Chapter 32: Alterations of the Reproductive Systems
1. Describe the causes, clinical indicators, and underlying pathologic
changes associated with primary and secondary Amenorrhea.
o Defined as the failure of Menarche. Also means absence of
menstruation by age 14 with no development of secondary
o Caused by: Congenital defects of Gonadotropin production
(Turner Syndrome), congenital CNS defects (Hydrocephalus),
congenital anatomic malformations of the reproductive
system (Absence of vagina or uterus), or acquired CNS
lesions, including trauma, infection, or tumors
o Major clinical manifestation includes the absence of
menarche. The cause of Amenorrhea determines if secondary
sex characteristics or height will be affected
In some congenital cases, the Hypothalamic – Pituitary –
Ovarian (HPO) axis is dysfunctional. Due to anatomic
defects of the CNS, the ovary does not receive the
hormonal signals that normally initiate the
development of secondary sex characteristics and
Has also been associated with the absence or
Hypoplasia of the uterus. Also related to some genetic
disorders, including Gonadal Dysgenisis (Turner
Syndrome), Androgen Insensitivity Syndrome (AIS), and
Poly – X Syndrome.
In Turner Syndrome (XO), the ovaries lack gametes and
ovarian failure is complete. In AIS, the individual is male
genetically but female morphologically.
o The absence of menstruation for a time equivalent to three or
more cycles or 6 months in women who have previously
o Normal during early adolescence, pregnancy, lactation, and
perimenopausal period. Can also be caused by high or low
o Major manifestation is absence of menses. There may also be
infertility, vasomotor flushes, vaginal atrophy, acne, and
hirsutism (abnormal hairiness) 2. Discuss the mechanism and symptoms of Polycystic Ovary Syndrome
POS is the most common endocrine disturbance affecting women.
Defined as the presence of any two of the following: (1) Polycystic (ie.
Small cysts) ovary, (2) Oligo – Anovulation (Few anovulatory cycles),
(3) or Hyperandrogenism
o Hyperinsulinism stimulates androgen secretion by the
ovarian stroma and reduces serum sex hormone binding
globulin (SHBG) directly and independently. The net effect is
an increase in free testosterone levels.
o Excessive androgens affect Follicle growth and insulin affects
follicular decline by suppressing apoptosis
o Inappropriate Gonadotropin secretion triggers anovulation
o Dysfunctional bleeding or amenorrhea, Hirsutism, and
Infertility. Some women are obese and some are
asymptomatic. Some even develop diabetes by the age of 30.
3. Discuss the manifestations and causes of Pelvic Inflammatory Disease
PID is an acute inflammatory process caused by infection. PID may
involve any organ, or combination of organs, of the upper GI tract. In
it’s most sever form, it can involve the entire peritoneal cavity.
Inflammation of the fallopian tubes is termed Salpingitis and
inflammation of the Ovaries is termed Oophoritis.
Sexually transmitted microorganisms that migrate from the vagina to
the uterus, fallopian tubes, and ovaries cause most cases.
Manifestations of PID vary from sudden, sever abdominal pain with
fever, to no symptoms at all. First sign of an ascending infection would
be bilateral abdominal pain, often dull and steady. Other
manifestations include Dysuria (Painful or difficult urination) and
irregular bleeding. 4. Discuss the various disorders associated with Pelvic Relaxtion,
including the clinical manifestations and risk factors for each.
o The descent of the bladder and anterior vaginal wall into the
vaginal canal. In severe cases, the bladder and anterior
vaginal wall will bulge outside the Introitus (vaginal
o Usually caused by prolonged labor, multiple births, or birth
of a large baby
o Signs are urinary frequency, urgency, incontinence, difficulty
emptying the bladder, or low backache
o Usually accompanied by Urethrocele
o Same as Cystocele, but with rectum and posterior vaginal
o Symptoms include: difficulty defecating
o Usually caused by childbirth
o The descent of the cervix or entire uterus into the vaginal
canal. In severe cases, the uterine falls entirely into the
vaginal canal and protrudes from the Introitus.
o First degree prolapse is not treated until causing discomfort
o Second and third degree can cause feeling of fullness,
heaviness, or collapse through vagina. Symptoms of other
pelvic relaxation disorders may be present.
o Sagging of the urethra
o Caused by pressure of fetal head on urethra and attachment
beneath the symphysis pubis
o Symptomatic unless it occurs in conjunction with Cystocele 5. Describe common benign cysts and growths for the female reproductive
system, including causative factors and treatments for each
Benign Ovarian Cysts
o May occur at any time over a female’s life. Most common
during reproductive years.
o Occurs when hormonal imbalances are more common,
around puberty and menopause. Two common causes of
benign ovarian enlargement are Follicular Cysts and Corpus
o Follicular Cysts can be caused by a transient condition
where the dominant follicle fails to rupture or one of the non
– dominant follicles fails to regress.
o Corpus Luteum Cysts may develop due to intracystic
hemorrhage that occurs in the vascularization stage, and the
effect cyst then consists of blood.
o Oral contraceptives may be used to prevent cysts from