Gender-Based Pathology

Female Athlete Triad

• 1. Disordered Eating: Wide spectrum of abnormal eating patterns

Female Athlete Triad

• Disordered Eating Cycle– Monitoring food Intake

↓– Restricting foods

↓– Limiting acceptable foods

↓– Voluntary starvation

Female Athlete Triad• Sports related Triggers – Disordered Eating

– 1.– 2.– 3.– 4.– 5.– 6.– 7.– 8.

• General Risk Factors of Disordered Eating– 1.– 2.– 3.– 4.– 5.– 6.– 7.

Female Athlete Triad

• Disordered Eating-Diagnostic criteria• Anorexia Nervosa:

• Bulimia Nervosa:

Female Athlete Triad

• Amenorrhea– Primary-

– Secondary-

– Starvation of the endocrine reproductive system

– Exercise →amenorrhea? OR – Eating Disorder →amenorrhea?

Female Athlete Triad

• Bone loss/Osteoporosis

– Prevention

– Screening

Female Athlete Triad

• Osteoporosis:– Treatment

The Menstrual Cycle

The Menstrual Cycle

• Hormone Cycle» Hypothalamus

↓ GnRH

» Anterior Pituitary

↓ FSH & LH

» Ovaries

Estrogen & Progesterone

↓

Endometrial Maturation

Exercise-Induced Menstrual Disorders• Delayed Menarche

• Shortening of Luteal Phase

• Oligomenorrhea/Amenorrhea

Exercise-induced Amenorrhea

• Definition: Absence of 3-12 consecutive menstrual periods

• Predisposing Factors:

• Etiology? 1.

2.

Exercise-Induced Amenorrhea

• Consequences:• 1.• 2.• 3.• 4.

• Treatment:

Dysmenorrhea

• Definition:

• Leading cause of Absenteeism in HS

• Primary Onset VS Secondary Onset

• TX:

Male Conditions

• 1. Varicocele

• 2. Hydrocele

• 3. Undescended Testicle

• 4. Testicular Cancer

• 5. Genital Injury

• 6. Gynecomastia

Varicocele

• “Bag of Worms”

• Rare before Puberty

• Infertility

• DX:

• TX:

Hydrocele

• Fluid collection (cyst) surrounding testicle d/t over production or diminished resorption

• DX:

• TX:

Undescended Testicle

• “cryptorchidism” – hidden testis• Not testicular retraction• Common at birth

• Tx:

Testicular Cancer

• Most common malignancy in 16-35 yr old men• 400-500 deaths per year• 85% cure rate with treatment• HX:

• DX:

Testicular Contusion

• Direct trauma

• S/S:

• TX:

• Need to inform Patient to monitor testis…if expanding mass, consider fracture of testicle or epididymis. If goes untreated, can lead to infertility/loss of testis.

Spermatic Cord Torsion

• TRUE SURGICAL EMERGENCY!• You will not be able to calm them down

on the field

• S/S:

• Tx: surgery

Penile Injuries

• Straddle or direct blow injury could cause urethral rupture, vascular injury, hematoma formation.

• Runner: Frostbite

• Cyclists: Pudendal Nerve damage.– Priapism

– Ischemic Neuropathy

Gynecomastia

• Palpable breast tissue in males• Must be distinguished from lipomastia• Cause: 1. Increase estrogen secretion

2. Testosterone Deficiency

Female Conditions

• 1. Common Breast Problems

• 2. Breast Cancer

• 3. Menstrual Cycle Irregularities

• Endometriosis

• Pregnancy

Breast Issues

• Most abnormalities are NOT breast cancer. ~ 1in 8 will be diagnosed.

• Cysts are very common in young women

• Self Breast Exams:– Start at age 18– Tumors are hard, irregular and not very

mobile– Examine monthly

• One week after menstrual cycle• Pain in not a good diagnostic indicator

Risk Factors for Breast CA

• Age• Race• Menarche ≤ 11yrs old• Menopause ≥ 55 yrs old• Nulliparity• First pregnancy ≥ 30 yrs• No lactation• Family Hx• Previous Brest CA• Use of fertility drugs• Previous exposure to

Radiation

• Prolonged use of postmenopausal estrogen replacement drugs

• Family hx of ovarian CA

Menstrual Irregularities

• Amenorrhea

• Oligomenorrhea

• Intermenstrual Bleeding• Exercise causes increase in many

hormones• VERY COMLPEX!

– Changes in diet, body fat, exercise, hormones

Endometriosis

• Definition: Presence of tissue that is biologically similar to normal endometrium in locations outside the endometrial cavity.

• Cause: Theory: Retrograde flow of menstrual fluid through fallopian tubes into free pelvis

• Typical Patient:

• S/S:

Endometriosis

• Found in 30-40% of Patients who present for an infertility evaluation

• Requires direct visualization via surgery• Brown Spots, “chocolate cysts”• Treatment:

Pregnancy

• Normal gestation is 40 weeks ~9 mo• ALL women of childbearing age should take a multivitamin with

400 micrograms of FOLATE (folic acid) – prevention of neural tube defects – 800 micrograms during pregnancy

• Physiological Changes of Pregnancy:– GI tract– Respiratory system– Cardiovascular system– Hemodynamic response– Urinary Tract– Skin– Breasts– Musculoskeletal changes

Physiological Changes during pregnancy• GI Tract

• Respiratory Changes

• Cardiovascular Changes

• Hemodynamic Response

Physiological Changes During Pregnancy• Urinary Tract

• Skin

• Breasts

• Musculoskeletal Response

Exercise during Pregnancy

• Not time to begin new strenuous exercise, can maintain regular routine for most of time.

• Absolute Obstetric Contraindications:– 1.– 2.– 3.– 4.– 5.– 6.

Exercise during Pregnancy

• Relative Obstetric Contraindications:– 1.– 2.– 3.– 4.

Special Considerations:

1.

2.

3.

4.

5.

6.

Pregnancy Restrictions

• No abdominal trauma sports:– Basketball– XC – extreme exertion– Hockey

Need to restrict after 1st trimester only.