Chapter 45: Disorders of the Female Reproductive System

Internal disorders begin with the cervix, highlighting the transformation zone as critical for malignancy development; precancerous lesions are classified using Cervical Intraepithelial Neoplasia (CIN) or Squamous Intraepithelial Lesion (SIL) terminology and detected via Pap smears. Uterine disorders include inflammation (endometritis), the presence of functional endometrial tissue outside the uterus (endometriosis), and benign smooth muscle tumors (leiomyomas or fibroids). Endometrial cancer, the most prevalent female pelvic cancer, is often linked to prolonged, unopposed estrogen stimulation leading to hyperplasia. Ascending infections cause pelvic inflammatory disease (PID), a major risk factor for ectopic pregnancy, a life-threatening implantation occurring outside the uterine cavity. Ovarian pathology addresses functional cysts and the common endocrine disorder Polycystic Ovary Syndrome (PCOS), characterized by chronic anovulation, hyperandrogenism, and insulin resistance. Ovarian cancer is particularly lethal as its nonspecific symptoms often lead to late diagnosis. Structural defects include weakened pelvic support leading to herniation of the bladder (cystocele) or rectum (rectocele) into the vagina, as well as uterine prolapse. Menstrual dysfunction is categorized by bleeding patterns (e.g., abnormal uterine bleeding or AUB, amenorrhea, dysmenorrhea), and the spectrum of premenstrual symptom disorders, ranging from PMS to PMDD. Finally, the chapter details disorders of the breast, such as inflammation (mastitis), benign masses (fibroadenomas and fibrocystic changes), and breast cancer, noting high-risk factors like BRCA1/2 mutations and emphasizing the importance of mammography for detection. The discussion concludes with an overview of male and female factors contributing to infertility and the role of Assisted Reproductive Technology (ART) like IVF.