Reproductive Problems

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I'm doing a research for my health class. Please respond asap. What are the disorders and diseases of the male reproductive system?

7th November 1999

Here are some examples of disorders and diseases of the male reproductive system:

Hypogonadism

This is less-than-normal functioning of the testes. The testes are an important source of testosterone and dihydrotestosterone - if there is insufficient production of these hormones the result may be infertility, impotence, and reduced maleness.

Cryptorchidism

The failure of one or both testes to descend from the abdominal cavity into the scrotum close to the time of birth. Most cases result from hypogonadism or mechanical obstruction. An undescended testis is smaller than usual, does not produce sperm, and is prone to malignant change. The condition is corrected by an operation when the child is between 1 and 5 years old.

Hypospadias

The urethra opens on the underside of the penis rather than at the tip. Correction of this developmental error is by operation.

Epispadias

The urethra opens on the upper surface of the penis. There may be associated abnormalities of the urinary system. The condition is corrected by surgery.

Testicular Torsion

A testis may twist within the scrotum, causing twisting of the spermatic cord and interruption of the normal blood supply to the testis. This results in pain and nausea, and prompt surgical intervention is required to avoid permanent damage to the testis.

Hydrocoele

This is an excessive collection of fluid in the tunica vaginalis - the sac that almost completely surrounds the testis. The condition is treated by surgery.

Variocoele

Abnormal dilation (varicosity) of the veins in the spermatic cord.

Benign Prostatic Hyperplasia

Benign enlargement of the prostate is common in older men and may obstruct the outflow of urine from the bladder, in which case surgery will be required.

Infections

Different parts of the male reproductive system can become infected. Here are some examples: balanitis is inflammation of the glans penis; urethritis is inflammation of the urethra; prostatitis is inflammation of the prostate; epididymitis is inflammation of the epididymis; and orchitis is inflammation of the testis.

Cancer

Prostatic cancer accounts for about one-fifth of all cancers in men. Treatment is by operation, chemotherapy, and/or radiotherapy. Testicular and penile cancers also occur.

Gynaecomastia

Enlargement of the breasts in males. It is usually a response to hormonal changes or therapeutic drugs.

Reading

Consult a pathology textbook such as:

Recently I have experienced my right testicle slipping upwards into my body and "disappearing". It can be felt through the skin, and then can be slid back down. The only pain is a dull ache that ensues. It seems to require some pressure on the scrotum to occur, such as my (extremely light) wife being frisky. Is there a term and/or a treatment for this? Is it serious?

7th December 1999

Remember that before birth the testes develop in the abdomen, and then migrate down into the scrotum at about the time of birth. The pathway they follow through the layers of the abdominal wall on each side is called the inguinal canal. Usually, when the testes have completed their descent they remain permanently within the scrotum from that time on. The slightly lower temperature in the scrotum is more favourable to sperm production after puberty. Slender bundles of muscle fibres derived from the middle layer of abdominal muscle are drawn into loops around the descending testis and form what is known as the cremaster muscle. During sexual arousal, the cremaster muscle contracts to draw each testis closer to the abdomen, and the smooth muscle of the scrotum contracts too. As a result the testes are transiently held in a more protected position during sexual intercourse. It is possible that your right testis has remained more mobile than usual, and is drawn back partially into the inguinal canal by contraction of the cremaster muscle during sexual activity. This is referred to as a retractile testis. If you are at all concerned about this possibility it will be worthwhile visiting your doctor to discuss the situation and whether or not any treatment is required.

Arrangement of Spermatic Cord

< Diagram showing arrangement of the spermatic cord and testis. The structures within the spermatic cord traverse the wall of the abdomen through the inguinal canal.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 




 

I stopped menstruating about a year ago - I am only 30 years old. The specialist tells me that my FSH levels are high, and that I may be going through an early menopause. Can you explain what may be going on so that I can discuss it with my doctor?

11th January 2001

When you visit your doctor to ask for advice, there are several points you may wish to discuss. The first is the finding of a high blood level of FSH (follicle stimulating hormone produced by the pituitary gland) which may indicate a problem with your ovaries. At the beginning of each menstrual cycle FSH normally stimulates maturation of some of the egg-containing follicles in the ovaries, and they then produce oestrogen. Usually, only one follicle ovulates (the others shrink and disappear) and when the egg has been released the remaining follicular cells produce progesterone. In your case, if oestrogen and progesterone levels are found to be low when measured over a period of time (the levels fluctuate even in normal circumstances, so several measurements will be required), then it could be that either your follicles are not responding to FSH, or that there are insufficient follicles remaining in your ovaries. On the other hand, if oestrogen and progesterone are being produced, then the problem may lie with the pituitary or hypothalamus (the part of the brain that controls the pituitary). It is reassuring to know that there are several tests that can be carried out to distinguish between these possibilities.

The second point is that if it turns out that you have ‘premature ovarian failure’ as it is called - and I would emphasise the "if" while the evidence is still so limited - then there is a good chance that the situation can be improved. It appears that sometimes the condition is linked with a stressful lifestyle, rapid dieting, exposure to cigarette smoke and other harmful chemicals and so on, factors that we are familiar with in everyday modern life. Reducing the impact of these factors can help. There are also treatments that can restart the menstrual cycle if it transpires that your ovaries are able to respond. If the ovaries are not responsive, then hormone replacement will be able to delay the changes associated with menopause. (There are recorded instances of women who have experienced premature menopause, been given hormonal support, and then had children some years later.)

The other aspect that came to mind is the possibility of an autoimmune condition. This is where the immune system begins to attack normal tissues of the body rather than protecting the body against infections etc. It is possible to have autoimmune damage to the ovaries, so that may be another avenue to explore. There are ways now of ‘turning down’ an overactive immune system.

After a sonohysterography ( 8 months ago) is it possible to have a blockage or twisted intestine? I have had oodles of tests,etc. and still remain full of gas and my bowel (stool) is half the size in width. What are treatments for this condition?

11th July 2001

It seems to us unlikely that sonohysterography could trigger a blockage or twisting of the bowel. During this diagnostic test, 10-20 ml of sterile saline is injected into the uterus through a narrow catheter that has been passed through the vagina and cervix into the uterine lumen. A transvaginal ultrasound is then performed. The cavity of the uterus is distended by the fluid, making it easier to detect any abnormalities of the lining or wall of the uterus. Some of the introduced saline may pass along the fallopian tubes into the peritoneal cavity, so there is a slight theoretical risk of infection being introduced into the abdomen in this way. Significant signs and symptoms of peritonitis would arise soon after the procedure in such a case, and we have not come across any reports of this actually happening in practice. We do not know from your question why the investigation was originally carried out, but presumably there was a need to obtain more information about a problem involving your uterus. When you see your doctor next, you may wish to discuss the possibility of endometriosis, in which cells from the lining of the uterus can end up in places where they shouldn’t be. There are occasions when the endometrial cells migrate to the walls of the intestines and may produce obstruction.

In the meantime, you may find that you can change your diet in ways that will ease your problem. Some foods can pass along the digestive tract more readily than others, and by trial and error you may be able to find the best combination of foods to minimise the sensation of bloating. Mild regular exercise such as walking can also be beneficial for digestion.

Reference

At the beginning of last year my 16-year-old daughter began to have very prolonged periods lasting no less than twenty-four-days which means she bleeds almost constantly through one cycle to the other. At one point we were told she had a condition called antithrombin 3 deficiency. This however does not explain her prolonged indeed non stop menstrual bleeding if that is what it is. She has had a blood transfusion 2months ago with no real effect.

I hope you can offer us some help as I am at my wits end with worry for my daughters health as she is constantly anaemic and of late she has taken on a yellow shade to her skin. Doctors keep doing blood-tests to check her levels of anaemia but do nothing more I just don’t know where to go for help for her or what to do. Please help.

17th May 2004

We are not in a position to make a diagnosis or recommend treatments. These are best decided upon by the doctors and other practitioners looking after your daughter. However, here are a few pointers that may help you in your discussions with the doctors and lead to a better resolution of this situation which is naturally very worrying for you and your daughter.

This situation is not a rare one - prolonged period bleeding occurs often enough in teenagers for doctors to have developed a strategy for dealing with it (Gidwani, 1984). Many cases are linked with disorders of the menstrual cycle, for example when the hormones released during the cycle have not yet taken on the proper pattern and ovulation is not occurring (Lavin, 1996). Sometimes, excessive bleeding is linked with pregnancy or contraceptive use. A small proportion of the cases may be linked with damage caused to the uterus or vagina by a tumour, ulcer, or some other lesion.

Recent research has revealed that mild clotting disorders of the blood are a significant cause of excessive uterine bleeding, and from what you say this appears to be one of the avenues being explored by your daughter’s doctors. It is certainly recommended now that adolescents who experience heavy period bleeding should have blood tests to find out whether their blood platelets are at the normal level and whether or not they have von Willebrand disease (Bevan et al, 2001; Edlund, 2001; Kouides, 2002; Oral et al, 2002; Strickland, 2004). Von Willebrand disease is much more common than classic haemophilia. It was first described by a Finnish doctor in the 1920s and named after him. The disorder is due to a deficiency of a blood factor which assists with the clotting of blood.

Have you noticed before at any time whether your daughter experienced bleeding for a longer period than you might expect, for example after visiting the dentist, or when she fell and damaged her skin? Evidence like this might help the doctors arrive at the correct diagnosis. You mention antithrombin 3 deficiency - this blood factor usually counteracts clotting of the blood, so a deficiency would cause enhanced clotting rather than prolonged bleeding (Lane, Olds, and Thein, 1992). It may be worth clarifying this with your doctor.

Whatever the underlying cause, excessive menstrual bleeding can result in severe anaemia as you have pointed out. This can require a blood transfusion to restore the level of red blood cells and haemoglobin. It could be that the jaundice that your daughter is experiencing is linked with that transfusion - the yellowish colour of her skin suggests that her liver is having difficulty clearing away bilirubin. This is a waste product formed when red cells are broken down. Some patients develop antibodies to antigens (molecular markers) on the surface of transfused blood cells, and the antibodies may speed up the breakdown of red cells and increase the possibility of jaundice. It will be worth asking your daughter’s doctor for advice on this.

Several clinical terms are used for this condition, for example ‘dysfunctional uterine bleeding’ and ‘menorrhagia in adolescents’, so if you are looking for information on the Internet try using these terms in your searches.

References

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