Case Study 1 - Structure and Function of the Male Genitourinary System

Mario is a 68-year-old male whose wife died of cancer five years ago. Since her death, he began to eat more fast food and stay at home and watch television. Recently, however, Mario's friend introduced him to a woman whom he became to like very much. After seeing her a few times, Mario became concerned about his health and went to see his doctor. He noticed a change in his sexual performance when he turned 60 and, after seeing so much on television about erectile dysfunction, was concerned he would experience this with his girlfriend.

1. What factors are present in Mario's history that predispose him to erectile dysfunction?

2. What condition would you suspect if Mario had a blood test indicating elevated LH and decreased testosterone levels? What effect do low testosterone levels have on the reproductive organs of the male?

3. How do the parasympathetic and sympathetic nervous systems generate erection, emission, and ejaculation?

Case Study 2 - Disorders of the Male Genitourinary System

Darius is 63 years old and began to wake up at night to urinate. When he went to the bathroom, he had to strain to initiate the flow, and the stream of urine was weak. Over time, the pattern became more apparent during the day; he often had a sense of urgency and felt he was going to the bathroom frequently. When he did, however, he did not always feel he had emptied his bladder, and he tended to dribble throughout the day. Much to his reluctance, his wife urged him to see a physician. At the doctor's office, his case history was carefully taken, a digital rectal exam was performed, and lab work was ordered. His blood results were unremarkable, but his urinalysis showed an elevated white blood cell count and bacteria. His physician diagnosed Darius with benign prostatic hyperplasia and urinary tract infection.

1. How does BPH contribute to the signs and symptoms of bladder dysfunction, and how was Darius prone to developing a urinary tract infection?

2. What are the static and dynamic components of BPH? Why are α1-adrenergic receptor blockers sometimes used to treat prostatic hyperplasia?

3. How does the prostate feel during a digital rectal exam with benign prostatic hyperplasia, acute bacterial prostatitis, and prostate cancer?

4. Why does the patient with prostate cancer present with symptoms later in the disease?

Case Study 3 - Structure and Function of the Female Reproductive System

Janice is 49 years old, is married, and has two teenage children. Over the last year, her periods tended to be irregular and heavier than usual. She also noticed intercourse was becoming more painful for her, and her interest in sex declined. She knew her mother was 51 when she reached menopause, and Janice was concerned about having the mood swings and hot flashes her mother had experienced. She phoned some of her friends to seek their advice. Some said she should try hormone therapy, while others said it was not a good idea at all. Other friends said she should use remedies like red clover tea and soy isoflavone supplements. Janice decided her best bet was to go to the local women's health care clinic to discuss her options with a nurse.

1. Using the data collected by the Women's Health Initiative and the Nurses' Health Study, why are some women at an increased risk for CHD and others are at a decreased risk when hormone therapy is prescribed?

2. Why are alternative methods like red clover and some plant oils being promoted for the menopausal woman? What are the changes that occur in a woman's reproductive organs when estrogen levels decline?

3. How does estrogen affect bone growth during puberty? Why are postmenopausal women at risk for osteoporosis?

Case Study 4 - Disorders of the Female Reproductive System

Tracie is 39 years old and is in a casual relationship with a man. She had her first sexual relationship when she was 13 and prefers to have short-term sexual relationships with men instead of a monogamous, committed partnership. It had been several years since Tracie had a complete physical, so before going on a vacation, she decided to have one done. Tracie's Pap smear indicated CIN 3 (HSIL) dysplasia. Her physician immediately ordered a colposcopy and LEEP excision, and then asked to see Tracie for a follow-up appointment 6 months later.

1. Why is cervical cancer considered a sexually transmitted disease?

2. Explain what the Pap smear entails and why it is an effective tool in the detection of cervical cancer. What does Tracie's result mean?

3. What is the transformation zone, and why is it vulnerable to the development of cervical cancer?

4. What is the LEEP procedure, and why is it useful for the diagnosis and treatment of cervical dysplasia?