Gynecological Surgery

Sexual Medicine and Infectious Diseases in Gynecology (Acute and chronic)

Sexual development:  the development of normal male and female genital organs and tracts is determined by several factors, all of which are time specific during embryogenesis. The critical period for gonadal development is at 6-7 weeks of embryogenesis when Y chromosome promotes male gonadal development. The external genital organs start developing at 10^th week and reach completion by 16^th week. The genetic sex is determined at fertilization, but the gonads remain undifferentiated until 6 weeks of intrauterine life. Fist the sex chromosomes determine into a testis or ovary. Y chromosome develops a male gonad and absence of Y and presence of XX chromosome ovaries. If the gonad is male, genes associated of the somatic cells in the primitive gonad and initiate development along the male lines.  The elaboration of the H–Y antigen complex in the short arm of Y chromosome known as sex-determining region Y (SRY) induces testicular development. The Sertoli cells in the developing testis produce Müllerian-inhibiting substance (MIS) that causes regression of the Müllerian (paramesonephric) ducts. In the absence of MIS, Müllerian ducts develop passively to form the fallopian tubes, uterus and upper vagina. Female internal organs and external genitalia develop partially without the need for ovarian hormones and differentiate even in the absence of the gonads, unless interrupted by the regressive influence of MIS. Differentiation of the Müllerian ducts proceeds cephalocaudally to form the female internal genital organs. In the absence of the masculinizing

Components Contributing to Determination of Sex:

Genetic Sex: In each individual, the nuclei of humans contain a diploid number of chromosomes, 22 pairs of autosomes and 1 pair of sex chromosomes, making a total of 46. During maturation, a reduction division results in each ovum or spermatozoon containing only the haploid number of 22 unpaired autosomes and 1 sex chromosome. In the ovum, the sex chromosome is always X, but in the sperm, it is either X or Y. The relative number of X- and Y-carrying spermatozoa is equal. As the spermatozoon carries either an X or a Y chromosome, fertilization results in a 46-chromosome pattern carrying either an XX or XY – a genetic female or a genetic male, respectively. Thus, the original diploid number of chromosomes is restored (22 pairs of autosomes plus the paired sex chromosomes – 46 in all). The genetic sex of an individual is determined at fertilization. In the fertilized egg, the Y chromosome directs the development of the undifferentiated gonads into testes and absence of Y into ovaries 2 weeks later. The ovaries do not participate in sexual development. Y chromosome contains on its short arm H–Y antigen (surface SRY cell antigen), which is responsible for the development of testes. The autosomes also take part. This Y chromosome has no further influence beyond the development of the gonads. The germ cells arise in the endodermal wall of the primitive gut near the yolk sac from where they migrate along the dorsal mesentery into the gonadal site. The Leydig cells (interstitial cells) produce testosterone that develops the Wolffian duct and urogenital sinus into male genital organs and external genitalia. External Anatomical Sex The shape of the body contours, the development of the musculature, the characteristics of the bones (notably the pelvis), the distribution of hair on the face and body, breast development and the external genitalia are strong presumptive evidence of either sex. Internal Anatomical Sex The presence of a recognizable uterus, fallopian tubes and ovaries is the evidence that the individual is a female. The rare exception is the true hermaphrodite. Gonadal Sex Gonadal sex depends on the histological appearance of the gonad from the study of a biopsy or the removal of the organs. It is not entirely diagnostic such as in the case of an ovotestis in which both female and male elements are histologically demonstrated. Also, it is possible to have a rudimentary testis on one side and a rudimentary ovary on the other. Such findings are, however, so rare that the sex of the gonad is a reasonably reliable guide to the true sex of an individual. Hormonal Influences In the female pseudohermaphrodite, an excess production of androgenic hormone by adrenal cortical hyperplasia can modify the external genitalia of a genetic female. Hypertrophy of the phallus and fusion of the labia majora may cause the parents to consider their child to be a male. The virilizing tumours of the ovary, such as arrhenoblastoma, can cause hirsutism, hypertrophy of the clitoris, deepening of the voice, masculine body contours and amenorrhoea. The presence of oestrogen in the male can cause gynaecomastia.  These are all examples of how hormones, natural or exogenous, can modify the sexual organs and secondary sexual characteristics.

Feminism

Swyer’s Syndrome

Turner’s Syndrome

Masculinism

Klinefelter Syndrome

Virilism

Hirsutism

Hirsutism is defined as distribution of coarse hair in a female normally present in a male, i.e. upper lip, chin, chest, lower abdomen and thighs. Hirsutism may or may not be associated with menstrual disturbances such as oligomenorrhoea and amenorrhoea. Virilization refers to a condition of hirsutism associated with other male characteristics such as temporal baldness, hoarse voice, clitoromegaly and muscle enlargement as well as defeminization such as amenorrhoea and breast atrophy

Causes of Hirsutism

Ø  Genetic and ethnic.

Ø  Excess androgen or increased sensitivity of the pilosebaceous unit to T.

Ø  Liver disease when the level of SHBG level drops.

Ø  Ovarian. Polycystic ovarian disease (PCOD), hyperthecosis, masculinizing ovarian tumours, e.g. arrhenoblastoma, hilus cell tumour.

Ø  Adrenal. Congenital adrenal hyperplasia, Cushing’s syndrome, adrenal tumour (1%–2% cases).

Ø  Drugs. Androgens; progestogens with androgenic effect, viz. 19-norsteroids, and levonorgestrel nabolic steroids, phenytoin, danazol, minoxidil.

Ø  Others. Obesity, hypothyroidism, anovulatory hypooestrogenism, idiopathic – 15%, hyperprolactinaemia.

Ø  Hirsutism occurs early in congenital adrenal hyperplasia, around puberty in PCOD and in elderly women at menopause.

Sexually Transmitted Diseases

Vulvar Infections: The normal vulva is composed of the skin consisting of stratified squamous epithelium. It contains sebaceous, sweat and apocrine glands, underlying subcutaneous tissue and the specialized Bartholin’s glands. Vulvar pruritus and burning account for approximately 10–15% of presenting complaints

Molluscum Contagiosum It is a benign viral infection caused by the poxvirus. It is spread by close sexual or nonsexual contact and by autoinoculation. The incubation period ranges from several weeks to months

Scabies Itch mite: It is transmitted through close contact/fomites.

Condylomata Acuminata Also called venereal warts, these are caused by the HPV, which is a small DNA double-ended virus. These warts spread diffusely over the whole of the vulval area. The verrucous growths may appear discrete or coalesce to form large cauliflower-like growths. They affect the skin of the smeared with water-soluble K-Y jelly and treated with dilute acetic acid. The vascular pattern is studied. The abnormal areas stained with toluidine blue are biopsied.

Related conferences:

Std Asia Pacific 2018, Summit on August 22-23, 2018 Tokyo, Japan

STD-AIDS-2018, Congress on May 30-31, 2018 Auckland, New Zealand

Bacteriology 2018, Conference on May 21-22, 2018 New York, USA

Infection Congress 2018, on March 1-2, 2018 Berlin, Germany

Bacteriology Congress 2018, on June 04-05, 2018 Osaka, Japan

HIV/AIDS MEET 2018, on August 20-21, 2018 Prague, Czech Republic

Infectious Diseases Congress 2018, on July 26-27, 2018 Melbourne, Australia

Infectious Diseases 2018, Congress on September 17-18, 2018 San Diego, USA

Infectious Diseases 2018, Conference on October 15-16, 2018,  Abu Dhabi, UAE

Neglected Tropical Diseases 2018, Summit on August 29-30, 2018 | Boston, USA