Please Read: Matters of sexual health: Common congenital conditions of the male and female reproductive system

 

For those outside the medical profession, Close to 90% of  the information about  human  reproductive system in terms of  the Anatomy, Physiology and disorders get to them from, social media, while the remaining 10% put together comes from family members, neighbors, schools, and churches.

THE PROBLEM 

For young teenage girls, lower abdominal pain involving the ovary, fallopian tube or bladder may be waved off as normal pain of maturity in females, but  could be a

dermoid cyst; a solid type of mass  in the ovary which if ignored could lead to cancer of the ovary and which by the time the patient becomes an adult would have gone beyond  simple removal by surgery.

Conditions of the human reproductive system may be uncommon, but do exist. Those commonly seen in this environment may be congenital or acquired due to trauma, infections, or arise from autoimmune disorders and neoplasia (new growth including cancers). 

Affected children   may be abandoned, locked inside a room and left to die or visited with some extreme end. In adults abnormal internal anatomy is responsible for some cases of  cancer, primary amenorrhea, problems of infertility, primary or secondary, such as low sperm count, or even no sperm cells at all,   intra psychic  conflicts  and other forms of misfit. Cases of  ambiguous genitalia  where it is difficult to tell whether  a child is a male or female, in majority of cases  result from imbalance or disruption in the biochemistry of steroids  along the hypothalamohypophysealgonadal axis which goes on to affect the hormone profile associated with the mother, the child or adult.  The assignment   to the wrong  sex ( wrongly naming  a real boy a girl on the strength of  what is seen  between the legs) must be avoided, and  surgeons can  reconstruct  a new   vagina  or penis putting  many factors into consideration ,including fact that it is easier to construct a  new vagina as opposed to a new penis . A solid tumor of the ovary such as dermoid cyst may be present at birth, but silent until puberty, when it may present as right iliac fossa pain as might also occur in acute appendicitis. The potential to develop and become life threatening cancer of the ovary is high and only early detection, adequate investigations and appropriate intervention will save the child and at the same time preserve her reproductive career. 

Prevalence of these conditions are difficult to ascertain because most cases are not reported because of shame and pride , characteristic features may not show up until puberty when changes that normally appear are either not seen , appear infantile or  become exaggerated .

The purpose of this paper is to  remind parents, guardian and  care providers  about some  conditions of the reproductive system that are fairly common, so as to create awareness that there are consequences  when medical help is not sought or medical opinion is rejected or ignored

MALE REPRODUCTIVE SYSTEM

 Undescended testicle (Cyptorchidism); 

 By about the 35th week in the womb, or at birth the testicle under normal condition should have left the abdomen and entered the scrotum in its biphasic, or  triphasic migration and all the surrounding structures that assisted it’s smooth uninterrupted journey should  have  shrunken and disappeared. In  this condition, one or the two testicle will have failed to reach and locate permanently in the scrotum , and  may have been going back and forth for about a year, at which time, parents who are vigilant will have noticed. 

Cause is unknown but scientists and surgeons believe  it may be due to hormonal imbalance involving a number of hormones which include, insulin like peptide 3 (ISL3), calcitionin gene related peptide (CGRP), anti Mulerian hormone( AMH), etc. Because of this role of different hormones in the regulation of testicular descent, exposure of a pregnant woman to environmental chemicals can predispose to the problem of undescended testicle. Unsupervised medication as in excessive ingestion of supplements during pregnancy may be responsible, as these chemicals and drugs are proteins, and can mimic the hormones. 

It is best to remove an un descended testicle if found early enough and between the third and fifth birth day, all depending on the peadiatrician or peadiatric surgeon.

As long as it is in the abdomen, sperm production and safe storage is abnormal. The risk of developing to cancer is also higher, though it remains a problem even when it has been removed. In the operation, called orchidopexy or testicle fixation, the testicle and the vessels and nerves that supply it are brought down carefully, stitched and secured to its proper position.

Chordee

The shape and form of the human penis begins around the fifth week of intrauterine life. Chordee is a condition  found in males characterized by abnormal, often downward  curvature of  the penis which is also congenital (present at birth). It may occur alone, or in combination with other defects such as hypospadias. The down ward bowing penis may become more pronounced during erection and become a psychosocial problem. 

Hypospadia is abnormal opening of the urethra on the underside of the penis instead of the tip.  It is the opposite of Epispadias where a similar opening   is on top of the body of the penis.. The actual  how and why of these conditions are presently the basis for extensive research, in urology and embryology. During development the urethra in both male and female fetuses are in the same location, and abnormalities  arise perhaps during  migration of the urethral folds over the urethral groove. These conditions are not known to seriously interfere with the abilty to archieve pregnancy, but excessive downward bowing may interfere with getting pregnanteven when coitus is successful coitus.

The last tissue to develop is the penile skin, and so when discovered the foreskin should be retained, and so  circumcision should be delayed,  because the  skin will be used for reconstruction without the problem  of hair growing out  the area.

- Dr Mike Oyakhire 

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