Goals & Objectives
Human Sexuality and Reproduction
The objectives provided in this handout are meant to guide your attention to relevant issues in human reproduction and sexuality. They are not meant to be comprehensive or to limit your reading or knowledge. During your training, you will be exposed to a vast amount of material that will complement these learning objectives. Additional materials and clinical skills obtained through coursework, PBL, PSD, clinical and research electives should be integrated with your knowledge of the reproductive system to improve your diagnostic and therapeutic skills.
Please note that the examination for the block will be based on the objectives as well as on course material and the PBL problems.
- Review from Previous Blocks
- Anatomy of the mid section (Development and Homeostasis)
- Ovogenesis and Spermatogenesis (Development and Homeostasis)
- Urinary Tract (Infection and Host Response)
- Prostate (Renal)
- Histology (Development and Homeostasis)
- Neoplasia (Haematology and Neoplasia)
- Embryology (Development and Homeostasis; Renal)
- Hypothalamus and Pituitary Gland (Endocrinology)
- Prostaglandins (Infection and Host Response)
- Sexually Transmitted infections & HIV (Infection and Host Response)
- Placenta and foetal development (Development and Homeostasis)
- Genetic influence on fetal development (Development and Homeostasis)
- Fetal Circulation (Cardiovascular)
- Effects of Warfarin on Fetal Development (Haematology and Neoplasia)
- Coagulation Disorders (Haematology and Neoplasia)
- Specific Learning Objectives
Female System - Anatomy
- Describe the functional anatomy of the uterus, cervix, vulva, vagina, ovaries, and fallopian tubes
- Know the differences between the parametrium, myometrium and endometrium.
- Know the differences between the mesovarium and mesosalpinx.
- Identify the important anatomical structures surrounding the uterus including pelvic blood supply and ureters.
- Describe the composition of the female urogenital triangle, perineum and their relationships to surrounding structures.
- Describe the pattern of innervation of the perineum.
- Describe the structural ligamentous support of the uterus.
- Describe the lymphatic drainage of the uterus.
- Describe the innervation of the uterus.
- Describe the ovarian blood supply and lymphatic drainage.
- Describe the four fornices of the vagina.
- Describe the innervation of the vagina.
- Describe the anatomy of the bony pelvis including its joints (lumbosacral, sacroiliac, symphysis, pubis and sacrococcygeal) and their clinical relevances to the practice of obstetrics.
- Describe the muscles forming the pelvic diaphragm and their function.
- Name and identify the main components of the external female genitalia.
- Describe the anatomy of the breast.
- Female System - Histology
- Recognize and identify the following normal microscopic structures of the ovaries: cortex and medulla, germinative epithelium, primordial follicles, secondary follicles, graffian follicles, oocytes, cumulus oophorus, zona pellucida, internal and external theca, blood vessels, lymphatic vessels and corpus luteum.
- Name and identify the various layers of the fallopian tubes.
- Identify the myometrium and endometrium.
- Identify the following structures on the cervix: Squamous and glandular epithelium, cervical glands and clefts, Transformation zone.
- Recognize and describe the normal microscopic appearance of the vagina and vulva
- Describe the appearance of hydatidiform mole.
- Hypothalamic-Pituitary-Ovarian Axis
- Describe the function of the hypothalamus in relation to the menstrual cycle and reproductive physiology.
- Describe the function of the pituitary gland in relation to the menstrual cycle and reproductive physiology.
- Explain the relationship between the hypothalamus and pituitary gland.
- Describe the principal effects of LH, FSH, Estrogen, Progesterone, Prolactin, Growth hormone and TSH on the menstrual cycle and reproductive physiology together with associated pathologies.
- Describe the inhibitory/stimulatory mechanisms regulating pituitary hormone release from birth to senescence.
- Define the term menarche, perimenopause, and menopause.
- Explain the physiological events triggering menarche.
- Explain the physiological events that lead to menopause and its clinical manifestations.
- Describe the synthesis of steroid sex hormones.
- Menstruation
- Define the following terms: adrenarche, pubarche, menarche, amenorrhea, primary/secondary dysmenorrhea, menorrhalgia in terms of their clinical presentations/ diagnosis and underlying pathogenesis.
- Describe the function of the ovaries and its relationship to the Hypothalamic-Pituitary-Adrenal axis in the normal and abnormal menstrual cycle.
- Describe the ovarian cycle of follicular development in terms of: follicular recruitment, follicular maturation, ovulation, lutenization, corpus luteum formation, and follicular atresia.
- Explain the origins of the three groups of ovarian hormones (estrogens, progesterones, and androgens) and their respective effects on the menstrual cycles and reproductive organs.
- Describe the role of prostaglandins in the menstrual cycle.
- Identify which cells produce estrogen, progesterone and androgens.
- Describe the actions of estrogen and progesterone on the endometrium and understand the functional and histological differences between proliferative, secretory and menstrual endometrium.
- Describe the effect of ovarian hormones (estrogens, progesterones, and androgens) on the breast, the uterus, the cervix and the vagina.
- Describe the process of oogenesis.
- Describe the steps in primary follicle development
- Describe the steps in secondary follicle development.
- Describe the layer surrounding the follicles generated in oogenesis.
- Describe the process of ovulation with respect to the hormones affecting each stage and associated clinical manifestations.
- Describe the corpus luteum and its functions.
- Describe the three phases of menstruation with respect to the hormone changes affecting each stage.
- Menopause
- Define the terms: perimenopause, menopause, amenorrhea, climacteric.
- Compare and contrast between menopause and amenorrhea.
- Compare and contrast premature ovarian failure and natural menopause.
- Describe the physiological mechanisms underlying the process of menopause and associated clinical importance.
- List common signs and symptoms of menopause.
- Describe the perimenopausal transitional years in terms of menstrual cycle and fertility changes.
- Describe the sexual changes that occur during perimenopause and climacteric period.
- Describe the effects of hormonal changes on the cardiovascular system.
- Describe the changes that occur in the metabolism of lipids in post-menopausal women.
- Describe the changes that occur in the bone metabolism of post-menopausal women.
- List the complications associated with the change in bone metabolism in post-menopausal women.
- Explain the scientific basis of hormone replacement therapy and proper usage of hormone replacement therapy in the context of women’s health maintenance and promotion including postmenopausal osteoporosis, cognitive disorders, cardiovascular disease and vaginal atrophy.
- Contraception
- Compare and contrast the various forms of contraception in terms of their effectiveness, advantages and disadvantages.
- Understand the pharmacologic mechanism of actions of combined estrogen and progesterone contraceptives in preventing pregnancy.
- Describe the absolute contraindications and relative contraindications to the use of combination oral contraceptive.
- Describe the mode of action of progesterone only contraceptives and their clinical indications.
- Describe the techniques of surgical sterilization in males and females, their respective effectiveness and potential complications.
- Describe the mechanisms of action of the Intrauterine Device (IUD).
- State the complications and contraindications to the use of an IUD.
- Describe the different contraceptive barrier methods available including: diaphragm, cervical cap, contraceptive foam, male and female condom and their efficacies.
- Explain the underlying basis for the following methods of contraception and their efficacies: post-coital douches, rhythm method, sympto-thermal methods, coitus interruptus.
- Conception
- Understand the following events which precede fertilization: ovulation, tubal transport, sperm activation, sperm capacitation, sperm transport, acrosome reaction.
- Describe the following molecular and cytological events that lead to fertilization: sperm zona binding, sperm oolemma binding, sperm decondensation and pronuclear formation, male and female pronucleii formation, first cleavage division.
- Describe the biochemical and molecular aspects of the life of the embryo before implantation.
- Explain the physiological role of the corpus luteum from ovulation through early gestation.
- Describe the genetic content of the ovum and spermatozoa just before conception.
- Explain the meiotic division at conception and its impact on fetal development.
- Fertilization and Implantation
- Describe the process of fertilization in terms of ovum preparation, spermatozoa preparation and the union of gametes.
- Describe the physiological maternal changes and adaptations that occur in order for the embryo to be implanted.
- Explain the functional role of the seminal vesicles in sperm preparation and fertilization.
- Understand the causes of infertility including disorders of ovulation, tubal disease, uterine abnormalities, hormonal abnormalities and male causes.
- State the therapeutic options involved in the treatment of infertility
- Describe the pathogenesis, risk factors, and clinical presentation of ectopic pregnancy including its signs and symptoms.
- Discuss the differential diagnosis of bleeding in early pregnancy. Understand the investigations required to diagnose the cause of the bleeding.
- Understand the diagnosis and treatment options for patients with an ectopic pregnancy
- Placenta and Feto-Placental Unit
- Describe the function of the placenta in terms of its metabolism, transport , paracrine and endocrine secretions.
- Name the two components of the placenta.
- Compare and contrast the histological and functional use of the epiblast and hypoblast.
- Define the term decidual reaction.
- Describe the process of vascularisation of the embryo.
- Describe the anatomy and physiology of placental circulation.
- Describe the anatomy and physiology of fetal cardiovascular circulation.
- Describe the adaptations in the fetal circulatory system that occur after birth.
- Maternal Physiology
- Describe and explain the normal physiological changes that are associated with pregnancy in the breast, cardiovascular system, hematological system, pulmonary system, endocrine system, GI tract, GU system, uterus, ovary, pituitary, and hypothalamus.
- Describe the effect of pregnancy on the endocrine system with particular reference to changes in carbohydrate metabolism and gestational diabetes.
- Describe the normal and abnormal physiology of lactation.
- Describe the composition of breast milk.
- List the advantages and disadvantages of breast feeding.
- Teratogenesis
- Explain the effects of smoking, alcohol, street drugs on pregnancy and the fetus.
- Describe the physician’s role in cultivating healthy attitudes in the management of addictions in pregnancy.
- Describe the common teratogenic effects of thalidomide , anticonvulsants, anticoagulant, and ACE inhibitors on fetal development.
- Describe the organ damage that occurs with tetracycline use during the antepartum period.
- Describe the effect of diethylstilbestrol on the female reproductive organs and external genitalia.
- Antenatal Care
- State the signs and symptoms of normal pregnancy.
- Describe available methods used to establish gestational age and their relative accuracy and the importance of accurate pregnancy dating.
- Explain the role of ultrasound examination in the diagnosis of early pregnancy.
- Explain the rational for a complete physical exam including pap test and pelvic exam during pregnancy.
- Describe and understand the rationales for routine prenatal tests required for proper antenatal care.
- Describe the different methods and of prenatal diagnosis for neural tube defects, anatomical disorders and genetic disorders.
- Understand the preventative steps recommended as part of routine antenatal care.
- Parturition
- Describe the relevant obstetrical landmarks of the female pelvis that are important in the management of labour.
- Describe the hormonal mechanisms involved in the initiation of labour.
- Describe the signs and symptoms which signal the onset of labour.
- Describe the stages of labour.
- Describe the mechanism of normal labour.
- Describe the cardinal movements of labour.
- Describe the methods available to monitor the well being of mother and fetus and their proper applications.
- Describe the management of normal spontaneous delivery.
- Describe the management of the third stage of labour.
- State the common fears regarding labour and delivery.
- Describe the pharmacological effects and clinical application of oxytocic agents (oxytocin and ergometrine) and prostaglandins in the peripartum period.
- State the different modes of analgesia and anaesthesia available to pregnant women during labour together with their indications, advantages, disadvantages, and common adverse side effects.
- Describe the pain pathway for labour and delivery.
- List the complications that may occur with the use of the above listed methods of anaesthesia.
- List common benefits of breast feedings
- Abnormal Uterine Bleeding
- Describe normal menstrual flow and recognition of abnormalities.
- Define the following terms: abnormal uterine bleeding, menorrhagia, metrorrhagia, hypomenorrhea, oligomenorrhea.
- Describe the characteristics of anovulatory bleeding using the above terms.
- Explain the causes of anovulatory bleeding.
- Explain how unopposed estrogen in relation to anovulatory cycles produces the following changes: endometrial hyperplasia and uterine cancer .
- Understand the differential diagnosis and clinical approach to abnormal vaginal bleeding in premenarchal, reproductive, and post menopausal age group.
- Pelvic Pain and Endometriosis
- Define the terms endometriosis and adenomyosis.
- Describe the common presentation and clinical findings suggestive of the diagnosis of endometriosis and adenomyosis.
- State the theories of pathogenesis of endometriosis.
- List the common sites of endometriosis and describe the gross and histological appearances of these lesions.
- State the confirmatory diagnostic methods available in the discovery of endometriosis.
- State the possible sequela of endometriosis.
- Describe the treatment principles of endometriosis.
- List the common gynecological and non-gynecological causes of acute and chronic pelvic pain, their typical clinical presentations, and the investigations for these.
- Pelvic Masses
- List the causes of pelvic masses of gynaecological and non-gynecological origin.
- List the common clinical presentations of various benign and malignant ovarian tumours
- Describe the diagnostic approach used in the detection of pelvic masses.
- Describe the proper clinical management of patients with masses of low and high malignant potential
- Imaging the Pelvis
- Explain the use of ultrasound in pelvic examination relating to diagnostic accuracy, cost and harmful effects.
- Understand the applications of pelvic ultrasound and other imaging modalities in gynecology.
- Diseases of the Breast
- Understand the histology and anatomy of the adult female breast.
- Understand the normal physiology of lactation
- Understand the normal physiology of lactation
- List factors that can cause pathology during lactation including mastitis and abscess.
- Describe the pathogenesis and histological findings of fibrocystic disease of the breast in both men and women.
- State the incidence of fibrocystic disease of the breast in men and in women.
- Explain the relationship between fibrocystic disease of the breast and breast cancer.
- Describe the clinical and histological manifestation of fibroadenoma.
- State the risk factors associated with gynecomastia.
- Describe the histological presentation of gynecomastia.
- State the risk factors associated with breast cancer.
- List the tests and screening recommendations to facilitate early detection of breast cancer and their proper applications.
- Describe the clinical manifestations of breast cancer.
- Describe the histology of breast cancer.
- List the factors affecting prognosis of breast cancer.
- Identify common sites of metastasises from breast cancer.
- Understand the histology and anatomy of the adult female breast.
- Male System - Anatomy
- State the boundaries of the perineum around the male genital anatomy.
- List the superficial perineal muscles around the male genital anatomy.
- List the external anatomy of the penis.
- List the internal anatomy of the penis.
- List the parts of the urogenital diaphragm.
- Describe the position of the corpus spongiosum and corpus cavernosum.
- List the arteries that are involved in filling the corpus during erection.
- List the layers of skin which comprise the scrotum.
- Describe the vasculature of the male genital system beginning from the testes.
- Describe the lymphatic drainage of the testes.
- Male reproductive organs:
- Describe the functional anatomy of the following:
- Scrotum and its content
- Testes
- Tunica vaginalis
- Epididymis
- Spermatic fascia and cord
- Vas deferens
- Seminal vesicle
- Prostate
- Scrotum and its content
- Male System - Histology
- Identify the following structures of the testes: seminiferous tubules, testicular interstitium, spermatogonia, primary spermatocytes, secondary spermatocytes, spermatozoa, Sertoli cells, epididymus (and its cell layers).
- Recognize normal and abnormal sperm on a sperm smear.
- List the layers that make up the prostate.
- Identify the erectile tissue in the penis.
- Hypothalamic-Pituitary-Testicular Axis
- Name the hypothalamic factors which control the release of pituitary hormones in men.
- Explain the origin of testicular hormones.
- Identify the cells which produce testicular hormones.
- Describe the inhibitory/stimulatory feedback loop in men regulating pituitary hormone release using inhibin, testosterone and estrogen as examples.
- Explain the physiological roles of androgens.
- Describe androgen synthesis, transport and action.
- Explain the interaction required by the neurologic, vascular, endocrine and urologic systems to produce a normal erection and ejaculation.
- Erectile Dysfunction
- Describe the types of male sexual dysfunction.
- State the prevalence of erectile dysfunction.
- List the origins of erectile dysfunction.
- Describe the abnormalities of the neurologic, vascular, endocrine and urologic systems that may result in impotence.
- Describe the pharmacological and non-pharmacological options utilized in erectile dysfunction.
- Describe the mechanism of action and potential adverse effects of sildenafil.
- Describe the physiology of erection acquisition including neural innervation and anatomical changes.
- Scrotal Diseases
- Define the term varicocele, hydrocele, epididymal cyst, acute orchitis, acute epididymitis, sperm granuloma.
- Describe testicular torsion and its complications.
- Describe how to diagnose testicular torsion.
- Describe the pathology of scrotal masses.
- State the prevalence and prognosis of testicular cancer.
- Explain the pathophysiology of testicular cancer.
- List the treatment for testicular cancer.
- Embryology of the Human Reproductive System
- Understand the development of the male and female gonads.
- State when morphological characteristics of male and female sex appear.
- List the developmental origin of the gonads.
- Explain the process of sex determination during fetal development.
- Describe the development of the testes and subsequent male external genitalia.
- Explain the process involved in the descent of the testes.
- Describe the development of the ovaries and subsequent female external genitalia.
- Sexual Function and Sexuality
- Define healthy sexuality.
- Describe the stages involved in the psychology of the sexual response cycle.
- Describe the physiological components of sexual activity.
- List the developmental factors that influence sexuality.
- List and explain the obstacles present in the achieving healthy sex life.
- Explain the doctor's role regarding patient sexuality.
- Define sexual dysfunction.
- 27. Sexually Transmitted Diseases
- List the infectious agents commonly associated with sexually transmitted infections (e.g. HPV, chlamydia, gonorrhea, herpes, condyloma, syphilis, hepatitis B, HIV, chancroid, inguinal granuloma, mycoplasma, ureaplasma, trichomonas) ,their clinical presentations and proper diagnostic tests
- List the anatomical sites which can be affected by STDs mentioned above.
- Describe the bacteriology and symptoms of bacterial vaginosis.
- List the STDs associated with genital ulcers.
- Explain the transmission and prevention of sexually transmitted diseases mentioned above.
- Describe the pathophysiological mechanism involved with sexually transmitted diseases mentioned above.
- State the etiology and mode of spread for pelvic infections including chlamydia and gonorrhea).
- Describe the clinical and histological presentation of HPV.
- Explain the relation that exists between HPV and lower genital tract neoplasia.
- Understand with the terminology used for PAP smear screening. Describe the proper follow-up and treatment of pap abnormalities.
- Describe the cytological appearance of LSIL, HSIL and invasive squamous carcinoma.
- Describe the laboratory tests and methods of diagnosis of pelvic infections.
- Explain the role of a PAP smear in the diagnosis of lower genital tract neoplasia.
- Describe the pathogenesis of epididymitis.
- Describe the gross and histological appearance of salpingitis and its complications. (tubo-ovarian abscess and hydrosalpinx)
- State the legal requirements to report the diagnosis of certain STDs.
- Pathology
- List a brief differential diagnosis for vulvar warts.
- Describe the cytologic, histologic and clinical treatment of cervical squamous intraepithelial lesions (LGSIL and HGSIL), and invasive carcinomas.
- State the risk factors related to invasive carcinoma of the cervix.
- Describe the pathologic features of acute and chronic salpingitis, hydrosalpinx and tubo-ovarian abscess.
- List the differential diagnosis for scrotal pain.
- List the pathological problems that can arise during pregnancy.
- Compare and contrast functional vs. neoplastic ovarian cysts.
- List the risk factors associated with ovarian neoplasia.
- List the major categories of ovarian neoplasms and give examples of each : (surface epithelial: serous, mucinoid, endometrioid ;germ cell :dysgerminoma, teratoma, endodermal sinus (yolk sac) tumour,choriocarcinoma ;sex-cord stromal cell: granulosa cell tumour.)
- List the common sites of origin of carcinomas metastatic to the ovary.
- Describe the pathogenesis of a breast abscess.
- Describe the pathogenesis of a cyst in the breast.
- Describe the pathogenesis of breast carcinoma.
- State the major cytogenetic differences, clinical behaviors and pathologic features of complete and partial hydatidiform moles.
- Describe the gross and histological appearances and clinical behavior of choriocarcinoma.
- List the risk factors associated with endometrial cancer and underlying pathogenesis.
- Describe the gross and histological appearance of endometrium during different phases of the menstrual cycles.
- Describe the classification, pathogenesis, and clinical behaviour of endometrial hyperplasia (simple, complex and atypical hyperplasia).
- Describe the gross and histological appearance of leiomyomas of the myometrium and state their clinical significance.
- Explain the classification, pathogenesis and clinical presentation of the functional ovarian cysts (follicular cyst, corpus luteum cyst).