's
genital fluids or with any open sores on her partner's body. (The use of a
dental dam or cellophane wrap has been advocated but has not been shown to be
as clearly of value as the condom is for heterosexuals.) In men, certain STDs
can appear as an inflammation of the urethra or a discharge, but also can occur
without symptoms. In women, there can be no symptoms. Both women and men should
be alert to the early signs of STDs, get treatment immediately, and avoid
spreading the disease to others (see "Sexually Transmitted
Diseases").
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Health Care Practitioners Women
can receive care for the reproduction system from any of the following health
care professionals:
For
routine examinations, men can see an internal medicine specialist or a family
practitioner. A man having a problem with his prostate or infertility may be
referred to a urologist for evaluation. |
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Sexually Transmitted Diseases Diseases
that are sexually transmitted (STDs) can affect both women and men. Often there
are no symptoms; when they occur, immediate treatment should be obtained.
Both sexual partners must be treated to avoid spreading the disease. To
protect against STDs, women and men should limit their sexual partners.
Mutually monogamous relationships and using a condom each time they have sex
are the best protection. Spermicides can provide additional protection from
STDs. Some of the more common STDs include the following:
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For Women
Every
woman's genitals are shaped individually, with different sizes for inner lips, outer
lips, and clitoris. Women of all ages should be familiar with the appearance of
their genitals and be aware of what is normal for them. In this way, changes
that may be the only signs of certain infections or precancerous conditions can
be detected early. Early diagnosis means conditions can be diagnosed and
treated before they have advanced to later stages. Small sores, ulcers, raw
areas, or pigmented areas can be the first and earliest signs of cancer of the
vulva. Use a mirror to inspect your vulva monthly to look for these signs.
Women
should protect themselves from unwanted pregnancy by using some method of birth
control. Ideally, the birth control method should also protect against
infections; a barrier method, such as a condom, is ideal. Of course not all
methods are perfect, and failures of contraception do occur. Early diagnosis of
a missed period allows your maximum choice in expression of your reproductive
desires. If you have had sex without birth control or your birth control has
failed, ask your doctor about postcoital, or emergency, contraception.
You
should have a pelvic examination and a Pap test annually to detect changes in
the cervix that could be early signs of cancer (see "The Pap Test").
(See Fig.
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The Pap Test The
Pap test was named after Dr. George Papanicolaou, the physician who developed
it. A Pap test can detect changes in the cells on the cervix that could be
early signs of cancer. For the test, a women lies on an examining table with
her feet in stirrups. An instrument called a speculum is inserted into her
vagina to hold it open. With a small brush or scraper, a sample of cells is
removed from the cervix and placed on a glass slide so it can be studied
under a microscope. If
menstruation starts and is heavy at the time of an appointment, the appointment
should be rescheduled. Also, a woman should not douche before the test. Test
results are reported in categories according to the The
Pap test has greatly reduced the number of deaths from cancer of the cervix,
and is used to prevent cervical cancer. The test should be performed
annually, with a pelvic exam, for women who have been sexually active or who
have reached the age of |
For Men
Recognition
and treatment of problems that can arise in the reproductive system as a man
ages are essential for a healthy life. Men should have regular checkups to
watch for early signs of problems. For example, signs of prostate enlargement
include changes or problems with urination such as more frequent urination, a
feeling of a need to urinate, and a weak stream of urine. The checkup should
include a thorough history and a physical examination. The history should
include a family history as well as an occupational and medical history, past
genitourinary surgery, or trauma to the reproductive organs. Men should ask
their doctors questions regarding any illnesses, changes in sex drive, or drugs
that may interfere with reproductive health.
Prostate
gland enlargement does not increase the risk of prostate cancer, but cancer
could be present at the same time or develop later. Many older men have some
symptoms of prostate enlargement. All men over age
Men
of all ages should perform testicular self- examination monthly to detect
problems that could be a sign of cancer of the testes. It only takes a few
minutes and can be done easily and painlessly, preferably after a warm bath or
shower or in a warm room when the scrotum is relaxed. To perform the exam, roll
each testicle between the thumbs and forefingers of both hands. Any hard lumps
or nodules should be brought to the attention of a physician.
Any
signs or symptoms of problems in the reproductive system warrant medical
attention. In women, problems that can signal a disorder include abnormal
bleeding or discharge, pain, or a change in the appearance of the genital
organs. In men, changes in their urination or pain can signal prostate
enlargement or cancer. In both women and men, any unusual lump or growth that
can be felt or seen should receive medical attention.
In Women
In
young women, any irregular bleeding may be linked to problems with the hormones
secreted by the ovaries. In older women, changes in their menstrual periods could
signal menopause. Some women may have irregular, unpredictable, and sometimes
heavy bleeding during menopause. They have a slightly higher chance of
developing precancerous or cancerous changes of the endometrium and should be
monitored by a physician. An endometrial biopsy can determine whether
precancerous changes are taking place. In this technique, a sample of the
tissue lining the uterus is obtained and studied. After menopause, when a woman
has stopped having menstrual periods for
It
is normal for women to have a clear vaginal discharge. This discharge cleans
the vagina, maintains its normal state, and keeps it free of organisms. A
discharge that is white or yellow, thick or frothy, or has an odor could be a
sign of an infection. Itching also may occur. These symptoms could signal a
major or minor problem; have them checked so the cause
can be identified and treated.
Pain
in the pelvic area can occur for many reasons, although it is usually due to
either a cramping of the uterus or conditions affecting the ovaries. Pain in
the pelvic region also can be related to any of the anatomic structures in this
area, including the ureters, bladder, and rectum. If the pain is sudden,
severe, and long lasting, or interferes with daily activities, consult your
physician.
A
pain in your right or left side can be a sign of ovulation. This pain, called mittelschmerz
(literally, middle pain), is caused by the release of the egg. It may be
accompanied by a clear vaginal discharge and increased sex drive. On rare
occasions, there may be slight bleeding.
In Men
Certain
symptoms can signal problems with the prostate in men. Many older men have
enlarged prostate glands, but this condition does not lead to cancer. Prostate cancer
is common in older men, however, so it should be considered when symptoms such
as the following are present:
Any
of these symptoms requires further evaluation by a primary care physician or,
if necessary, a urologist.
Conditions and Disorders in
Women
The
female reproductive system is a fairly complicated mechanism that sustains the
monthly cycles that are part of fertility as well as pregnancy and childbirth.
Because of the complexity of the reproductive organs and the functions needed
to maintain it, some normal conditions as well as disorders may require regular
medical attention.
Birth Control
Many
methods of birth control, or contraception, are available that have a very high
degree of safety and effectiveness (see "Contraceptive Failure
Rates"). These methods allow you to choose if and when you wish to have children
and to plan your family just as you plan other aspects of your life. Without
such methods, up to
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Abortion The
medical term for termination of a pregnancy by any cause is abortion . The term spontaneous abortion
describes a natural end of the pregnancy, also called a miscarriage, before
the fetus is able to live outside the uterus (about the first With
any form of abortion, the initial step is confirming the pregnancy. Most
commercially available pregnancy tests inform you of your pregnancy status at
the time of the first missed menstrual period. Although this usually occurs
about Elective
abortions can be performed in a physician's office as early as Before
the procedure, a woman has her blood type checked and a pregnancy test
repeated. She is counseled by health care workers about the procedure and
given a chance to ask questions. Consent forms must be signed by the patient
and may be required from others, depending on state law. In most cases, the Vacuum
curettage is performed with a local anesthetic, injected into and around the
cervix. The cervix is then dilated, or opened, using a series of gradually
larger metal rods or a synthetic material that swells. The contents of the
uterus are then removed with a suction device. As the uterus contracts to its
previous size, some cramping may result. The amount of blood lost is usually
small. In most clinics, only about Abortions
in later stages have a higher risk of complications and should be performed
in a hospital or a specialized clinic. They can be done with suction or by
administering agents that bring on labor. In some extreme cases, surgery may
be required.
In
the days when abortions were outlawed, women sought abortions from unlicensed
providers who frequently did not use sterile techniques and who did not
monitor women for complications. As a result, women developed advanced
infections that spread from the uterus to the bloodstream and the abdominal
cavity. Such infections could result in permanent sterility or death. Today,
abortions are extremely safe when performed in a proper medical setting by a
licensed practitioner. An abortion has no effect on a woman's ability to have
children in the future. |
Hormonal
Methods
Pregnancy
can be prevented by using hormones to regulate fertility. The hormone estrogen prevents
ovulation, the release of an egg. The hormone progesterone blocks the release
of the egg during ovulation, although not as well as estrogen, and creates an
environment in the uterine lining that makes pregnancy unlikely. These hormones
may be used alone or in combination, depending on the technique.
Hormones
are used for postcoital, or emergency, contraception, also known as the morning
after pill. A doctor or family planning clinic can prescribe the pill, which is
usually a combination of birth control pills taken at specific intervals. This
technique can be used if a woman has had unprotected intercourse because her
method failed or she was sexually assaulted or for any number of reasons. The
morning after pill must be administered within hours of intercourse to be
effective.
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Contraceptive Failure Rates*
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Oral
Contraceptives
Birth control pills,
or oral contraceptives, are very effective when used properly. There are two types
of birth control pills: combination pills, containing the hormones estrogen and
progestin, and mini-pills containing only progestin. Progestin is a synthetic
version of the natural female hormone progesterone. Women use the combination
pills most often; those women who cannot take estrogen use the mini-pill.
To
be effective, the pill must be taken regularly. Some pills are taken daily
during a
Aside
from preventing pregnancy, birth control pills have other benefits. Oral
contraceptives protect against cancer of the ovary and the endometrium. The
longer a woman takes the pill, the greater the protective effect. Women who
take the pill have a lower risk of ovarian cysts, ovarian and endometrial
cancer, uterine fibroids, noncancerous breast disease, and ectopic pregnancies.
They also tend to have more regular periods with less monthly flow and fewer
premenstrual symptoms. The estrogen in oral contraceptives also appears to
increase bone density, reducing the risk of bone loss that occurs during
menopause.
On
the other hand, oral contraceptives have been linked to certain types of
cardiovascular disease and cancer of the breast. These effects were observed
when higher dose formulations were in use and other factors linked to disease,
such as smoking, were not taken into consideration. In general, today's
low-dose pills do not seem to pose the same risk. There is, however, an
increased risk of thromboembolism (blood clots) in women who smoke and take the
pill. Although one study has shown a link between breast cancer and oral
contraceptives, others have not been able to confirm that finding.
Oral
contraceptives can be used by most healthy women. Do not take birth control
pills, however, if any of the following factors apply to you:
Women
over age
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Women's Choices About
Contraception A
woman's choice about which method of birth control to use is largely affected
by whether she wishes to have children in the future. Women who do wish to
have children choose oral contraceptives most often ( Among
all women, these are the percentages of women who select specific methods:
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Implants
Implants involve a new
technique of inserting small plastic tubes containing a progestin or
levonorgestrel just under the skin of the arm (see Fig.
Injections
The injection
technique involves injecting a long- acting type of progesterone into the body
every
Barrier
Methods
Some,
but not all, barrier methods provide protection against STDs. They can be used in
combination to offer extra protection against pregnancy and STDs.
Diaphragm
The diaphragm is a
reusable round rubber disk with a flexible rim that fits inside the vagina to
cover the cervix (see Fig.
The
diaphragm should be inserted
Cervical
Cap
The cervical cap is
similar to the diaphragm, although it is smaller. Fitting snugly over the
cervix, it is held in place by suction (see Fig.
Condom
Condoms, for use by
both men and women, are all available without prescription. They offer good
protection against STDs, including the HIV infection that causes AIDS, as well
as pregnancy when used properly. Condoms protect against both viral and
bacterial infections, and their use lowers the risk of cancer of the cervix.
With new sexual partners of unknown risk for STD, use condoms regardless of
other contraceptive methods you may be using. Condoms are disposable. Use one
time only and then discard.
The
male condom is a sheath that fits over the erect penis and collects the sperm
when a man ejaculates. Most condoms are made of latex rubber, although they can
be made of animal intestines. Only latex rubber condoms protect against
disease, however. Some condoms contain a spermicide (e.g., nonoynol) that
immobilizes and kills the sperm, providing additional contraception. You can
get extra protection by using a foam that contains
spermicide, along with the condom.
The male
condom should be applied just before intercourse, when the man's penis is
erect, before he touches the sexual partner's genitals. When the penis is being
withdrawn, the condom should always be held at the base so that there is less
risk of spillage, leakage, or tears (see Fig.
The female
condom is made of polyurethane, a thin but strong material that resists
tearing during use. It consists of two flexible rings connected by a loose-
fitting sheath. One of the rings is used to insert the condom and hold it
inside the vagina. The other ring remains outside and covers the woman's labia
and the base of the penis during intercourse. The female condom is
prelubricated and lines the vagina after insertion (see Fig.
Sponge
The sponge is available without a prescription; it is made of polyurethane and
contains a spermicide. Before intercourse, the sponge is inserted into the
vagina to cover the cervix, forming both a physical shield and chemical barrier
to sperm. It should be left in place for at least
Intrauterine
Devices
There
are currently two types of intrauterine devices (IUD) available. One is a
plastic device shaped like the letter T that is wound with copper, and
the other is a device that releases the hormone progesterone. When placed
inside the uterus, the IUD causes an inflammatory reaction in the uterine
lining that prevents pregnancy.
The
IUD device must be put in place by a trained physician or nurse. It is inserted
through the cervix into the uterus. Threads hang through the cervix and must be
checked monthly after each period to be sure the IUD is still in place (see
Fig.
Some
women have uncomfortable short-term side effects, including cramping and
dizziness at the time of insertion; bleeding, cramps, and backache that may
continue for a few days after insertion; spotting between periods; and longer
and heavier periods during the first few cycles after insertion. Use of a
copper IUD increases the amount of blood lost each month, while use of the
hormone IUD decreases it. The device can migrate into the muscular wall of the
uterus and sometimes tear it, although this is rare.
The
copper-releasing IUD increases the risk of developing pelvic inflammatory
disease (PID), which can result in infertility, especially in those at risk of
PID. These people are not good candidates for an IUD; they include women with
multiple sexual partners, those with a history of PID, and women under
Periodic
Abstinence
Also
known as natural family planning or the rhythm method, periodic abstinence
relies on close observation of a woman's cycle to detect when ovulation occurs.
Women using this method note the temperature increase that occurs just before
ovulation and the change in cervical mucus from dry to wet and slippery that
occurs around the same time. It takes into account the fact that sperm live an
average of
Sterilization
Men
and women who no longer wish to have children may choose to undergo
sterilization. The technique for women is known as tubal ligation, and the one
for men is called vasectomy. The procedure for male sterilization is less risky
and less expensive than female sterilization (see "Conditions and
Disorders in Men"). Sterilization should be considered a permanent form of
birth control, although in some cases it can be reversed.
Sterilization
in women is usually done by laparoscopy. Laparoscopic surgery has been
nicknamed Band- Aid surgery because of the small size of the incision near or
through the navel.
For
the procedure, gas is introduced into the abdominal cavity; the gas pushes the
intestine away from the uterus and fallopian tubes. A lighted tube called a
laparoscope is inserted through the same incision to allow the surgeon to view
the internal area. Operating instruments can either be inserted through the
laparoscope or through a second small incision at the pubic hair line. The
fallopian tubes are then sealed with electric current that also stops bleeding.
In some cases, a ring or clip can be inserted over the tubes through the
laparoscope to seal them (see Fig.
The
procedure is very effective in preventing pregnancy. Complications are rare but
include injuries to the bowel or blood vessels and infection.
Cancer Detection
When
cancer develops in a woman's reproductive organs, it is rarely accompanied by
symptoms. (See Figure
Cervix
The
Pap test can detect changes in the cells of the cervix that are not cancer but
may warn that cancer could develop (see Fig.
There
are virtually no symptoms during the earliest stage of cervical cancer. The
most common early warning signs of cervical cancer are spotting or irregular
bleeding or bleeding after intercourse. These signs should prompt an immediate
visit to a gynecologist.
Risk
factors for cervical cancer include early age at first intercourse, having
multiple sexual partners, smoking, and infection with humanpapillomavirus
(HPV). Because HPV is spread through sexual contact, the risk factors for
contacting this virus include having multiple male sexual partners, who
themselves have had multiple sexual partners. Women are most at risk during the
teenage years when cervical cells are maturing.
In
the Pap test, cells of the cervix are examined under a microscope to detect
abnormalities (see Fig.
There
is a
Uterus
Cancer
of the lining of the uterus, the endometrium, is the most common gynecologic
cancer. About
The
most frequent symptom of endometrial cancer is spotting or irregular bleeding,
which should alert a woman to seek treatment. Women in the menopausal years
should consult their physicians immediately if they develop spotting after
their regular periods have stopped for
The
greatest risk factor for endometrial cancer appears to be excess amounts of the
hormone estrogen. Estrogen stimulates the uterine lining to grow, causing a condition
called endometrial hyperplasia, a form of precancer. The excess estrogen can
come from a variety of sources:
The
diagnosis is confirmed by performing a uterine biopsy to obtain a sample of the
lining to study. This procedure can be performed in a physician's office,
without any anesthesia. The "D&C," or dilation and curettage, is
rarely needed now that suction biopsies can be done in the office.
Treatment
usually consists of a hysterectomy. The ovaries are usually removed
(oophorectomy), along with the lymph nodes. A careful search is made for any
sign of further spread (see "Staging of Endometrial Cancer"). A
general gynecologist can perform the surgery in early stage cancer but a
gynecologic oncologist should always be available if advanced disease is found
during the surgery. If advanced disease is diagnosed preoperatively, the
gynecologic oncologist should perform the surgery. After surgery and complete
pathological evaluation of the uterus, the ovaries, and the lymph nodes,
further treatment may be recommended in the form of either radiation or
chemotherapy.
Ovarian
Cancer
Ovarian
cancer is the most malignant of all of the gynecologic cancers. Approximately
Ovarian
cancer gives only vague early warning signs, such as a change in bowel pattern,
a feeling of bloating, or simply pelvic discomfort. These symptoms may be due
to pressure from a pelvic mass or tumor implants on the bowel wall.
When
ovarian cancer grows, some women think they are only getting fat and don't
investigate the cause of the swelling. The cancer can cause fluid to accumulate
within the abdominal cavity, causing the abdomen to swell. This fluid contains
cancer cells and can spread even into the lung cavity, where more fluid can
accumulate.
Since
there are so few warning signs in the early stages, this cancer is usually
diagnosed later, when tumor nodules from the ovaries extend to the surface of
the liver, the bowel, the stomach, or inside the abdominal wall. Cancer is
often suspected by pelvic exam and confirmed by ultrasound. A blood test also
can be performed to measure a substance called CA-
Therapy
usually begins with surgery to remove all the tumor,
followed by chemotherapy. The chemotherapy is fairly effective at removing any
tumor cells left after surgery. While a complete cure of this cancer occurs in
only about
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Staging of Endometrial Cancer
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Ovarian
Cysts
Often
a cyst may develop on an ovary. This fluid-filled growth is not cancerous in
most cases. Some may be the earliest sign that a cancer has formed,
however, so all ovarian cysts should be taken seriously and evaluated. Ovarian
cysts may have no symptoms; large cysts can cause a feeling of pelvic pressure
or fullness. Diagnosis is usually by vaginal ultrasound: A small probe is
passed into the vagina that reveals details of the ovaries and uterus. The CA-
Vagina
Cancer
of the vagina that does not involve the vulva or the cervix is rare. One form
is caused by exposure to a drug called diethylstilbestrol, or DES, in women
whose mothers took the drug while they were pregnant. In the early
Vulva
Vulvar
cancer is a rare gynecologic malignancy. It almost always strikes women who are
in the menopausal years and appears to be linked to infection with HPV. The
cancer appears as a small sore or small lump on one of the outer lips of the
vulva. Sometimes it can itch, but it usually does not cause any pain. Many
women delay seeing their gynecologists, hoping the sore will disappear,
however, this delay allows for continued tumor growth. If you have a small
sore, lump, or ulcer on any area of the vulva that is new and does not go away
within a week, see your physician.
The
diagnosis is based on the results of a biopsy, in which the area is numbed and
a small amount of tissue is removed to be studied. If the cancer is found in
early stages, surgery is performed. Usually, the area of cancer must be removed
with a rim of normal tissue of approximately
Ectopic Pregnancy
Normally,
once the egg is fertilized in the fallopian tubes, it travels to the uterus and
becomes implanted there. When, for any reason, the fertilized egg implants
anywhere else along the route, the pregnancy is said to be ectopic, or in the
wrong place (see Fig.
Ectopic
pregnancy occurs when the opening of the fallopian tube is twisted or narrowed,
due to scar tissue formed by infection or surgery. The passage of the
fertilized egg to the uterus is blocked, and the egg begins to develop within
the fallopian tube lining, on the surface of the ovary, or within the abdominal
or pelvic cavity. The egg can only develop for a few weeks before its growth is
hindered by the size of the fallopian tube.
In
an ectopic pregnancy, symptoms of early pregnancy, an abnormally light period,
and pelvic pain can occur. Many women have no symptoms until the pregnancy
causes a rupture of the fallopian tube or there is bleeding from a nearby blood
vessel. This causes severe abdominal pain, shock, and collapse -- a medical
emergency of the first order.
If
you have a history of tubal infections or previous ectopic pregnancy and
suspect you are pregnant, you should be carefully monitored by your physician
to be sure that the pregnancy is within the uterus. Ectopic pregnancy is
diagnosed by doing tests to measure hormone levels that indicate pregnancy.
Once pregnancy has been confirmed, ultrasound can determine its location and
size.
If
the fallopian tube has ruptured, ectopic pregnancy is an emergency that
requires surgery to remove the pregnancy and control bleeding. In some cases,
the tube can then be rejoined. Many surgeons are now performing this procedure
through the laparoscope. Conservative surgery in which the fallopian tube is
simply opened and the pregnancy lifted out is frequently possible and conserves
the tube, and thus your ability to have children. Another procedure for small,
early ectopic pregnancies involves the intramuscular injection of chemotherapy;
the usual result is loss of the pregnancy in about
Endometriosis
The
tissue that lines the inside of the uterus responds to hormones that cause it
to thicken and bleed each month. This tissue can also grow outside the uterus,
on the pelvic organs. When this occurs, these areas can become inflamed and
sometimes painful, and scar tissue develops.
Some
women with endometriosis, even severe endometriosis, have no symptoms. Others can
have intense pain, especially when the endometrial tissue is shed into the
pelvic area during the menstrual period. The pain can be felt throughout the
entire area or may be confined to the uterus. Pain usually appears only during
the menstrual period, but can start just before and gradually increase until
bleeding starts, usually easing after up to
Researchers
have not been able to pinpoint causes of endometriosis. One theory is that
endometrial tissue travels through the fallopian tubes and becomes implanted on
surrounding structures (see Fig.
Laparoscopy
is used for both definitive diagnosis and treatment of endometriosis. The
treatment of endometriosis depends largely on the patient's needs and desires. If
relief of pain is of most importance and childbearing has been completed, a
hysterectomy with removal of the ovaries, followed by hormone replacement
therapy, is often recommended. When fertility is desired, the spots of
endometriosis can be removed by laparoscopy with laser therapy. Unfortunately,
the condition recurs in about one-third of women treated.
Synthetic
hormones can be used to shrink the endometriosis implants, but the effect is
temporary. The implants usually return to their premedication level within a
few months after treatment ends. Treatment can be given for only
Fibroids
Benign
fibrous growths of the uterine wall are called fibroids. Some fibroids bulge
outward from the wall; others extend from the uterine surface on a stalk. A
fibroid can also extend into the uterine lining, compressing the endometrium or
forming a growth on a stem within the endometrial cavity. About
Fibroids
enlarge the uterus and can cause pressure and discomfort in the pelvis,
however. Internal uterine fibroids can also compress the endometrial lining and
cause excessive bleeding during and occasionally between menstrual periods.
Younger women rarely have fibroids, but when they do, the fibroids can press
against the lining of the uterus causing infertility. The most serious
complication is pressure and blockage of the ureters, the tubes draining the kidneys.
On rare occasions, a fibroid can develop into a malignant tumor. Fibroids have
been the most common reason for hysterectomy in the past, as well as currently.
The only reason for removing the fibroids or for doing a hysterectomy for
fibroids is if they cause symptoms like bladder or pelvic pressure, excessive
bleeding, infertility, or pain.
Ultrasound
is used to determine the size and location of fibroids. Two types of surgery,
if needed, are used to remove the growths:
The
selection of the type of surgery used rests with the woman and her surgeon. For
a woman who wants to maintain her fertility, a myomectomy is the treatment of
choice. It might also be preferred by the woman who wishes to have her uterus
and ovaries left intact.
Myomectomy
usually involves more blood loss than a hysterectomy, because the fibroid can
have a rich blood supply. During a hysterectomy, the location of each blood
vessel that feeds the uterus is well known and can be clamped off so that
little bleeding occurs. During myomectomy, the blood supply to the fibroid is
less clearly defined and blood loss can be heavy. Many gynecologists recommend
that women who do not want to retain fertility simply have the top half or the
entire uterus removed in what is called a partial hysterectomy.
Sometimes
this procedure can be made easier by shrinking the fibroid prior to surgery.
This is done by prescribing hormones that mimic menopause and decrease the
amount of estrogens, resulting in shrinkage of the fibroid by as much as
Women
can usually become pregnant after removal of a fibroid and carry the pregnancy
to full term, although they may occasionally likely require a caesarean
delivery.
Menopause
At
menopause, a woman stops menstruating and her ovaries no longer produce
estrogen. The average age at the last menstrual period is
Not
all women have all of these symptoms and they are not always long lasting. You
can continue to have a full and healthy life for many years beyond menopause.
Some of the symptoms of menopause can be eased through diet and exercise.
Others can be relieved by replacing the estrogen no longer produced by the
ovaries. Hormone replacement therapy can relieve the symptoms of menopause, in
addition to lowering the risk of heart disease and osteoporosis.
Estrogen
is given along with the hormone progestin (a synthetic version of the natural
hormone progesterone) to protect against endometrial cancer, a risk when
estrogen is taken alone. Estrogen by itself causes the lining of the uterus to
overgrow and increases the risk of cancer of the endometrium. Progestin is
taken with estrogen to oppose it and keep the lining of the endometrium in
check. In fact, taking progestin with estrogen actually lowers the risk of cancer
to less than that of a woman not taking hormone therapy.
Estrogen
is processed through the liver and affects the levels of cholesterol. Estrogen
increases high- density cholesterol (the good cholesterol) and lowers low-density
cholesterol (the bad cholesterol), thus reducing the risk of heart disease.
Without estrogen, a woman's risk of heart disease approaches that of a man by
age
Women
are at higher risk of osteoporosis because they have less bone mass than men to
begin with and because they tend to have less calcium stored in their bones. Thus, when they lose the protective effect of estrogen, the natural
process of bone loss speeds up so they are losing bone faster than it is being
replaced.
Osteoporosis
and cardiovascular disease do not have symptoms in their early stages as they
are conditions that develop over time. Hormone replacement therapy to prevent
symptoms of menopause also helps prevent these conditions. To provide long-term
protection, the therapy must be taken long term.
Hormone
replacement therapy is not for everyone. It is not recommended for women who
have had breast cancer, endometrial cancer, or liver cancer. The link between
breast cancer and hormone replacement therapy is still not clear. There may be
a slight increase in a woman's chance of developing breast cancer if she has
been taking hormones for more than
Hormone
replacement therapy can have other side effects. The progestin causes monthly
bleeding or spotting, which can be unexpected and bothersome. Other side
effects include breast tenderness, fluid retention, swelling, mood changes, and
pelvic cramping. Because of the side effects, some women choose to take
estrogen alone. These women should be monitored carefully for abnormal
bleeding. Their doctors may suggest that an endometrial biopsy be performed so
a small amount of tissue can be examined.
Women
who prefer not to take hormone replacement therapy can obtain relief of
symptoms and help prevent bone loss and heart disease in other ways. To
facilitate decisions about hormones, women should have a
fasting cholesterol and a bone density test. Estrogen cream, used in the
vagina, can treat vaginal dryness. A balanced diet rich in calcium and low in
fat, regular exercise, and avoiding alcohol and tobacco can help reduce the
rate of bone loss and protect against heart disease. Regardless of age or
whether they are taking hormone replacement therapy, women should continue to
have regular pelvic exams, mammograms, and Pap tests after they reach
menopause.
Menstrual Problems
Most
women experience some discomfort with their menstrual periods. Certain
conditions, such as endometriosis or fibroids, can increase pain during
menstrual periods. Any severe pain, unusual spotting or bleeding, or missed
menstrual periods could be a sign of a problem that requires medical attention.
Amenorrhea
Amenorrhea
is the absence of menstruation. This absence is normal before puberty, after
menopause, and during pregnancy. Primary amenorrhea occurs when a woman reaches
the age of
Primary
amenorrhea
Secondary
amenorrhea
To
diagnose and treat amenorrhea it may be necessary to consult a reproductive
endocrinologist. Treatment is based on the problem diagnosed. Blood tests are
usually performed and many patients are asked to keep a record of their early
morning temperatures to detect the rise in temperature that occurs with
ovulation.
Cramps
The
sensation of spasmodic cramping or a feeling of chronic achy fullness can occur
with a normal menstrual cycle and a normal anatomy. The pain is due to uterine
contractions, caused by substances called prostaglandins.
Prostaglandins
circulate within the blood. They can cause diarrhea by speeding up the
contractions of the intestinal tract and lower blood pressure by relaxing the
muscles of blood vessels. Thus many women frequently notice that severe
menstrual pain is associated with mild diarrhea and occasionally an overall
sensation of faintness in which they become pale, sweaty, and sometimes
nauseated. Some women actually have fainting spells because of the low blood
pressure resulting from the action of prostaglandins.
To
relieve cramps, your doctor may recommend drugs called prostaglandin inhibitors
or nonsteroidal anti-inflammatory drugs (NSAIDs), which are available without a
prescription. Taking medication immediately at the onset of any symptoms
usually results in dramatic improvement or complete relief. Taking these drugs
even before symptoms begin may help, too. Relief also may be obtained by
applications of heat and mild exercise.
Excessive
Bleeding
Some
women experience a menopause characterized by irregular, unpredictable, often
heavy bleeding. If you develop severe irregular bleeding as you approach
menopause, or experience new bleeding a year after your final period, your
doctor should do a biopsy to confirm that no precancerous changes have taken
place. This biopsy does not need to be the traditional dilation and curettage
(D&C) that is performed in a hospital under general anesthesia. Rather, the
biopsy is a simple procedure that takes place in the doctor's office. A
slender, soft, plastic canula is inserted through the cervix and a small sample
of uterine tissue is obtained. The cost of this biopsy is about
Pelvic Inflammatory Disease
Infection
with the STDs chlamydia and gonorrhea can lead to pelvic inflammatory disease
(PID). In PID, infection spreads upward through the cervix, the uterus, and the
fallopian tubes into the pelvic cavity. White blood cells battling the infection
cause a puslike discharge to surround the ovaries. The body tries to wall off
this infection by creating filmy adhesions (a fibrous wall) from organ to organ
to limit the spread of the infection. The adhesions can distort the fallopian
tubes and result in infertility.
Early
symptoms of PID include pelvic pain associated with fever and weakness; there
also may be a vaginal discharge. If the infection continues, an abscess can
form within the pelvis. The typical PID attack strikes after a menstrual period
and begins with pelvic pain. Motion, even walking, can be painful. If the
abscess develops, it can send bacteria into the blood stream, causing high
fever, chills, joint infections, and even death.
Diagnosis
usually is based on the symptoms and presence of the abscess. In some cases, a
sample of the discharge from the abscess can be used to identify the organism
causing the infection. Antibiotics can stop the infection before an abscess has
formed, if treatment is started early. If the infection is severe, some
patients may require intravenous antibiotics in a hospital setting. Surgery may
be necessary to drain an abscess, but it is usually not necessary to remove the
uterus, tubes, and ovaries.
Premenstrual Syndrome
The
regular, recurring symptoms that occur just prior to menstruation are called
premenstrual syndrome (PMS). PMS is not a disease but rather a collection of
symptoms that disappear once the menstrual period has begun.
Nearly
all menstruating women experience a set of symptoms that tell them their
periods are coming. For some women, these symptoms can be quite severe,
involving a combination of emotional and physical changes. Emotional changes
may include anger, anxiety, confusion, mood swings, tension, crying,
depression, and an inability to concentrate. Physical symptoms include
bloating, swollen breasts, fatigue, constipation, headache, and clumsiness.
The
diagnosis rests on confirming the cyclic nature of these symptoms and ruling
out any underlying psychological or physical dysfunction. Many women are asked
to chart their symptoms so they can be related to the menstrual cycle to detect
a pattern. The symptoms usually occur about
The
cause of PMS is unknown, despite extensive research into abnormal types of
hormones that are secreted at this time, unusual ratios of one hormone to
another, and imbalance between sodium and body water retention. Many theories
have been studied, but none has been shown to be the primary cause. As a
result, the condition is difficult to treat.
Treatment
is generally aimed at relieving symptoms. Keeping a calendar and being aware of
when symptoms occur helps most women; simply knowing their distressing symptoms
are related to the onset of their periods can have a calming effect. There are
other things you can try to ease symptoms of PMS:
Many
medications have been tried with limited success. Some of them are expensive
and most have side effects. It may be necessary to combine some remedies on a
trial and error basis, along with modifications in diet and exercise.
Rape
Rape
is sexual intercourse by force; it is epidemic in our country. This violent
crime has both psychological (see Chapter
A rape
should be reported within
A
physician first asks the women to describe what happened, and then examines her
clothing for damage, taking particular note if there are any materials such as
soil or stains such as body fluids sticking to the clothing. The physician next
asks if any drugs or alcohol were taken by the woman or the rapist, because
this may become an important issue during court procedures.
The
physical exam consists of looking for evidence on the whole body, even though
not every woman who has been raped has been physically injured. The physician
measures and charts all injuries and may photograph them, looking carefully for
bite marks, bruises, grip marks, and scratches. Samples are taken of the
vaginal fluid to check for infection or sperm. Mouth swabs and saliva samples
are obtained to look for bacteria and semen and possibly to perform DNA studies
of the sample. Urine samples may be obtained to determine whether drugs were
involved. Blood samples are obtained to test for HIV as well as hepatitis. If
the HIV test is negative, another HIV test should be done in
After
the exam, comfort, support, and counseling are key to
complete recovery. There are many groups available to counsel women who are
recovering from previous molestation or rape.
Vaginitis
The
internal environment of the vagina consists of a delicate balance of organisms
that, along with normal vaginal secretions, keep it healthy and clean. When
that balance is disrupted by either an infection, a
health problem, or some type of irritation, vaginitis can occur. Bacteria or
yeast that grows normally in the vagina can overgrow and cause itching,
redness, and pain in the vaginal area. Infections from other organisms, as well
as allergic reactions, can also cause vaginitis.
Any
new discharge accompanied by an odor, or abnormal itching, could be a sign of a
vaginal infection. The characteristics of the discharge -- its color, odor, and
amount -- can be a clue to the cause. Yeast is the most common cause of
vaginitis, but bacteria and parasites can also cause it. The cause of vaginitis
must be identified for treatment to be effective.
Bacterial
Vaginosis
Among
the more common vaginal infections, bacterial vaginosis is caused by the Gardnerella,
Bacteriodes, and Peptostreptococcus bacteria. The primary symptom is
a foul-smelling, profuse, watery vaginal discharge.
The
diagnosis is confirmed by microscopic examination of the discharge. Treatment
for this infection is the antibiotic metronidazole. Often, the infection
recurs; longer treatment may be needed to prevent recurrences.
Yeast
Infection
Some
women are unusually susceptible to this most common of all vaginal infections.
The cause may be a recent course of antibiotics that can decrease the normal
vaginal bacteria and allow for an overgrowth of yeast. Other conditions, like
diabetes and HIV infection, are also associated with recurrent yeast
infections.
Your
doctor will want to confirm that yeast is the cause by examining the vaginal
discharge under a microscope. Discuss multiple recurrent yeast infections with
your physician, because other problems such as diabetes should be ruled out.
Once
you can recognize the symptoms of yeast vaginitis, you can treat yourself by
purchasing any one of the over-the-counter antifungal creams or suppository
preparations. Treatment is also available in pill form by prescription.
Cryotherapy
Cryotherapy
involves freezing cells on the cervix to remove abnormal cells. Freezing kills
cells but does not remove them from the vagina. The dead cells dissolve into
the vaginal fluid and are washed away in the normal secretions. This can cause
an increased vaginal discharge for about
Colposcopy
In
colposcopy, the cervix, vagina, and vulva skin are examined systematically
under microscopic magnification. When abnormal areas are detected, a sample is
taken for further examination (a biopsy).
During
the procedure, a speculum is inserted in the vagina to spread the vaginal
walls, and a vinegar solution is sprayed into the cervix. The abnormal surface
cells appear white, and normal cells remain pink. The entire area is examined,
and a biopsy of any white area is performed.
Most
women have a slight cramp for a minute or so during the biopsy. Otherwise, this
procedure requires no anesthesia and is well tolerated. If a woman has severe
cramps with her menstrual cycle, medication can be given before the exam to
reduce discomfort.
Occasionally
a scraping of tissue is obtained from the inner lining of the cervix beyond the
limits of the area that can be seen. This scraping provides extra assurance
that the entire abnormality has been identified. Once the biopsy results are
available, therapy can be started.
Dilation and Curettage
Often
referred to as a D&C, dilation and curettage removes the lining and contents
of the uterus. Once the cervix is widened by dilators, the uterine lining is
scraped out with a curette, a spoonlike instrument. A D&C is used to
perform abortions, remove the lining of the uterus in cases of severe bleeding,
or test for uterine cancer (see Fig.
Hysterectomy
A
complete or total hysterectomy is removal of the entire uterus with the cervix.
A partial (see Fig.
Reasons
for performing a hysterectomy should be clearly understood prior to the
procedure. Following are the most common reasons for a hysterectomy:
A
vertical incision in the lower abdomen is used for abdominal hysterectomy or
for cancer or a very large fibroid. For other conditions, a horizontal incision
is placed just above the pubic bone, which can be hidden in the pubic hair (see
Fig.
A
vaginal hysterectomy involves less discomfort than an abdominal hysterectomy
because no abdominal incision must be made. Vaginal hysterectomies are seldom
performed on women who have had no children because the ligaments are tighter
and the vaginal passage is small. It is indicated when there is a small uterus,
and the patient has had children, because the vagina and the connecting
structures of the uterus are more pliable.
Vaginal
hysterectomy is now available to more women because it can be done with a
laparoscope. When the laparoscope is used, it is placed into the abdomen
through a small incision in the abdominal wall. The laparoscope is a
telescopelike probe that can identify the structures and cut away problems
outside the uterus, such as adhesions. The uterus can then be removed through
the vagina with less postoperative pain and scarring.
Recovery
time varies depending on the procedure. Usually, normal activities, including
sex, can be resumed in about
Very
few women notice a change in their sexual sensations after hysterectomy that
could be related to the functions of the uterus during sexual activity or to
their own sense of loss of their uterus. For most women, however, hysterectomy
has no effect on sexual satisfaction. Many women have a sense of freedom from
symptoms of the condition corrected, as well as from the concern of monthly
periods and potential pregnancy. If you have any doubts about having a
hysterectomy, always get a second opinion.
Hysteroscopy
Hysteroscopy
allows the inside of the uterus and the openings of the fallopian tubes to be
viewed on a video camera or a monitor. The hysteroscope is a telescope that is
inserted to look at the walls of the uterus for signs of disease or other
problems (such as an IUD that has slipped out of place). It can be guided to
the fallopian tubes to find any obstruction and, in some cases, remove it. Some
surgical procedures can also be performed with hysteroscopy. The procedure may
be performed in a doctor's office using local anesthetic.
Laparoscopy
In
laparoscopy, a lighted tube with a magnifying lens on the end allows the
operator to see inside the body. Laparoscopy can be used to diagnose a
condition, such as endometriosis; it also can be used to perform surgery.
Laparoscopic
surgery uses small holes or punctures rather than one large incision. These
small incisions result in less postoperative pain and shorter recovery, as
compared with an abdominal incision. Women usually return to work within
Many
procedures can now be done through a laparoscope:
Laser
Laser
therapy uses a beam of very intense and focused light to perform surgery. It is
used to remove abnormal tissue from the cervix that could be a sign of early
cancer. The laser also can remove warts that result from HPV infection. To
increase the likelihood of complete cure, a small margin of normal tissue may
also be removed. An anesthetic is given before surgery, and recovery is usually
very rapid.
For
a loop electrosurgical excision procedure, known as LEEP, a high-intensity
electrical current passes through a wire used to cut a thin slice of tissue
from the cervix. This tissue can be examined under a microscope. In addition to
obtaining samples of tissue for diagnosis, LEEP also can be used for treatment
by removing abnormal tissue. A local anesthetic is administered before the
procedure, and pain medication may be given to ease postoperative discomfort. A
minimal discharge is experienced after this procedure.
Ultrasound
In
ultrasound, inaudible super-swift sound waves are projected into the body. The
reflected echoes are captured to create an image of the internal structures of
the body; this is transferred to a black and white image on a monitor screen.
From this image the physician or diagnostic expert can tell the size and shape
of the ovaries, the uterus, and other pelvic structures. It can determine the
age and exact location of the fetus within the uterus. In some situations
physical details of a fetus can be identified; it is especially helpful in
confirming a possible multiple birth.
Conditions and Disorders in Men
When
there is a disorder in the reproductive system of men, it can affect several
functions, including urination and sexual function.
Benign Prostatic Hyperplasia
The
prostate gland continues to grow during most of a man's life. It is common for
the prostate gland to become enlarged as a man ages. This growth is called
benign prostatic hyperplasia, or BPH. Over half of all men over age
Symptoms
are caused by pressure from the prostate growth around the urethra, which
obstructs the bladder. The bladder cannot fully empty, leaving urine behind.
Eventually this can lead to urinary tract infections, bladder or kidney damage,
bladder stones, and incontinence. The cause of BPH is not clear, but is
dependent on aging and androgens. Although some of the signs of BPH and
prostate cancer are similar, having BPH does not seem to increase the chances
of getting prostate cancer.
When
BPH causes a partial obstruction of the urethra, certain factors can bring on
symptoms. Some over-the-counter cold or allergy medicines can prevent the
bladder from allowing urine to pass. Other conditions that can bring on urinary
retention include alcohol, cold temperatures, or a long period of immobility.
Treatment
may not be required in the early stages. If problems develop, however, medical
or surgical treatment may be required. Some medications used to treat BPH
shrink the prostate cells or relax the smooth muscle of the prostate. The blood
pressure drugs terazosim (Hytrin) and doxazosin can be used to relax smooth
muscle in the prostate.
Sometimes,
surgery to remove the enlarged part of the prostate is recommended. In most
cases, surgery is performed through the urethra with a light-transmitting
instrument that has an electrical loop at the end to cut tissue. Surgery can
also be performed through an open incision. Most men recover completely within
Cancer
Prostate
Cancer
One
of the most common cancers in the
The
cancer is usually discovered by digital rectal examination (DRE), in which a
hard lump or growth in the prostate gland can be detected before symptoms
develop. Tests are then performed to confirm the diagnosis. In addition to
imaging studies, blood tests to measure a chemical called prostate-specific
antigen (PSA) are performed to detect the high levels that occur in the
presence of cancer. Biopsies are done to obtain a piece of tissue for further
study and, if cancer cells are present, the stage of disease is determined (see
"Stages of Prostate Cancer").
Treatment
can include surgery, radiation therapy, hormone therapy, or a combination of
these treatments. Because prostate cancer cells use the male hormones to grow,
blocking production of these hormones with gonadotropin androgens and
antiandrogens may control the disease. All of these treatments have side
effects. The chance of complete cure is good when the disease is detected in
its early stages.
|
Stages of Prostate Cancer
|
Testicular
Cancers
Cancer
of the testis is the most common type of cancer in men between the ages of
Any
unusual lump on the testis, or any new lump, even if it is not painful, should
be evaluated by a physician. When a tumor is found in one testis, surgical
removal is required; the remaining testis maintains the body's normal
functions. The loss of both testes results in loss of hormone production, and
testosterone therapy will be necessary to maintain sexual function.
Cryptorchidism
Cryptorchidism
is also known as hidden testis or undescended testis, because the testis has
not reached its normal position in the scrotum. A physician can confirm the
absence of the testis by feeling the scrotum, and all young boys should be
checked early for this condition. The undescended testis must be removed if it
cannot be put in the normal scrotal position because it carrries increased risk
of testicular cancer.
Epididymitis
Infection
of the epididymis, the coiled tube that transports sperm to the vas deferens,
is caused either by the STDs, including chlamydia and gonorrhea, or by the E.
coli bacteria. This condition is easily transmitted and can be very painful.
The infecting organism can sometimes be identified in samples of urine.
Antibiotics are usually prescribed. Ice packs applied to the scrotum reduce
swelling and pain. It is important to distinguish epididymitis from torsion of
the testis, which should be treated immediately.
Gynecomastia
Enlargement
of the male breasts, know as gynecomastia, can occur
on one or both sides. It is usually triggered by an imbalance in the normal
ratio of androgen to estrogen in the blood supply -- either androgen production
is decreased or estrogen levels are increased. Gynecomastia can occur normally
in newborns, at adolescence, or with aging. It also can result from several
endocrine disorders and some medications; gynecomastia should be evaluated.
Erectile Dysfunction (Impotence)
The
inability to have or keep an erection sufficient to permit intercourse or
masturbation is called impotence or erectile dysfunction. Nearly every man
experiences temporary impotence related to fatigue, stress, or illness. More
than
Many
factors can affect the complex interaction of vascular, neurologic, and endocrine
systems that allow normal erectile function. Although sexual function and
desire may decrease with age, age is not necessarily a cause of impotence.
Medication side effects, stress, smoking, and alcoholism can be risk factors.
Inadequate testosterone, anxiety, premature ejaculation, and Peyronie's disease
are some of the treatable causes of the problem. Diabetes is the most common
disease associated with erectile problems.
Treatment
requires a medical history and physical examination; this should include an
evaluation of testis size, shape, and consistency and palpation of the shaft of
the penis. A testoterone level and a nocturnal penile tumescence test can be
used to detect whether a man is having an erection at night while he sleeps. If
a man is physically able to have an erection, his impotence could be caused by
psychological reasons, and he may benefit from counseling.
Some
of the methods of treatment include the use of penile or intracavernous
injections, vacuum devices, and penile implants. Support groups, changes in
life- style, or medications can be helpful.
Infertility
Defined
as the inability of a couple to conceive after
A
physician's examination should include palpation of the testes and the
epididymis to look for possible obstructions that could prevent sperm from traveling
out the penis. A rectal examination should be performed to evaluate the
prostate and possible abnormalities of the structures involved in ejaculation.
Two or more semen analyses should be done. Additional tests may include
evaluation of the hormone testosterone. Treatments are directed at the specific
causes identified by the couple's history, the physical exams, and testing. (See Chapter
Peyronie's Disease
In
Peyronie's disease a firm plaque or growth occurs on the connective tissue of
the penis. This plaque can cause pain during an erection and make vaginal
penetration difficult. This growth is not malignant and can go away on its own.
If it lasts more than one year, surgery may be helpful.
Premature Ejaculation
Ejaculation
that occurs just before or shortly after penetration of the woman is considered
premature. Often associated with problems in a relationship, it may also be due
to inadequate control over the ejaculatory process and does not have a physical
cause.
In
the past, treatment included efforts to decrease anxiety by concentrating on
nonsexual fantasies, use of cerebral depressants or sedatives, and distractive
maneuvers such as compressing the glans of the penis. To decrease penile
sensation, anesthetic ointments were applied, condoms were used, and penile
movement in the vagina was minimized. Today it is recognized that this is a
psychological problem that requires behavioral therapy. Such therapy is usually
successful when both partners participate.
Priapism
Priapism
is a prolonged, often painful penile erection that lasts for more than
Prostatitis
An
inflammation of the prostate, prostatitis may arise suddenly or be longlasting
or recurring. Symptoms include difficulty urinating; pain in the lower back,
muscles, joints, or the area between the scrotum and anus; or painful
ejaculation. If untreated, prostatitis can cause abscesses, spread of
infection, and urinary retention. Prostatitis is diagnosed by a careful digital
rectal examination and urinalysis to identify any bacterial infection. When the
condition is caused by bacteria, it is treated with antibiotics; hot baths
sometimes provide relief from the symptoms.
Retrograde Ejaculation
In
retrograde ejaculation, orgasm occurs, but no ejaculate leaves the penis. This
condition usually arises after surgery to remove an enlarged prostate, when the
muscles around the bladder neck are removed. Instead of being expelled through
the penis, sperm enters the urethra near the opening of the bladder and is
flushed out with urine. Although a man may be unable to have children, without
special assisted techniques, he retains his libido, potency, and ability to
have an erection and orgasm.
Testicular Failure
Testicular
failure is rare. It is caused by both chromosomal abnormalities as well as
damage to the mature testes due to disease or injury. The loss of sex drive
typical with this condition often can be restored through a program of androgen
replacement. Fertility cannot be restored.
Varicocele
A
swelling in the scrotum caused by enlarged veins, varicocele is common in
otherwise healthy men. It is caused by problems with the valves located in the
veins leading from the testes. The blockage causes blood to back up, resulting
in swelling and infertility. When varicocele causes infertility, surgery is
necessary.
Nocturnal Penile Tumescence Test
Sleep-associated
erections can be monitored with the nocturnal penile tumescence test to
evaluate impotence. Normal males have three to five erections per night's
sleep. Both intrapenile injections and the penile tumescence test may be used
in a complete diagnostic evaluation.
Semen Analysis
Semen
is collected from a male after
Vasectomy
About
a half million men in the
Vasectomies
are usually reversible. A vasovasectomy is the rejoining of the two ends of the
vas; this procedure has a high success rate, and a pregnancy rate of up to