 |
||||||
| Immune, Nervous, and Reproductive Systems Part III: The Reproductive System |
||||||
 |
||||||
| The Female Reproductive System Menopause occurs between ages 45 and 55 in 99% of women, and is marked by the cessation of ovulation. The main feature of menopause is the enormous decrease in the production of estrogen by the ovary. The effect on the female body is dramatic. When estrogen disappears, so do all of its the stimulatory effects. The vagina atrophies and secretions decrease causing women to complain of discomfort during sex. The urinary bladder and sphincter weaken causing a dramatic increase in the incidence of urinary incontinence. Vaginal and urinary tract infections also increase due to the decrease in acid secretions. Bone mass more rapidly decreases resulting in postmenopausal osteoporosis. To guard against these changes many women are put on estrogen supplementation therapy. The most common drugs are PREMARIN (estrogen) and Provera (progesterone). Each women must be considered individually, however, since a history of female cancers may rule against using estrogens. A history of fibrocystic growths in the breast or malignancies rule out PREMARIN use. There is also an increased risk of breast cancer among women with a family history of this condition. |
||||||
|
||||||
|
Your sex drive or libido is the sum of cognitive and psychological drives which direct you to pursue sexual behavior. It is difficult to separate changes in libido from the so called "husband effect", where women over the age of 55 often complain of a decrease in the number of sexual episodes due to their husbands disinterest or impotence. Menopause may contribute to sexual decline related to vaginal dryness and discomfort. Use of over the counter lubricants greatly reduce these problems. Subjects receiving estrogen supplementation therapy to appear to experience a reversal of most of these changes. However, other women comment on an increase in libido and happiness with their sex lives after menopause. This perception may reflect, in part, the loss of risk for pregnancy following intercourse. |
||||||
|
|
||||||
| Breast Cancer The key to the identification and treatment of breast cancer is early detection. Women before the age of 40 should do monthly self examination to detect small lumps which may be a precursor to breast cancer. After the age of 40, annual mammograms are highly encouraged for all women. The mammogram is not reliable for women younger than 40 because their breast tissue is too dense and false negatives may result. If a tumor is identified, a lumpectomy will be performed followed by (if necessary) removal of the lymph nodes. If the cancer is severe, the entire breast will be removed (mastectomy). A recent drug used to fight breast cancer is Tamoxifen. It blocks the action of estrogen on the breast's estrogen receptor, and is useful in early stages. Often in late stages, the cancer takes a new form where it loses estrogen receptors and Tamoxifen becomes ineffective. Thereafter, traditional chemo- and radiation therapy are used. |
||||||
|
||||||
|
Aging of the Male Reproductive System Men experience an age-related decrease in testicular size and in sperm production. In some men, there is an almost linear decline in testosterone production that becomes noticeable after the age of 40. However, many males experience no decline in testosterone levels. Both the decrease in testosterone and the decrease in sperm production causes an age-related decrease in fertility. The loss of testosterone also results in a decrease in bone and muscle mass in the aging male. The loss of testosterone may also contribute to sexual dysfunction with age in men. |
||||||
|
||||||
|
There are many changes in sexual function with aging. Men experience a gradual decline in orgasmic activity after late adolescence. The rate of achieving an erection is six times slower in men 50-65 than in men 20-30 years of age. There are also decreases in the strength and frequency of contractions during orgasm that reduce the force of your ejaculation. After ejaculating, men experience an age-related increase in the time it takes them to be responsive to another sexual episode (minutes in adolescence to days in old age). It also takes men much longer to achieve an orgasm as they age, which greatly reduces the incidence of premature ejaculation. While there is still some controversy, part of the age-related decline in male libido and potency can be attributed to the steady decline in testosterone that occurs with age. Other contributing factors include, in terms of libido, an age-related decline in brain arousal chemistry (dopamine and noradrenaline). A final factor worth considering is the many drugs that the elderly often find themselves taking (antihypertensive, antidepressants) which can affect libido.
|
||||||
|
||||||
|
Benign prostatic hypertrophy is a disease of advancing age that essentially affects all males to a greater or lesser degree. It is rarely seen before the age of 40, but the incidence increases to 90% of men over the age of 80. Testosterone stimulates growth of the gland as we age. As it grows, the prostate compresses the urethra resulting in symptoms of urinary obstruction. If the bladder is not emptied, it increases the risk of incontinence, bacterial infections and bladder pain from diverticula. The symptoms of urinary obstruction include a hesitancy to void and straining and decreased volume of urine. There will be dribbling and a feeling that there is still urine left in your bladder and an increase in the daily frequency of urinations. The normal prostate is the size of a walnut, but the enlarged prostate can be the size of a lemon. Prostatic enlargement can be detected by a physician performing a rectal examination. The initial diagnosis can be verified by ultrasound imaging and scoping. Treatment can begin early with a drug called Proscar, which inhibits the enzyme for making the active form of testosterone. A side effect, however, is a reduction of sex drive, since it also blocks testosterone action in the brain. If medical treatment is not successful, surgery may be necessary. A simple operation, transurethral resection of the prostate (TURP), can remove enough prostate tissue to provide permanent relief. |
||||||
|
||||||
|
Much like benign hypertrophy, prostate cancer is rare before the age of 50, but the incidence increases steadily thereafter. It can be asymptomatic or have symptoms similar to benign hypertrophy. Men after the age of 40 are encouraged to have a blood test to measure their prostate serum antigen (PSA). An elevated PSA level suggests the possible presence of cancer and needs to be followed up by sonography of the prostate. Prostatic cancer is a leading cause of cancer death in men age 50 to 65. However, when present in men in the 80's and 90's. it is a very slow growing tumor and unlikely to cause death.
|
||||||
 |
||||||
