7.4 – Female Reproductive Diseases, Disorders and Diagnostic Testing

Cancer

Breast Cancer

Breast cancer starts in the cells that line the ducts or the lobule of the breast. Some warning signs include a new lump in the breast or axilla, thickening or swelling, irritation or dimpling of the breast skin, redness or flaky skin, pain, discharge (all in the breast or nipple area), and change in breast size. Risk factors include family history, obesity, hormonal treatment, and changes in breast cancer-related genes (BRCA1 or BRCA2) (Centers for Disease Control and Prevention, n.d.; Cancer Care Ontario, n.d.).

Treatment options include chemotherapy, radiation, and surgical interventions, such as mastectomy, biopsy, incision and drainage, and mammoplasty (Centers for Disease Control and Prevention, n.d.; Cancer Care Ontario, n.d.). To learn more about breast cancer, view the Cancer Care Ontario: Breast Cancer web page [New Tab].

Cervical Cancer

Cervical cancer is a typically slow-growing cancer and is highly curable when found and treated early. Advanced cervical cancer may cause abnormal bleeding or discharge from the vagina, such as bleeding after sex. It is diagnosed during a Papanicolaou test (or Pap smear), which looks for precancers (cell changes) on the cervix. The Pap test can find cervical cancer early, when treatment is most effective. The Pap test only screens for cervical cancer (Centers for Disease Control and Prevention, 2019).

The HPV (Human papillomavirus) test looks for HPV strains, which is the virus that can cause precancerous cell changes. Almost all cervical cancers are caused by HPV. HPV is a common virus that is passed from one person to another during sexual contact. In Canada, there is the HPV vaccine. The age of administration varies between the provinces and territories. See below under HPV for more information about the HPV vaccine (York Region Health Connect, n.d.). To learn more about cervical cancer, please visit the Centers for Disease Control and Prevention’s cervical cancer factsheet [PDF].

Endometriosis

Endometriosis is an abnormal condition of the endometrium. Endometriosis occurs when a tissue similar to the endometrium grows and implants outside the uterus. The female hormone estrogen causes these implants to grow, bleed, and break down. They are implanted outside the uterus and have no way to leave the body. They become painful, inflamed, and swollen. The inflammation causes scar tissue around nearby organs, which can interfere with their normal functioning and cause pain (Canadian Women’s Health Network, 2012).

Endometriosis generally appears between the ages of 15 and 50.  Signs and symptoms may include dysmenorrhea, lumbago, dyspareunia, menstrual irregularity, and infertility. One third of women diagnosed with endometriosis have no symptoms at all. Diagnosis may include laparoscopy and endometrial biopsy. Treatment may include medication and surgical interventions such as hysterectomy and oophorectomy. The cause of endometriosis is unknown (Canadian Women’s Health Network, 2012). To learn more about endometriosis, visit the World Health Organization’s page on Endometriosis [New Tab].

PCOS

Polycystic Ovary Syndrome (PCOS) has no known etiology, but researchers have linked it to excessive insulin production. Excessive insulin in the body can release extra male hormones in women. Since the ovaries produce high levels of androgens, this causes the eggs to develop into cysts and instead of releasing during ovulation, the cysts build up and enlarge. The most common symptoms of PCOS include oligomenorrhea, amenorrhea, polymenorrhea, enlarged ovaries with multiple small painless cysts or follicles that form in the ovary, acrochordons, acanthosis nigricans, hirsutism, thinning hair, acne, weight gain, anxiety, depression, hyperglycemia, and infertility (Canadian Women’s Health Network, 2012a).

Treatments like medications such as birth control pills or antiandrogens can help balance the patient’s hormones and relieve some of the symptoms (Canadian Women’s Health Network, 2012a). To learn more about PCOS, visit the World Health Organization’s page on PCOS [New Tab].

Sexually Transmitted Infections (STIs)

The terms for Sexually Transmitted Infections (STI) and Sexuality Transmitted Diseases (STD) are often used interchangeably. Sexuality Transmitted Diseases (STD) implies the disease was acquired through sexual transmission. A disease is a disorder of structure or function in a human, which produces specific signs or symptoms. A disease must be managed, as in the case of Human Immunodeficiency Virus (which can also be acquired through the transmission of other bodily fluids; thus not solely sexual transmission). The treatment may include antiretrovirals or anti-virals (Urology Care Foundation, 2019).

Chlamydia (CT)

Chlamydia is one of the most common sexually transmitted infections (STIs) caused by bacteria that infect the cervix, urethra, and other reproductive organs. Chlamydia is easy to treat and can be cured. Many people with chlamydia do not have any symptoms and unknowingly pass the infection to their sexual partner(s). If symptoms develop, they usually appear two to six weeks after sexual contact with an infected person. While females are most often asymptomatic, they may experience cervicitis. Left untreated, chlamydia in females can lead to Pelvic Inflammatory Disease (PID), which can cause permanent damage to the reproductive organs and subsequent infertility (Sexually Transmitted Infections (STIs) Chlamydia, 2018) (Chlamydia and Gonorrhea, n.d.).

Chlamydia spreads through unprotected oral, anal or vaginal sex with an infected person. Chlamydia can be spread to the eyes via the hands with direct contact with infected fluids. Until a patient finishes their treatment, they continue to have the infection and can continue to pass it to others. Chlamydia is treated with antibiotic pills. If the patient has epididymitis, they may need to be hospitalized and be treated with intravenous (IV) antibiotics. All sexual partners within the past 60 days should be examined, treated, and informed that having no symptoms does not mean there is no infection (Klein, 2023).

Gonorrhea (Gonococcus) – (GC)

Gonorrhea is a sexually transmitted infection (STI) caused by bacteria that infects the cervix, urethra, and other reproductive organs. Infections can also infect the throat and anus. Gonorrhea can be treated and cured. Many people infected with Gonorrhea have no symptoms and can unknowingly pass the infection on to their sexual partner(s). If symptoms develop, they may appear two to seven days after sexual contact with an infected person. Symptoms vary depending on which part of the body is infected. Females may experience abnormal vaginal bleeding, discharge, or dysuria. Left untreated, Gonorrhea in females may lead to pelvic inflammatory disease and fertility complications, such as ectopic pregnancy. Gonorrhea infection from oral sex may lead to sore throat and swollen glands. Gonorrhea infection from anal sex may cause itchiness and discharge from the anus. Gonorrhea is spread through unprotected oral, vaginal or anal sex with an infected person.  Until the patient finishes their treatment, they continue to have the infection and can pass it to others (Klein, 2023).

Gonorrhea is treated with oral antibiotics in combination with an intramuscular (IM) injection. It is important that one complete the treatment and abstain from unprotected sexual activity for at least seven days following treatment. All sexual partners within the past 60 days should be examined, treated, and informed that having no symptoms does not mean there is no infection (Klein, 2023).

Reportable Diseases

Both chlamydia and gonorrhea are reportable diseases to the Ministry of Health. Therefore, the local health department will be calling the doctors office or patient to ensure correct treatment was received and sexual partners have been followed up with testing and treatment. To learn more about STIs and STDs such as chlamydia and gonorrhea, please go to the Public Health Ontario web page on sexually transmitted infections [New Tab].

Human Papillomavirus- HPV

HPV is a common sexually transmitted infection (STI). Both males and females can be infected with HPV. Almost three quarters of sexually active individuals have been exposed to HPV during their lifetime. There are over 100 strains of HPV and some strains of HPV can cause visible genital warts. The warts are usually painless, but may be itchy, uncomfortable, and hard to treat. Some strains of HPV cause genital, anal, throat, and cervical cancers. HPV spreads through sexual activity and skin-to-skin contact in the genital area with an infected person. Since some people are asymptomatic, they don’t know they have the virus and consequently pass the virus to their sexual partners. Treatments are available for genital warts, but there is no cure for HPV (York Region Health Connect, n.d.). To learn more about HPV symptoms, treatments, and prognosis, visit the Mayo Clinic page on HPV Infection [New Tab].

HPV Vaccine

A vaccine called Gardasil® 9 is available for 9 HPV strains. This vaccine assists the immune system in protecting the body against infections and diseases caused by HPV (York Region Health Connect, n.d.). To learn more about Gardasil® 9 treatments, please visit the Gardasil® 9 website [New Tab].

Herpes Simplex Virus (HSV)

Genital herpes is a sexually transmitted infection (STI) that is caused by a virus called herpes simplex virus (HSV). There are two types of herpes simplex viruses:

• Type 1- oral herpes or cold sores (HSV-1)
• Type 2- genital herpes (HSV-2)

These viruses are very similar and either type can cause genital herpes or cold sores. Symptoms might include dysuria, enlarged glands, myalgia, arthralgia and fever. Once a patient is infected with HSV, the virus remains in their body even after the symptoms are gone and can cause recurring outbreaks. Between the outbreaks, the virus stays in their body. When the virus becomes active again, the symptoms return but are usually less painful and heal faster. Recurring outbreaks vary from person-to-person, however they can be triggered by emotional or physical stress, exposure to sunlight, hormonal changes, poor nutrition, sexual intercourse, lack of sleep or a low immune system (Mayo Clinic Staff, 2022).

Herpes is spread through direct contact with the sores or blisters of an infected person. Contact (and transfer of the virus) can occur from genitals-to-genitals, mouth-to-genitals or mouth-to-mouth. Herpes can also be passed to the anal area. Herpes spreads easily during sexual contact while symptoms are present or just before an outbreak of symptoms. An infected person may spread herpes even when they have no symptoms; this is called asymptomatic shedding. One can spread the herpes virus to other parts of their body after touching the sores; autoinoculation. The fingers, eyes, and other body areas can accidentally become infected in this way. Hand washing after touching sores and blisters is recommended to prevent spreading the virus (Mayo Clinic Staff, 2022).

There is no cure for herpes. Antiviral pills help to reduce symptoms and speed the healing of blisters or sores and are prescribed by a doctor. Treatment of symptoms may be managed with medication for pain, bath salts, cold compresses, and urinating in water may help to relieve discomfort. Keep the infected area clean and dry, wear cotton underwear and loose clothing to reduce discomfort. All sexual partner(s) should be informed. The only way to reduce the risk of transmission of herpes is to avoid direct contact with the sores and to use condoms. Condoms will reduce but not eliminate risk as the virus can be present and shed from the skin in the genital area (Mayo Clinic Staff, 2022).

To learn more about the symptoms, complications, treatments and prognosis of HSV please visit the Mayo Clinic’s page on Genital Herpes [New Tab], or Public Health Ontario’s Testing Index [New Tab].

Medical Specialties and Procedures related to the Female Reproductive System

Gynecology

A gynecologist is a specialist in the area of gynecology, focusing on the diagnosis, treatment, management and prevention of diseases and disorders of the female reproductive system. Obstetrics is a specialty that provides care through pregnancy, labour, and puerperium. Further subspecialties in women’s health include contraception, reproductive endocrinology, infertility, adolescent gynecology, endoscopy and gynecological oncology (Canadian Medical Association, 2018). To learn more about obstetrics or gynecology, please follow visit the Canadian Medical Association’s Obstetrics/Gynecology Profile page [PDF].

Hysterectomy

A hysterectomy /pb_glossary] is done to stage or treat female reproductive cancers, treat precancerous conditions of the cervix and some non-cancerous conditions that have not responded to other forms of treatment. There are three types of hysterectomy:

Sometimes the ovaries and fallopian tubes are removed at the same time that a hysterectomy is done. A [pb_glossary id="220"]bilateral salpino-oophorectomy (BSO) removes both ovaries and fallopian tubes. A unilateral salpingo-oophorectomy removes one ovary and one Fallopian tube (Canadian Cancer Society, 2020). To learn more about hysterectomy, please visit the Canadian Cancer Society's page on hysterectomies [New Tab].

Attribution

Except where otherwise noted, this chapter is adapted from “Female Reproductive System” in Building a Medical Terminology Foundation by Kimberlee Carter and Marie Rutherford, licensed under CC BY 4.0. / A derivative of Betts et al., which can be accessed for free from Anatomy and Physiology (OpenStax). Adaptations: dividing Female Reproductive System chapter content into sub-chapters.