REPRODUCTIVE PATHOLOGY

Male reproductive pathology

The male reproductive system consists of a number of sex organs that play a role in the process
of human reproduction. These organs are located on the outside of the body, and within the pelvis.
The main male sex organs are the penis and the scrotum which contains the testicles that
produce semen and sperm, which, as part of sexual intercourse, fertilize an ovum in the female's body;
the fertilized ovum (zygote) develops into a fetus, which is later born as an infant.
The corresponding system in females is the female reproductive system.

Penis
The penis is an intromittent organ with a long shaft, an enlarged bulbous-shaped tip called
the glans and its foreskin for protection. Inside the penis is the urethra, which is used
to ejaculate semen and to excrete urine. Both substances exit through the meatus.
When the male becomes sexually aroused, the penis becomes erect and ready for sexual activity.
Erection occurs because sinuses within the erectile tissue of the penis become filled with blood. The
arteries of the penis are dilated while the veins are compressed so that blood flows into the
erectile cartilage under pressure. The penis is supplied by the pudendal artery.

Scrotum
The scrotum is a sac of skin that hangs behind the penis. It holds and protects the testicles. It also
contains numerous nerves and blood vessels. During times of lower temperatures, the cremaster
muscle contracts and pulls the scrotum closer to the body, while the dartos muscle gives it a wrinkled
appearance; when the temperature increases, the cremaster and dartos muscles relax to bring down the
scrotum away from the body and remove the wrinkles respectively.
The scrotum remains connected with the abdomen or pelvic cavity through the inguinal canal. (The
spermatic cord, formed from spermatic artery, vein and nerve bound together with connective tissue
passes into the testis through inguinal canal.)
Image showing innervation and blood supply of the human external male genitalia

Testicles
The testicles have two major functions: to produce sperm by meiotic division of germ cells within the
seminiferous tubules, and to synthesize and secrete androgens that regulate the male reproductive
functions. The site of production of androgens is the Leydig cells that are located in the interstitium
between seminiferous tubules.

Epididymis
The epididymis is a long whitish mass of tightly coiled tube. The sperm that are produced in the
seminiferous tubules flow into the epididymis. During passage via the epididymis, the sperm undergo
maturation and are concentrated by the action of ion channels located on the apical membrane of the
epididymis.

Vas deferens
The vas deferens, which is also known as the sperm duct, is a thin tube approximately 30 centimetres
(0.98 ft) long that starts from the epididymis to the pelvic cavity. It carries the spermatozoa from the
epididymis to ejaculatory duct.

Accessory glands
Three accessory glands provide fluids that lubricate the duct system and nourish the sperm cells.
Seminal vesicles: two glands behind the bladder that secrete many of the semen's components.
Prostate gland: a gland located below the bladder that produces seminal fluid and helps regulate urine
flow.
Bulbourethral glands: add fluid to semen during ejaculation (pre-ejaculate).

Diseases of the mal genital system

A male genital disease is a condition that affects the male reproductive system.
Classification by type of disease
Infection-Aetiological agents include bacteria (eg Fournier's Gangrene), fungi (eg candidiasis),
parasites (pubic lice), viruses (mollascum contagiosum, herpes).
Inflammation - An example of a male genital disease is orchitis (testicular inflammation).
Cancers - The probability of cancerous development depends on age, ethnicity and the existence, or
non-existence, of environmental causation. Unlike all other genitally situated cancers, the incidence of
penis cancer is related to sexual mode of transmission.
Classification by location of disease
Prostate
The three most statistically frequently occurring diseases of the prostate gland are benign
hyperplasia (a swelling of the gland, not due to cancerous accumulation), prostatitis (inflammation),
cancer (which is the proliferation of malignant cells in the gland)
 Infertility - Most causes of infertility in men is as a result of male reproductive system
disorders: Structural disorders: An abnormal penis may not be able to deliver
the semen properly. In hypospadias or epispadias where the opening of the penis is in an
abnormal position, male infertility is a possibility.
 Varicocele: This is a condition characterized by enlargement, elongation and coiling of
the blood vessels around the scrotum. Most times, it appears as bag of warm in
the scrotum. It is seen in 10% of normal males and 40% of males with infertility.
 Drugs: Impotence in men has been found as side effects of
some drugs like nitrofurantoin, antihypertensive drug particularly
the sympatholytic ones, cimetidine, cancer drugs etc.
 Irradiation like X-ray, GSM etc. triggers release of free radicals and can directly halt
the Spermatogenesis (process of sperm formation). This is the reason behind covering
the scrotum (Testes) during X-ray.
 Autoimmune Antibodies: It has been found that some people have antibodies (defense
chemicals) against their own sperm cells. By this interaction, the antibodies destroy the
sperm cells leading to Azoospermia, oligospermia or normospermia depending on the
degree of damage. This condition can be treated if diagnosed.
 Liver disease: The liver is a vital organ which ensures that the
male hormone (testosterone) dominates in action than female hormone, oestrogen. This it
does by breaking down the oestrogen continually. However in a case of liver
disease which may impair liver functions, the level of female hormone, oestrogen,
increases leading to male characteristics, loss of pubic hair and impotence.

Female reproductive pathology

The female reproductive system is the internal and external sex organs that work in reproduction.
It includes the vagina, uterus, and fallopian tubes and ovaries. The female reproductive system is
not active at birth. It begins growing at puberty and becomes able to produce ova and carry a
baby to full term. The vagina is connected to the uterus at the cervix. The external sex organs are
also known as the genitals. These are the organs of the vulva: the labia, clitoris, and vaginal
opening.
During the woman's menstrual cycle, the ovaries release an ovum. The ovum goes through the
fallopian tube into the uterus. If the ovum egg cell meets with sperm on its way to the uterus, it
can combine with it, fertilizing it into a zygote.
Fertilization usually happens in the fallopian tubes. This is the beginning of embryogenesis. The
fertilized egg will then go through many divisions to form a blastocyst. The blastocyst implants
in the wall of the uterus and grows to fetus till term.
The female external reproductive organs on the outside of the body are the secondary sex organs
which is the vulva and includes the mons pubis, pudendal cleft, labia majora, labia
minora, Bartholin's glands, Skene's glands, clitoris, urethra, and vaginal opening.
The female internal reproductive organs are the vagina, uterus, Fallopian tubes, and ovaries.
Vagina - The vagina is a canal leading from the outside of the body to the cervix of the uterus or
womb. It is also referred to as the birth canal. The vagina receives the male penis during sexual
intercourse. Semen which contain spermatozoa is ejaculated from the penis into the vagina.
Cervix - The cervix is the bottom part of the uterus. This is the lower, narrow portion joining
with the upper part of the vagina. It is cylindrical or conical in shape and sticks down through the
upper vaginal wall. Approximately half its length is visible. It is the opening where the baby
emerges during birth.
Uterus - The uterus or womb is the major female reproductive organ. The uterus protects the
growing baby. It gives nutrition and removes waste products. The contractions of the uterus
pushes out the baby at the time of birth. The uterus is a pear-shaped muscular organ. Its major
function is to accept a fertilized ovum which becomes implanted into the lining of the uterus.
The baby gets its nourishment from blood vessels of the uterus.
Fallopian tube - The Fallopian tubes are two tubes leading from the ovaries into the uterus. When
the ovary releases an ovum it enters the Fallopian tube. It travels toward the uterus. This trip can
take hours or days. When the ovum is fertilized by a sperm cell while in the Fallopian tube, then
it normally implants in the womb.
Ovaries - The ovaries are small and located near the side walls of the pelvic cavity. The ovaries
produce the egg cells (ova). They also secrete hormones. After the ovary releases an egg cell it
travels down the Fallopian tube to the uterus. The egg can then be fertilized by a sperm.

Diseases of the female reproductive system

Female genital disease is a disorder of the structure or function of the female reproductive
system that has a known cause and a distinctive group of symptoms, signs, or anatomical
changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina,
and vulva. Female genital diseases can be classified by affected location or by type of disease,
such as malformation, inflammation, or infection.
Type of disease
Malformations can be congenital. They are classified by location of the malformation, such
as uterine malformation.
Inflammation or infection – example is salpingitis
Location of disease
Diseases of the vulva
Bartholin's cyst - A Bartholin's cyst is an abscess of a Bartholin's gland. Bartholin's glands are
located within the labia, or the skin folds surrounding the vaginal opening. Bartholin's cysts can
be painful and may require drainage or surgical removal in order to resolve.
Vulvodynia- Vulvodynia is a chronic pain condition which involves the sensation of pain in the
area surrounding the vaginal opening in response to physical stimulation such as vaginal
penetration. This condition can be distressing to people who have it as it can interfere with
intimacy. There is no standardized treatment for vulvodynia, but some options include pelvic
floor physical therapy and pharmacologic pain management.
Disease of the Vagina
Vaginal prolapse -Vaginal prolapse, otherwise known as pelvic organ prolapse, is when a
person’s vagina descends due to pelvic organ pressure or due to tissue injury and/or muscle
weakness. Some of the risk factors include previous pelvic surgeries as well as activities and
conditions that increase intrabdominal pressure such as childbirth, obesity, and older age.
Symptoms of vaginal prolapse are vaginal bulge, urinary and fecal incontinence, and sexual
dysfunction.
Bacterial vaginosis -Bacterial vaginosis is a condition that occurs when there is an overgrowth
of normal bacteria in the vagina. The community of bacteria that normally exists in the vagina is
called the vaginal flora. The flora serves as a defense against the invasion and colonization of
opportunistic pathogens including bacterial vaginosis, fungi, viruses, and protozoa. Historically,
it was believed that the bacterium Gardnerella caused bacterial vaginosis, but studies have shown
that bacterial vaginosis can be caused by a variety of bacteria. Women are at an increased risk of
having bacterial vaginosis if they smoke cigarettes, recently used antibiotics, use an intrauterine
device, have multiple sexual partners, and practice vaginal douching.
Trichomoniasis - Trichomoniasis, also known as "trich", is a sexually transmitted disease caused
by a protozoan parasite called trichomonas vaginalis. It is the most common protozoal infection
in the United States. This motile organism is not exclusive to women, but can also be found in
the prostate and urethra of men. Individuals are at an increased risk of contracting trich if they
have a history of sexually transmitted infections, have new or multiple sex partners, abuse IV
drugs, and do not use any type of protection during sex.
Disease of the cervix
Cervicitis - Cervicitis is inflammation of the cervix in individuals with a uterus, most commonly
identified in those presenting as women. While some patients report pus and mucus like
discharge, a majority of individuals with this condition do not present with any symptoms. Less
than half of the cases of cervicitis are linked to either Neisseria gonorrhoeae or Chlamydia
trachomatis, likely sexually transmitted. However, more than half have unknown infectious
etiology. Complications can result in pelvic inflammatory disease, difficulties bearing
pregnancy, and endometriosis. Due to these adverse outcomes, the CDC recommends that
women undergo routine nucleic acid amplification technique (NAAT) testing, which can aid in
the detection of chlamydia and gonorrhea.
Diseases of the uterus
Uterine malformation - Uterine malformations are sometimes referred to as congenital uterine
anomalies. A uterine malformation is an abnormality in the development of a person's uterus.
This condition can result in fertility problems such as increased risk of miscarriage.
Uterine fibroids - Uterine fibroids, also known as uterine leiomyomas, are solid growths of
noncancerous smooth muscle cells that are located on the uterus. There is no cause, but risk
factors such as family history, reproductive issues, hormones, and viruses are associated with
fibroid growth. Previous research suggested an association between diet and hormonal changes
that has the potential to form fibroids and give them the environment to grow. Despite other
research contradicting this statement, further research stated that low fruit and vegetable intake
as well as Vitamin D insufficiency and food contaminants have been correlated to fibroid
formation and growth. In most cases, uterine fibroids are asymptomatic and therefore will not
need treatment.
Endometriosis - Endometriosis is when a person has their uterine endometrial tissue that is
growing somewhere besides its normal location, most commonly at the pelvic peritoneum. This
can also be regarded as "lesions outside of the uterus".This condition has been described as
"benign and estrogen dependent", therefore impacting those who produce estrogen. Other
locations where this may occur, although more rare, include ovaries, pericardium, rectovaginal
septum, bladder, and more. Most commonly, this can be associated with pelvic pain and
infertility.

Diseases of the fallopian tubes

Salpingitis - Salpingitis, or salpingitis isthmica nodosa, is a disease involving inflammation
within the Fallopian tubes. This condition can be caused by infections, such as sexually
transmitted infections. Salpingitis may be associated with fertility problems, such as infertility
and ectopic pregnancy.
Ectopic pregnancy - Ectopic pregnancy, or tubal ectopic pregnancy, is a condition that occurs
when a developing pregnancy implants outside of the uterus, such as in the Fallopian tubes. This
condition is an emergency and can be fatal to the pregnant person.
Diseases of the ovaries
Oophoritis -Oophoritis is a condition affecting one or both of the ovaries which results in
inflammation. Oophoritis can be caused by an infection or by an autoimmune disease called
primary ovarian insufficiency.
Sexually transmitted infections - A sexually transmitted infection (STI), also known as sexually
transmitted disease (STD), is an infection caused by a virus, fungus, bacteria, or parasite that is
spread through sexual contact. STIs are very common and can be passed from one person to
another through vaginal, oral, and anal sex. Sexually transmitted infections can impact female
reproductive health. Women experience a larger impact on their health compared to men because
of how exposed and vulnerable their urogenital anatomy is. The vaginal mucosa is thin and can
be easily penetrated by infectious agents. Some complications that women experience from STIs
are infertility, chronic pelvic pain, increased peripartum morbidity, and
increased peripartum mortality.