This system is concerned with procreation. It is composed differently in males and females. The male reproductive structures are:
The testis is an oval organ about the size of a kolanut. The pair is located in the scrotum. The testis subserves two functions: production of testosterone (the ‘male’ hormone) and sperm production.
The epididymis and vas deferens
The epididymis is a firm structure, attached behind the testis. It is hollow and continues further as the vas deferens. This then pierces the prostate and opens by the ejaculatory duct into the urethra. This arrangement provides a channel through which semen leaves the male genitals.
The prostate and seminal vesicles
The prostate is a small, solid gland located at the base of the urinary bladder. It is found only in males and is normally about the size of a walnut. The prostate is wrapped around the urethra, the tube that through which urine and semen move out of the body. It provides about 30% of the volume of seminal fluid.
The seminal vesicle is a thin-walled, elongated sac applied to the base of the bladder above the prostate. They produce about 60% of the seminal fluid volume.
This is the organ for copulation. The urethra runs through it and it fits into the vagina in the female during intercourse such that semen may be deposited there. The penis is composed of sponge-like tissues whose structure at any time determines the size and shape of the penis. In the non-excited state, the tissues are empty and the penis is in its flabby state. When excited, the tissues are engorged with blood and the penis is larger and erect.
In the uncircumcised state, the tip of the penis (the glans) is covered by a fold of skin called the prepuce. The prepuce is cut away during circumcision.
The female reproductive organs are:
This is a muscular organ whose function is to provide a nidus for the developing foetus. In virgins, it is the shape of a flattened pear and about 8 by 5 by 3 cm in dimension. The uterus has 3 parts: a fundus, a body and a cervix.
The fallopian tubes enter the sides of the uterus below the fundus. The cervix is the neck of the uterus and protrudes into the vault of the vagina where it opens. The body of the uterus tapers downwards from the fundus, and the cavity of the uterus occupies it.
The fallopian (uterine) tubes
Each tube is 10 cm long. It has one narrow end joined to the uterus and a wider, trumpet-shaped end with a number of finger-like processes called fimbriae. One of these fimbriae is longer and typically applied to the ovary.
The tube conducts sperm to the egg released by the ovary for fertilisation. Afterwards, the product of fertilisation passes back through it for implantation in the uterus.
This organ is ovoid in shape and smaller than the testis measuring 3 cm long, 2 cm wide and 1 cm thick. It is smaller before the first menses and after the menopause. The ovaries are normally positioned on either sides of the pelvic cavity such that they can be reached through the vagina by the tip of an examining finger.
The ovaries produce ova (eggs) as well as the ‘female’ hormones oestrogen and progesterone.
This is a highly expandable muscular tube about 10 cm in length. Its lower end is the introitus which opens in between the labia on the outside. Its upper end is slightly expanded and receives the uterine cervix which projects into it. The urethra opens immediately in front of the vaginal orifice.
The female external genitals include the mons pubis, the labia majora, labia minora, the clitoris and the vestibule with its glands. They are collectively called the vulva.
All the structures seen in the male are present in the female, but greatly modified for functional reasons. The mons pubis is the mound of hairy skin and fat in front of the junction of the two pubic bones. It extends backwards on either side as the labia majora (larger lips) which represents the scrotum.
The labia minora (smaller lips) corresponds to the spongy tissue in the penis, and forms the boundaries of the vestibule. The clitoris has a similar structure to the penis (only smaller and doesn’t contain the urethra) and is highly sensitive to sexual stimulation. It is usually overlapped by the prepuce (foreskin).
The vestibule contains the external opening of the urethra and the opening of the vagina. The glands of the vestibule may play a minor role in lubricating the lower vagina.
The hymen is a fold of tissue of variable extent and thickness at the margins of the vaginal opening. It may be absent from birth or may completely close the opening, in which case it has to be cut open at the age when menstruation begins. Its remains after rupture by the first sexual intercourse may form small tags.
Symptoms of Reproductive Diseases
Problems with the reproductive system may present as follows. Some of them may overlap with symptoms from other related systems like the urinary and the endocrine systems.
- Urethral discharge
- Painful urination
- Increased urinary frequency
- Vaginal discharge
- Painful intercourse
- Genital sore
- Painful scrotal swelling
- Pubic and genital itch
- Genital rash
- Delayed puberty
This is usually only noticed by men and always requires further investigation. There may be associated symptoms of urethral irritation and the underlying disease is likely to be an inflammation of the urethra, which is often infective and sexually transmitted.
A pussy discharge suggests gonorrhoea, whereas chlamydial infection is more likely to give a scanty slimy discharge. Sometimes the patient only notices the discharge in the morning, or by staining of his underwear. Prostatic secretions, which are normal, may present as urethral discharge in men who have abstained from sexual intercourse or masturbation.
This is called dysuria. It is a specific form of discomfort arising from the urinary tract in which there is pain immediately before, during or after urination. The urine is often described as ‘burning’ or ‘scalding’, and there is usually associated increased frequency of urination and decreased functional bladder capacity. Infection and cancer of the bladder or urethra are the most important causes.
Increased frequency of urination
Increased frequency of micturition results from polyuria, a reduction in effective bladder capacity, or irritation of the bladder or urethra. The commonest cause of polyuria is excessive fluid intake, whereas reduced functional bladder capacity is seen most frequently in patients with prostate enlargement and obstruction of the bladder outlet. Lower urinary tract infection (cystitis) causes bladder irritation and an increase in urinary frequency. Some patients with neurological diseases, also have frequency of micturition.
An itchy vaginal discharge is usually suggestive of thrush. Smelly discharges are usually due to parasites and bacterial infections or retained foreign bodies such as tampons.
Normal discharge can occur after sexual stimulation or during pregnancy, but is not itchy or offensive. Vaginal discharge may also arise from infections like gonorrhoea, chlamydia or herpes.
Pain on sexual intercourse is called dyspareunia. In women, pain around the vulva can be due to inflammation. Pain that is deep in the vagina may result from infections in the pelvis (pelvic inflammatory disease), inflammation of the womb and other gynaecological diseases, particularly endometriosis.
Painful ulcers are usually due to genital herpes or trauma, whereas a painless ulcer may be due to syphilis. However, syphilitic ulcers can be painful. A genital ulcer lasting for a short while is most likely from syphilis or herpes unless proved otherwise; herpetic ulcer lasting more than 1 month is caused by AIDS.
Painful scrotal swelling
An infection of the testis may occur following a sexually transmitted infection. Painful scrotal swelling is also a feature of surgical emergencies such as torsion (twisting) of the testis.
Other causes include trauma to the scrotum and recent vasectomy (cutting of the vas deferens).
Testicular infection in sexually active men below the age of 35 is likely to result from gonorrhoea or chlamydia. In those over the age of 40, it is more likely from bacterial urinary tract infection. Testicular cancer may sometimes present as a painful swelling.
Pubic and genital itch
This is usually due to pubic lice, scabies or other inflammatory genital conditions, such as allergic skin disease, but may be psychological. Sexual or household contacts may also complain of itching due to pubic lice or scabies. In pubic lice infestation, you may notice ‘crabs’ and nits on the hair shaft. Itching at night is suggestive of scabies and is likely to be generalized except for the face.
An itchy rash on the vulva or tip of the penis is seen in thrush, scabies and inflammatory skin conditions. Non-itchy rash may be seen in syphilis. Drug reactions or cancer of the vulva may present as a genital rash.
Puberty is considered to be delayed if the physical features of sexual maturation have not started showing up by the age of 14 in boys and 13 in girls.
Genetic factors have a major influence in determining the timing of the beginning of puberty. However, because there is also a minimum body weight that is required for normal puberty to start, the onset of puberty can be influenced by other factors including, chronic illness, excessive exercise and starvation.
Psychological stress and damage to the testes or ovaries from infections, trauma or surgery, drugs or irradiation, and tuberculosis can cause delayed puberty. Any other condition that can cause low levels of sex hormones may also be a cause.
Infertility affects around 1 in 7 couples of reproductive age, often causing substantial psychological distress. In women, infertility may result from absence of ovulation or from abnormalities of the reproductive tract that prevent fertilisation or implantation, most commonly damaged fallopian tubes from previous infection. In men, infertility may result from reduced sperm quality or number. In many couples, more than one factor causing subfertility is present, and in a substantial proportion no cause can be identified.