the reproductive system chapter 16 ___________________-primary sex organs-ie. testes and ovaries...

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The Reproductive System

Chapter 16

• ___________________-primary sex organs-ie. Testes and ovaries

• _______________________--sex cells produced by gonads as well as gonads secrete sex hormones

• _______________________________-remaining reproductive structures

• Joint purpose of Reproductive system is produce offspring---via sperm in males and ___________ in females

gonads gametes

Accessory reproductive organs

ova

• Zygote becomes embryo and then fetus

• Anatomy of Male Reproductive System• Testes have exocrine-sperm producing-

function and endocrine-testosterone producing

• Accessory structures in delivery of sperm to exterior or to female

Anatomy of Male Reproductive SystemTestes have exocrine-sperm producing- function and endocrine-testosterone producingAccessory structures in delivery of sperm to exterior or to femaleTESTES-

TESTES-

• Plum shaped---4 cm –sized surrounded by fibrous connective tissue capsule-_____________________________-“white coat”

• Extensions of capsule extend into testes and divide into wedge-shaped ______________________each containing 1-4 _____________________________-sperm producing portion

Tunica albuginea

lobulesSeminiferous tubules

• Seminiferous tubules empty into another set of tubules---____________________on each side of testis-sperm travel from rete to enter 1st part of duct system-____________________-hugging external testis

• In soft tissue around seminiferous tubules are -__________________-that produce androgens-esp. testosterone---thus different tissue process sperm and then hormones

Rete testis epididymis

Interstitial cells

• DUCT SYSTEM-inc. edididymis,ducus deferns, and urethra• A.___________________________-highly coiled tube-~6 m-

capping superior testis and extends posterolaterally-temporary storage for immature sperm entering from testis

• Takes sperm about _____________days to travel epididymis,maturing along the way...and become motile

• During ejaculation,epididymis contracts to expel ___________into--_________________________________

epididymis20

Sperm….ductus deferens

• . Ductus Deferens (= vas deferens)-extends upward from epididymis through inguinal canal,to pelvic cavity and arches over superior bladder…enclosed w/ blood vessels and nerves and connective tissue sheath-______________________ and it travels up through inguinal canal

Spermatic cord

• Loops medially over ureter and goes down posterior bladder-expands as ampulla and empties into _________________--this passes through prostate gland and merges w/ urethra

• Main function of ductus deferens is to _________________________

• At ejaculation smooth muscle squeeze sperm forward by ___________________

Ejaculatory duct

Propel live sperm from storage-epididymis and distal vas deferns

peristalsis

• A __________________________________is a contraceptive procedure that ligates-“ties-off” ducus deferns in part that lies in scrotum---sperm are still produced-but don’t reach body exterior and are phagocytized-rendering male sterile

vasectomy

Urethra

• From base bladder to tip of penis-terminal feature of male system-carries urine and sperm-however both never travel @ same time---bladder sphincter constricts @ ejaculation preventing this

• 3 regions: 1) ______________-surrounded by prostrate

• 2)_____________-from prostatic urethra to penis and 3)__________-runs length of penis

Prostatic urethra

Membranous urethra

Spongy (penile)urethra

ACCESSORY GLANDS AND SEMEN-inc. paired seminal vesicles,single prostate,bulbourethral glands and semen• A.____________________@ base of bladder make

~60% of seminal fluid-secretion rich in _________________which nourish and activate sperm

• Each of its duct joins vas deferens on same side to form __________----thus sperm and seminal fluid enter urethra during ejaculation

Seminal vesiclesFructose, vitamin C, proglastins…

Ejaculatory duct

Prostate-single doughnut –shaped gland-encircles prostatic urethra below bladder

• Its glandular , milky secretion helps activate sperm---during ejaculation-fluid enters urethra through several small ducts

• Since near rectum,can be palpitated rectally

• Older men suffer hypertrophy of gland, strangling urethra-making urination difficult and increases risk of bladder infections-________________ and kidney damage

• Treatments include :surgery,drugs or microwaves to shrink prostate,insertion of small balloon to push prostate away from urethra,incineration w/low energy radiation

• ___________________-inflammation of prostate-common• _______________-most prevalent cancer in men-slow

growing,usually

cystitisprostatitis Prostatic

cancer

• C. _______________________-tiny pea-sized glands posterior to prostate, produce thick,c lear mucus draining into penile urethra----is 1st secretion to pass upon sexual arousal ---functions in cleansing urethra of acidic urine and is a sexual lubricant

Bulbourethral glands

D. Semen-milky white, somewhat sticky mixture of sperm and gland secretions ;transport medium for nutrients and chemicals

that protect and aid in movement of sperm

• Sperm have little cytoplasm or stored nutrients so __________________ is energy fuel

• pH ~ 7.2-7.6 helps neutralize acidic vagina(3.5-4.0)-protecting sperm(sperm are sluggish in acidic environment)

• ________________-antibiotic chemical destroying certain bacteria

• Hormone_______________-………………………….

fructoseseminalplasmin

relaxin

Semen cont’d

• Enzymes to enhance sperm motility• Substances to inhibit female reproductive immune

response• Male infertility---causes include obstruction of duct

system, hormone imbalance , environmental estrogens ,pesticides, too much alcohol….often _________________is checked to analyze sperm count, motility, and morphology,semen volume ,pH, fructose amount…sperm count should not be below 20 million /mL

Semen analysis

EXTERNAL GENITALIA-ie. Scrotum and penis• Scrotum-divided sac of skin outside abdominal cavity,

normally hangs loosely, rendering testes temperature below body temp.( @ ~ 5.4 degrees lower)-necessary for healthy sperm production ,changes in scrotal surface area help maintain temp—example -wrinkles as pulls toward body during external cold temp’s

• Penis-delivers sperm-consists of shaft ,glans penis tip and prepuce or foreskin-loose skin covering-often removed at circumcision/Internally-spongy urethra SURROUNDED by 3 elongated areas of _______________________that fill w/ blood during arousal-causing rigid erection

Erectile tissue

Male Reproductive Functions• SPERMATOGENESIS=sperm production-begins @

puberty and is lifelong• Millions/day• _________________primitive stem cells @

periphery of each seminiferous tubule/rapid mitotic division to build stem cell line….from birth to puberty

spermatogonia

Spermatogeneisis cont’d• @ puberty _______________________(FSH) is secreted in

increasing amounts by ant. Pituitary gland…from here on out ,each division produces 1 stem cell-type A daughter ---which remains @ tubule periphery to maintain stem population…and 2nd,type B daughter-pushed toward tubule lumen to become primary spermatocyte and will undergo MEIOSIS

• Gametes @ this stage are called _______-made by meiosis and have ½ genetic material (2n in humans=23 x 2)

• As meiosis occurs ,primar y,then secondary spermatocytes pushed toward tubule of lumen

• Spermatids NOT functional sperm-nonmotile and excess cellular baggage

Follicle-stimulating hormone

spermatids

Spermatogenesis cont’d• During last stage-_______________-excess

cytoplasm sloughed off and now have _________________________,equipped w/high metabolism and motility

• Sperm head has DNA---essentailly nucleus• Anterior to head is ______________made by golgi

and similar to large lysosome---which breaks down @ membrane and releases to help sperm penetrate follicle of egg

Mature sperm compacted into 3 regions-head,midpiece and tail

Acrosome-helmutlike

Spermatogenesis cont’d• Filaments make long tail from centriloes in midpiece

w/mitochondria wrapped around for necessary ATP• All of spermatogenesis-from primary spermatocyte to

release of immature sperm takes 64-72 days• Sperm in lumen nonmotile and can’t fertilize….moved by

peristalsis from tubules into epididymis---there further maturation and increased motility

• Things that can alter sperm formation:________________-

Some antibiotics,radiation,lead,some pesticides,marijuana,tobacco, excessive alcohol

Testosterone production• PRODUCED BY INTERSITIAL CELLS• @ puberty FSH prods sperm production and

________________(LH) is also released by anterior pituitary on from here on out testosterone is produced continuosly,rising levels responsible for secondary sexual characteristics:___________________-testosterone not produced and secondary sex characteristics not produced….castration will cause this or malfunction of interstitial cells…also cause sterility

Luteinizing hormoneDeeping voice,increased hair all over most of body-esp. axillary and pubic;skeletal muscle enlargement-more muscle mass;increased bone growth and density of bone

FEMALE REPRODUCTIVE ANATOMY

• Function in producing gametes(ova) and nurture/protect developing fetus

• _____________________primary reproductive organs-both exocrine and endocrine in nature

ovaries

OVARIES • Shape of almonds but about twice as large• Internally __________________-each consisting of an

immature egg-oocyte-surrounded by 1 or more layers called __________

• As developing egg matures follicle enlarges and produces fluid filled antrum-At this point follicle is called vesicular or _________________follicle,which is mature and ready to released during ____________________.

• After ovulation,ruptured follicle is transformed into ___________________--“yellow body”,which degenerates

Ovarian follicles

Follicle cells

Graafian follicle ovulation

Corpus luteum

Ovarian follicle

Follicle cells

Ovaries cont’d

• Ovulation ~ every 28 days….in older women ovaries are scarred and pitted from release of many eggs

• Ovaries secured to lateral pelvis by _________________and medially by ______________and in between held by fold of peritoneum-broad ligament

Suspensory ligaments

Ovarian ligaments

DUCT SYSTEM-uterine tube,uterus and vagina

• Fallopian(uterine) tubes—internal duct system• receive ovulated oocyte and provide fertilization site• each about 4” long,extends medially from ovary to empty in

superior uterus• enclosed and supported by broad ligament

Fallopian tubes cont’d

• little or no contact between fallopian tubes and ovaries-instead contact @ distal end is by funnel-shaped ____________________that has fingerlike projections-fimbriae that surround ovary-- WHICH create fluidlike current that carries oocyte into fallopian tube---to thus journey to uterus

• At this point is where many potential eggs are lost in peritoneal cavity

• Cilia and peristalsis move oocyte along to uterus-taking about 3-4 days,but egg is viable ~24 hrs. after ovulation,so fertilization is usually in fallopian tube

• To reach oocyte,sperm must swim up through vagina and uterus to fallopian tubes---swimming against a downward beat of Cilia!

infundibulum

Fallopian tubes cont’d

• Because fallopian tubes and ovaries are not physically continuous,this makes this area vulnerable to infection,such as bacteria of Gonorrhea…maybe causing __________________which can cause scarring and closing of tubes

Pelvic inflammatory disease

Uterus-located in pelvis between bladder and rectum• Hallow/functions to receive,retain,and nourish a fertilized

egg• About the size and shape of a pear in women who haven’t

been pregnant• Suspended by broad ligament and anchored by round and

uterosacral ligaments• _________________=main portion• _________________-superior,rounded region above

fallopian tube entrance

bodyfundus

Uterus cont’d• ______________-narrow outlet into vagina below• Wall is thick w/3 layers:1)inner mucosa-

________________-At implantation-fertilized egg burrows here/This layer sloughs off during ________________-menstruation every 28 days-- if not fertilized

• 2)______________-interlacing bundles of smooth muscle making bulky middle layer-contracts during labor 3) perimetrium-outer serous layer(visceral peritoneum

cervix endometrium menses

myometrium

• __________________________________-common in women 30-50-risks factors inc. cervical inflammation,STDs,multiple pregnancies,promiscuity/detected w/Pap smear/slow growing ,usually

Cervical cancer

EXTERNAL GENITALIA=VULVA• mons pubis-fatty,rounded area overlying pubic symphysis-

hair after puberty• laterally are 2 skin folds w/hair-labia majora (encloses

vestibule which houses external urethra opening and vagina)and l.minora

• ______________ surround vagina and secretes for distal vagina

• Clitoris-small protrusion that is corresponding to penis w/erectile tissue but no reproductive duct

• ___________________-between ant. labial folds,anus and ischial tuberosities

Greater vestibular glands

perineum

FEMALE REPRODUCTIVE FUNCTIONS AND CYCLES

• OOGENESIS AND THE OVARIAN CYCLE• Females’ reproductive ability begins at puberty and ends around

50’s(menopause)• In developing female fetus,_________-female stem cells multiply

rapidly to increase their numbers,then daughter cells-primary oocytes-push into ovary connective tissue and primary follicle forms around them

• By birth,oogonia cease to exist and a lifetime supply of primary oocytes are in place---waiting 10-14 years to undergo MEIOSIS!

• @ puberty , ant. Pituitary produces_________FSH-stimulates a small # of primary follicles to grow and mature each month and then ovulation occurs monthly….constituting the _________cycle

oogonia Follicle-stimulating hormone

ovarian

Oogenesis and ovarian cycle cont’d• @ puberty ~ 250,000 oocytes remain w/ a small # activated

each month….appx 500 of the 250,000 ova are released in the limited # of years of fertility

• The FSH prods the follicle to enlarge ,accumulating fluid in central antrum/Primary oocyte replicates chromosomes and MEIOSIS occurs-producing 1 ________________and polar bod

• Follicle development to the point of rupture takes about 14 days with ___ovulation________________ occurring at just about this time

• Ovulation occurs at the response to _luteinizing hormone__LH

• Secondary oocyte is still surrounded by follicle cell capsule now called_corona radiata(“radiating crown”)…abdominal pain can accompany this-mittelschmerz

Secondary oocyte

• 1 developing follicle dominates each month/mature follicles not ovulated are overripe and deteriorate

• Besides triggering ovulation each month,LH aso causes ruptured follicle to turn into corpus luteum(Both c.luteum and maturing follicle produce hormones)

• If ovulated, secondary oocyte is penetrated by sperm in fallopian tube,THEN oocyte undergoes_________________________________making another polar body and ovum

2nd meiotic division

• ….its 23 chromosomes are combined w/23 of sperm in fertilized egg

• If not fertilized, deteriorates • Polar bodies deteriorate• Sperm v. egg:-sperm relies mostly on surrounding for

nutrients,while—egg larger and______________________-stocked w/ nutrients

nonmotile

UTERINE (MENSTRUAL) CYCLE• receptive to implantation only briefly---~ 7 days after

ovulation• events of _____________________ are cyclic changes

that endometrium goes through monthly in response to ovarian hormone changes

• Anterior pituitary ____________________ hormones FSH and LH regulate Ovarian estrogen and progesterone

• Typically cycle is 28 days w/ovulation occurring midway

Menstrual cycle gonadotropic

Menstrual cycle cont’d• 3 stages:• 1)______________________--superficial functional layer of

thick endometrium is sloughed off-accompanied by 3-5 days bleeding---passing out vagina as menstrual flow/average blood loss 50-150mL(1/4-1/2 cup)….By day 5 ovarian follicles begin to produce estrogen

• 2)__________________---is stimulated by estrogen levels to cause basal layer of endometrium to regenerate ,glands form w/in and endometrial blood supply increases…endometrium restores to velvety,thick and well vascularized—ovulation @ end of this phase in response to LH

Days 1-5-Menstrual phase

Days 6-14-Proliferative phase

Menstrual cycle cont’d• 3)______________________-progestrone levels have

risen(by corpus luteum) and act on estrogen charged endometrium and increase blood supply more/also increasing size of endometrial glands and begin supplying nutrients into uterine cavity to sustain an embryo until implanted

Days 15-28-Secretory phase

• If fertilization does occur,embryo produces hormone similar to LH-causes ______________________________

• If fertilization does NOT occur,c. luteum degenerates and LH levels drop…This causes vessels supplying endometrium to go into spasms and kink—causing endometrial cells-deprived of O2 –to die ….setting stage for next menses

• Cycle can vary from 21-40 days ,but time of ovulation is usually @ 14-15 days

Corpus luteum to cont. producing its hormones

HORMONE PRODUCTION BY OVARIES• Begin @ puberty• Follicle cells of growing follicles

produce_______________________-causing the appearance of secondary sex characteristics :enlargement of fallopian tubes, vagina and external genitalia ;development of breasts ;axillary and pubic hair ;increased fat in hips and breasts and in general; Widening and lightening of pelvis; Onset of menses

• Estrogen also has metabolic effects---ex-maintaing blood cholesterol(high HDL) and help Ca2+ uptake

estrogens

• Other ovarian hormone is ______________________________made by c.luteum as long as LH is present in blood…stopping 10-14 days after ovulation/helps establish menses w/estrogen,but does NOT contribute to secondary sex traits…plays a role in pregnancy by inhibiting contraction of endometrium and prepares_____________________(source of progesterone in pregnancy is placenta)

progesterone

For lactation

Mammary glands

• In both sexes ,but has normal functions in female---being important only once reproduction is accomplished—

stimulated to increase size by estrogen• Are actually modified sweat glands and part of

integument ,in that sense….and anterior to pectoral muscles• ________________-center pigmented area w/protruding

nipple• Internally has 15-25 lobes radiating around nipple/lobes are

padded and separated by connective tissue and fat• Within each lobe are smaller _________________ w/clusters

of alveolar glands that _______________-produce milk into lactiferous ducts opening via the nipple to the outside

areolalobules lactate

• ______________________-2nd most common cause of death in American women---1 in 8 developing this condition….~10% hereditary and half traced to BRCA 1 and 2 gene/80% of women w/ gene contract cancer---other risk factors inc. early menses,late menopause,estrogen replacement therapy….Breast cancer is signaled by change in skin texture ,puckering and nipple leakage…can be detected by self examination and by ___________________-X-rays that reveal tumors too small to feel(<1 cm.)

Breast cancermammography

ACCOMPLISHING FERTILIZATION• Sperm must reach secondary oocyte-viable 12-24 hours after

leaving ovary/sperm viable ~ 24-48 hrs….Therfore, intercourse must occur no more than 2 days before ovulation and no later than 24 hrs. after ovulation---when oocyte is appx. 1/3 way down fallopian tube

• Sperm attracted to oocyte by “homing device” chemicals—locating oocyte

• Sperm take __hours to reach fallopian tube,however many leak out or are destroyed by vagina’s acidity---only a few hundred –few thousand make it to area of egg’s location

• When sperm reach oocyte,cell surface hyraluronidase enzymes break down “cement” holding follicle cells of corona radiate around oocyte

1-2

• Once path cleared through corona,1000’s sperm undergo_______________________where acrosome membrane break down-releasing enzymes to lyse through oocyte membrane….then a single sperm can make contact w/oocyte membrane receptors---pulling head(nucleus) of sperm pulled into oocyte cytoplasm….****sperm reaching this point after acrosomal reactions have started are the more likely to fertilize

• After a sperm has reached oocyte,2nd meiosis occurs---making ovum and polar body

• Changes in fertilized egg preventing other sperm entry• _________________occurs @ moment genetic material of

sperm combines w/ that of ovum to make________________-fertilized egg

Acrosomal reactionzygote

fertilization

EVENTS OF EMBRYONIC AND FETAL DEVELOPMENT

• Rapid MITOTIC division as zygote goes down fallopian tube-________________,w/daughter cells becoming smaller and smaller—large # of cells will be building block of embryo-until 9th week

• By time embryo reaches uterus(3 days after ovulation)=_________________-ball of 16 cells looking like a raspberry…Since uterus not totally prepared for embryo yet, embryo floats in uterine cavity---using uterine secretions for nutreints @ this time---Unattached,continues to develop to ~ 100 cells---It then hallows out to form_________or chorionic vesicle

cleavagemorula

blastocyst

• @ this same time ,it is secreting a hormone called______________________(hCG)-this prods c.luteum of ovary continue hormone production(otherwise,endometrium would shed)

• Pregnancy tests usually detect______________levels• Blastocyst also has __________________-forming large fluid-

filled sphere and also an inner cell mass-small cell cluster to one side

• By day 7 after ovulation,blastocyst attahes to endometrium,eroding away some of lining and envelops into thick mucosa

Human chorionic gonadotropin

hcgtrophoblast

• During this time the primary germ layers are forming from inner mass:

• ______________________gives rise to nervous system and epidermis

• ______________________forms mucosa and associated glands

• __________________________gives rises to basically everything else

ectodermendoderm

mesoderm

• By day 14 after ovulation,implantation is complete and mucosa grown over embryo…The ______________of the blastocyst develops projections called chorionic villi,combining w/uterus to produce __________________________

trohoblastplacenta

• Once placenta has formed,embryonic body is surrounded by_____________________________-fluid –filled sac and attaches w/blood vessel stalk-_____________________________________

• By 3rd week,placenta delivers nutrients and O2 to and removes wastes from embryonic blood---all through ____________________________

• By end of 2nd month,placeta becomes endocrine organ producing estrogen,progesterone,and other hormones to maintain pregnancy…c.luteum becomes inactive

amnionUmbilical cord

Placental barrier

• By week 8--all organ systems laid down in some form and looks human

• Week 9—Now called__________-now growth and organ specialization are major activities

• As fetus,grows from ~ 3cm. and 1g to 36 cm(14”),~4kg(6-10 lbs.)…at birth ~ 22”

• 270 days-10th lunar month-full term

fetus

EFFECTS OF PREGNANCY ON MOTHER• ___________________________-period from conception to birth• Anatomical changes-• Uterus goes from fist sized to eventually nearing level of xiphoid

process-thorax widens as organs press on diaphragm • Center of gravity changes sometimes causing lordosois---thus backaches• Placental hormone____________________causes pelvic ligaments and

pubic symphsis to relax,widen and become more flexible• Good nutrition necessary—needing only about 300 calories extra/day• Substances that can cross placental barriers are alcohol,nicotine,many

drugs and maternal infections• _________________ termination of pregnancy by loss of fetus---

spontaneous abortion is a miscarriage

pregnancyrelaxin

abortion

• Physiological Changes• GI system-morning sickness usually first trimester,as mother adjusts

to elevated estrogens;heartburn because of displaced esophagus and displaced stomach;constipation –because GI motility decreased

• Urinary system-kidneys now need to dispose of fetal metabolic wastes,producing MORE urine;also uterus compresses bladder---frequent urination-Ie. stress incontinence

• Respiratory System-nasal mucosa responds to estrogen by swelling and congested,maybe nosebleeds ;respiratory rate increases but residual volume declines causing_______________-difficult breathing in later stages

• Cardiovascular system-Total body water rises and blood volume increases 25-40%---helping in safeguarding from blood loss effects during labor;BP and pulse increase and raise cardiac output 20-40%;venous return from lower limbs may be impaired---maybe causing varicose veins

CHILDBIRTH=________________________

• Usually w/in 15 days of calculated due date (280 days from last menstrual period)

• _________________-series of events that expel infant from uterus

• Initiation of labor• Estrogen has reached highest levels causing myometrium to

form much ________________receptors-to be receptive to that hormone

• AND interfering with progesterone’s quieting influence on uterine muscle—causing weak uterine contractions---called _________________contractions—often producing false labor

parturition

laboroxytocin

Braxton-Hicks contractions

• Then ,cells of fetus produce oxytocin and this stimulates placenta to release _______________________stimulating more frequent and powerful contractions

• Mom’s hypothalamus activated by emotional and physical stress---signals oxytocin release by posterior pituitary gland ---rhythmic ,expulsive contractions-TRUE LABOR…positive feedback mechanism now w/hypothalamus,strengthening contractions

• Anything that interferes w/oxytocin or proglastins can hinder onset of labor….example--antiproglastin drugs such as aspirin and ibuprofen

proglastins

Stages of Labor

• 1st-_____________________________from time of true contractions until full-10 cm-dilation of cervix….contractions move from upper uterus to vagina,becoming more vigorous and softening cervix and thinning….amnion ruptures-“water –breaking”-----usually 6-12 hours or MORE!!!

• 2nd-Expulsion stage-full dilation to delivery…urge increases to push 20 min -50 min.---sometimes 2 hrs

• Infant should be head first-Vertex position-skull as a wedge to dilate cervix…after head,rest of body comes out more easily…umbilical cord clamped off

• _______________-buttocks-first• _________________-during a difficult 2nd stage,O2 delivery

inadequate leading to cerebral palsy or epilepsy….often a C-section done to prevent these

• 3rd-____________________-w/in 15 min.placenta usually expelled---placenta and other fetal membranes constitute ____________________

breech dystociaPlacental stage afterbirth

DEVELOPMENTAL ASPECTS

• Gonads from 8th week and then accessory structures and external genitalia….all depends on presence or absence of testosterone

• If genetic male fails to produce testosterone-female accessory structures form and external genitalia…

• --If genetic female exposed to testosterone-male accessory ducts and glands as well as penis and scrotum….both cases are pseudohermaphrodites----a true hermaphrodite possesses ovaries and testes-rare case

• XO female appears normal but lacks ovaries/YO males perish• __________________narrowing of foreskin of penis and

misplaced urethral openings• _______________________-failure of full descent of testes

phimosis cryptorchidism

• _______________=period ~11-13---taking another 2 years for dependable ovulation

• Most common problem in females are infection-sometimes caused by STD’s

• Male inflammatory conditions include _______________________,maybe following STD transmission

• ______________-inflammation of testes….maybe following STD or mumps

• Neoplasms a danger in both genders• Women reach peak reproductive abilities @ late 20’s,estrogen

declines eventually producing________________-producing a ceasing of menses—irritability and mood changes can accompany

• Dangers can accompany HRT• Its all downhill…! • Puberty @ 10-15 yrs.

puberty

Urethritis,prostatitis,epididymitis

menopause

orchiditis

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