He Sinh Duc

H SINH DC
DR. L Hng Thnh

EMAIL: LHT28388@GMAIL.COM 0945.904.456
www.trungtamtinhoc.edu.vn
NI DUNG
1
CU TO H SINH DC NAM & N
2
SINH L H SINH DC
3 NM C 1 S BNH L THNG GP H SINH DC (biu hin, hng iu tr)
H SINH DC NAM
Bu: Tinh hon, mo tinh, ng dn tinh
Dng vt: niu o, m cng, TK, MM
Cc tuyn ph thuc: ti tinh, tuyn tin lit

S ct dc gia y chu nam

Xng cng Bng quang
Ti tinh Trc trng ng dn tinh
Xng mu R dng vt Thn dng vt

Mo tinh hon
Tin lit tuyn Tuyn hnh niu o
Hu mn
Tinh hon Quy u dng vt

ng dn Tinh
Cc Tiu thy (cha ng sinh tinh)
Mo Tinh
Li Tinh
Cc ng sinh tinh
Tin lit tuyn
Ti Tinh
ng phng Tinh
ng dn Tinh
TINH HOAN, NG DAN TINH, TUYEN SINH DUC PHU VA DNG VAT
7
NG DN TINH
ng sinh tinh ng ra li tinh ng thng ng mo tinh ng dn tinh. ng dn tinh ni tip mo tinh hon i vo ng bn ra sau bng quang vo niu o tin lit. D tr ti tinh
Cu to tinh trng
u: Th cc u: cha enzym ph hy mng trng Nhn cha b NST n bi (n) C: ni u vi phn gia Phn gia: cha ty th to nng lng ui: gip tinh trng chuyn ng
TIN LIT TUYN

L khi hnh nn c y trn, nh di Nm di c bng quang v bao quanh niu o on tin lit tuyn Vai tr: Tit dch ra, kt hp tinh trng ca ti tinh to tinh dch
DNG VT (PENIS)
Xng cng Bng quang
Ti tinh Trc trng ng dn tinh
Xng mu
Tin lit tuyn Tuyn hnh niu o
R dng vt
Thn dng vt
Mo tinh hon
Hu mn
Tinh hon
Quy u dng vt
R dv: nm y chu v dnh vo xng mu bi dy chng treo dng vt Thn dv: hnh tr, c bao bc bi da Qui u dv: tn cng ca vt xp
Cu to bn trong: 2 vt hang Vt xp: di 2 vt hang, gia c niu o
vui hc
Theo bn kch thc trung bnh DV ngi VN l bao nhiu? Ngn l di < ?
vui hc
Vit Nam(BV Bnh Dn) Di 11,2 (5-14,5cm) Ngn l < 6 cm
Chu vi: 8,8 cm (4-13,5cm)
Php - c
15 cm
Rp M
Malaysia Vit Nam
13,5 cm 12,9 cm
12,1 cm 11,1 cm
n
Hn Quc
10,6 cm
9,6 cm
Chc nng ca tinh hon

chc nng ngoi tit: To tinh trng
ng sinh tinh: sn sinh (120 triu/ngy) Mo tinh: trng thnh (di ng) ng dn tinh: d tr (1 thng)
Sn xut tinh trng: t lc dy th sut i.
Chc nng ca tinh hon

chc nng ni tit: To Testosteron - Do t bo k (Leydig) ca tinh hon sn xut.
- c tnh sinh dc nam th pht (dy th, ) - Kch thch sn sinh tinh trng. - ng ha protein, pht trin c xng. - Tng chuyn ha c bn, s lng hng cu. - Gi mui v nc.
- iu ha bi tit: LH
Hot ng sinh dc nam

Hin tng cng Phn x ty, trung tm on tht lng (ph giao cm). Kch thch c hc v tm l. p ng: khi c (+) v tnh dc gin tiu M lm mu vo cc xoang mch mu nhiu (th hang) p vo TM, lm mu thot ko c cng cng khi no M co li mu TM thot ra c xu li
Hot ng sinh dc nam

Hin tng phng tinh Phn x ty, trung tm on tht lng (giao cm). Kch thch c hc v tm l. p ng: co c trn ng sinh dc. Lc c (+) C vng bng quang ng li, ngn nc tiu Tit tinh dch di chuyn vo niu o C bu hang co tht phng ra khi niu o/cc khoi.
Tinh dch
Tinh dch = tinh trng + cht tit ca ti tinh, tuyn tin lit, tuyn Cowper v tuyn hnh niu o.
Mi ln phng tinh ~ 2,5-3,5ml tinh dch Tinh dch bnh thng cha 100 triu tinh trng/ml. Tinh dch cha < 20 triu tinh trng/ml v sinh
Mi trng thch hp cho tinh dch : kim, 370C
Tinh dch c vai tr g

Vai tr ca dch ti tinh: Vai tr ca dch tin lit tuyn: y tinh trng ra khi niu o. Bo v tinh trng. Dinh dng tinh trng. ng nh v long tr li. Tng tip nhn, di chuyn. Tng tip nhn, di chuyn.
Tinh dch: tiu chun ca WHO Mu : trng c. Mi : tanh nng. Trng lng ring : 1.028. pH : 7,2-8,0. Th tch : >2mL/ln phng tinh. Mt tinh trng : >20triu/mL. T l tinh trng sng : >75%. T l tinh trng khe : >50%. T l tinh trng bt thng : <30%.
Hot ng giao hp nam
Cc bin php trnh thai nam

Pha kch thch Pha bnh nguyn Pha cc khoi Pha hon thnh
Tm thi Vnh vin
Ri lon hot ng sinh dc nam
Bnh l SD nam:
Lit dng Xut tinh sm Xut tinh mun
U x tin lit tuyn Ung th tin lit tuyn Suy gim chc nng sinh dc
U x tin lit tuyn

Thng gp nam > 50 tui. Tin lit tuyn tng kch thc, x ha. Triu chng: ri lon tiu tin, c th gy b tiu. iu tr: thuc, phu thut
Ung th tin lit tuyn

L loi ung th thng gp Din tin nhanh ph thuc vo testosteron iu tr: ct b khi u (giai on sm) v ct tinh hon
Suy gim chc nng sinh dc
Bm sinh: - Tinh hon bt hot - Thiu testosteron.
Trc tui dy th: tinh hon mt/ bt hot khng dy th
Sau tui dy th: gim Testosterone
H SINH DC N
MC TIU
1. Cu to h SD n 2. Sinh l SD n
Chu k bung trng Chu k kinh nguyt = chu k ni mc t cung
3. Cc bin php trnh thai 4. Mt s bnh l thng gp h SD n
CU TO I TH
CQSD ngoi: m h CQSD trong: m o, t cung, vi t cung, bung trng Tuyn v
S ct dc gia vng chu

Vi t cung Bung trng Trc trng C t cung T cung
Bng quang
Xng mu
m o (7-8cm)
Hu mn
m vt Mi b Mi ln
Mng trinh Tuyn Bartholin

M H
Mi ln Mi b m vt L m o Mng trinh
L Tuyn Skene
L Tuyn Bartholin
CC DNG MNG TRINH
Vi TC Thn TC y TC
Thn TC
Eo TC Bung trng
C TC
Hong th
T CUNG
T cung gm: C, eo, thn, y Thnh t cung: cu to c trn, ph i khi c thai. Ni mc t cung: L Biu m tr (lp y v lp chc nng) C t cung: L ngoi c t cung L trong c t cung Chc nng ca t cung ?
Kch thc t cung

Di
Tr em Lc dy th Thi k sinh sn Mn kinh 3 cm 5-7cm 7-10cm
Ngang
<3cm 3-4cm 4-6cm
Trc-sau (DAP) 1-2cm

3cm 3-5cm
4cm
<4cm
<3cm
VI T CUNG
C 2 l thng: vi t cung v bng Chia 4 on:
Phu vi (loa vi) Bng vi Eo vi Ni thnh t cung
Biu m: tr gi tng c lng chuyn
BUNG TRNG
Hnh dng: hnh ovan, 3 x 2 x 1cm Nm trong bng Cha trng v sinh ra ni tit t. Ni tit:
tit estrogen (t bo nang trng); progesteron (hong th)
Slinh l SD n, c 2 chu k quan trng

Chu k bung trng: Chu k ni mc t cung
Mi chu k c tnh t
Ngy 1 (chu k 1) Ngy 1 (chu k 2)
chu k bung trng

Thay i non bun trng phng non to Hong th (phn cn li ca nang Graff)
Non nguyn thy
Non s cp
Non th cp Ngy 6 1 s non
Non vt tri
NangDe Graaf Ngy 14 Phng non
Ngy 1 Nhiu non
chu k bung trng

Hong th: tit Estradiol, estrone, androgene, v progesterone (hormone c hiu ca hong th) Nu non ko th tinh sau 12-14 ngy hong th b thoi ha, to so x nh trn bung trng. Nu non c th tinh m nui ca trng tit ra hCG (+) hong th to ra thnh hong th thai k tip tc ch tit n ht 3 thng u thai k.
S ieu hoa hoat ong buong trng bi

CHU K KINH NGUYT
Chu k kinh nguyt

Di 25-32 ngy (trung bnh 28 ngy) 3 giai on:
Tng trng: sau thi k hnh kinh, Estrogen tng (+) ni mc t cung tng trng ko n ngy 14. Phn Tit: T ngy 15, Estrogen v Progesterone cc tuyn pht trin, ngon ngoo, m m ph n, cc ng mch xon hn Ngy 24: chiu dy ni mc t mc ti a 10mm sau ni mc tr nn mng t ngt do hin tng ti hp thu dch gian bo.
Chu k kinh nguyt

Di 25-32 ngy (trung bnh 28 ngy) 3 giai on:
Tng trng: ngy 5-14 Phn Tit: ngy 15-28 Hnh kinh: ngy 1-5 (#3-5 ngy), mt # 80 ml/ngy, mu sm, long, ko ng gm mu, nim mc bong trc, cht nhy c t cung v vi trng m o. Nu ra mu nhiu, di ngy, ti v c cc nn i khm ph khoa.
V sinh kinh nguyt

Do vi khun m o d pht trin trong mu nn tm ra nhiu hn, v sinh m h v thay bang v sinh mi 6 gi (ngy 4 ln). Qun o lt, sing thay, git k vi x phng, phi ngoi nng tit trng. Trnh lao ng nng, ru, bia, thuc l, cht (+) Khng nn giao hp: d XH do nim mc ph n, d gy nhim trng do c t cung h m vim bung t cung
Cc bin php nga thai an ton v hiu qu ??
Trong vng 72 gi QHTD khng an ton
C 28 vin/ 21 vin, dng ng gi mi ngy
Cc bin php nga thai

* Dng cho n: -Thuc trnh thai: gm Progesteron (chnh) v estrogen c ch tit LH v FSH /ch rng trng. - t thuc dit tinh trng. - Mng ngn m o. - Dng c t cung. * Dng cho nam: Xut tinh ra ngoi m o, Bao cao su. * Dng cho c nam v n: - Tnh ngy rng trng (PP Ogino Knaus). - Trit sn
BNH L H SINH DC
VIM M O do VK
Bnh thng: vi trng i kh sng trong m o, ch yu l Lactobacilli, chuyn ha glycogen to acid lactic duy tr pH m o < 4.5, dch m o mu trng c, mn nh bng.
Nu pH m o b kim to k cho vk k kh khc pht trin (Gardnerella vaginalis, Mycoplasma hominis,..>) vim m o hay gp ph n c nhiu bn tnh, c thi quen tht ra m o
Vim m o do VK chn on
Huyt trng hi
pH m o > 4.5
nhiu, ng nht, trng xm, bm thnh m o, c mi hi, nht l sau giao hp
Whiff test (+): Pht m o:
nh 1 git KOH 10% vo huyt trng s bc mi nh c n t/ khng c lactobacilli, t bch cu, nhiu clue cell (t bo thng b bm trn b mt, nhiu VK lm Tb m i)
Vim m o do VK iu tr
Chn 1 trong cc phc sau y Metronidazole 2 g Liu dng Ung 1 liu Ghi ch Dng Metronidazole phi c bia ru n sau 2 ngy ngng thuc Khng dng Metronidazole trong 3 thng u thai k
Metronidazole 500mg
Ung 2 ln/ ngy x 7 ngy

Ung 2 ln/ ngy x 7 ngy Bm m o 1 ln/ ngy x 7ngy
Clindamycin 300mg
Clindamycin cream 2%
Vim m o do Nm
Nm candida albicans hay gp
Yu t thun li:
75% ph n b nhim nm m o 1 ln trong i
Dng khng sinh ph rng: penicillin, cephalosporin, tetracyclin
Tng Glycogen m o: Thai k, bnh T, dng thuc nga thai c Estrogen liu cao
Suy gim MD: dng thuc c ch MD (cortisol),AIDS
Yu t ti ch: m o nng m, mc qun b cht.
Vim m o do Nm
Triu chng
Nga m h - m o, cm gic nng/ tiu rt/ giao hp au Vim m h v nim mc m o Huyt trng: vng c, ln cn # sa ng
Chn on:
pH m o <=4 Soi ti huyt trng: c si t nm/ bo t nm (d thy hn khi gi 1 git KOH 10%)
Vim m o do Nm
Chn 1 trong cc phc sau y Liu dng cho 1 ngy S ngy dng
Nystatin 100.000 UI
t m o 1 vin
X 14 ngy
X 6 ngy
Miconazol/ clotrimazol 100mg t m o 1 vin
Miconazol/ clotrimazol 200mg t m o 1 vin
X 3 ngy
Fluconazol 150mg Itraconazol 100mg
Ung 1 vin duy nht 2 vin x 2ln 2 vin x 1 ln
1 ngy X 1 ngy X 3 ngy

Vim m o do Trichomonas
Trichomonas Vaginalis l 1 loi trng roi ly qua ng giao hp, c th tm thy nm o, niu o, cc tuyn
cht nhn m h Triu chng:
Huyt trng nhiu: vng/ xanh, long, c bt, mi tanh
C th km nga, rt.
Vim m o do Trichomonas
Chn on:
pH m o >= 4.5 soi ti huyt trng: thy trng roi di ng v nhiu bch cu
iu tr:
Metronidazol 2g: ung 1 liu duy nht Metronidazol 500mg: 2 ln/ ngy x 7ngy
iu tr cho bn tnh:
Metronidazol 2g: ung 1 liu duy nht
Vim c t cung
Vim c t cung:
L vim c t cung trong nhy m (vim cc TB tuyn
ca knh c T cung)
2 tc nhn hay gp: Lu cu = Neisseria gonorrhoreae, v Chlamydia Trachomatis 10-20 % dn n vim vng chu ( vim SD trn)
Vim c t cung
Triu chng
Khm c nhiu huyt trng: mu vng/ xanh ng nhiu
c TC
C TC c th b l tuyn, vim , ph n, d chy mu khi chm.
Vim c t cung
Chn on
Xt nghim vi trng hc t mu huyt trng ly t knh c
TC sau khi chi sch c ngoi. Nu thy song cu gram (-) hnh ht c ph trong TB nhim Lu cu.
Ngoi ra dung cc test Min dch hunh quang chn on vim do Chlamydia.
Vim c t cung
iu tr lu cu
Cefixime 400mg ung liu duy nht/ Levofloxacin 250 mg ung liu duy nht
iu tr lu cu
Azithromycin 1g liu duy nht/ Erythromycin 500mgx 4ln/ ngy x 7 ngy
VIM PHN PH
nh ngha: l tnh trng vim vi trng, bung trng v dy chng quanh t cung bung trng Nguyn nhn: l bin chng ca vim m h, m o c t cung, do th thut ph khoa khng an ton, quan h tnh dc khng an ton Mm bnh: t cu, lin cu, lu cu, Chlamydia
VIM PHN PH (tt)

Vim phn ph cp - au h chu, st, st nh, kh h - iu tr: khng sinh (Ofloxacin, levofloxacin), phu thut (p xe, iu tr ni khng p ng) - Bin chng: tc ng dn trng, thai ngoi t cung
VIM PHN PH (tt)

Vim phn ph mn - Triu chng: au h chu, au tng ln khi vn ng, kh h - iu tr: ni khoa, khng sinh, ngoi khoa, ct t cung bn phn hay ton phn + vi t cung + bung trng khi c bin chng
Ung th
V tr no cng c th pht sinh ung th. Thng ph n: ung th c t cung, ung th v, ung th ni mc t cung. Nn chch nga bnh ung th c t cung (virus HPV) cho n gii tui QHTD
Thai ngoi t cung

Thai khng lm t trong t cung Thng gp l vi t cung Triu chng: tr kinh, au bng, ra huyt bt thng. iu tr: thng l phu thut, dng thuc hy thai (t dng)
SY THAI
nh ngha: l tnh trng thai b tng ra ngoi t cung trc khi thai nhi c kh nng t sng < 20 tun Nguyn nhn: 80% xy ra trong giai on 12 tun u ca thai k
bt thng nhim sc th, tui m hoc cha, s ln mang thai, bnh mn tnh ca m, nhim trng cp ca m, bt thng c quan sinh dc m, chn thng, ru, bia, thuc l, cht gy nghin.
SY THAI (tt)
Triu chng: - Do sy thai: ra huyt m o, au bng - Sy thai kh trnh: xut huyt m o + c t cung m, au bng di - Sy thai: thai nhi b tng ra ngoi trc 20 tun tui, xut huyt, au bng, c t cung m - Sy thai hon ton: thai + nhau b tng hon ton ra c t cung gy xut huyt m o
SY THAI (tt)
iu tr: (do sy thai) ngh ngi tuyt i, progesterone, gim co tht (sparmaverin) Phng nga: khm thai nh k, trnh nhng cht gy nghin, kim sot bnh mn tnh, iu tr bnh nhim trng, nhim siu vi, m bc nhn x, khu h eo c t cung.

He Sinh Duc

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

He Sinh Duc

Uploaded by

Copyright:

Available Formats

H SINH DC

DR. L Hng Thnh

CU TO H SINH DC NAM & N

3 NM C 1 S BNH L THNG GP H SINH DC (biu hin, hng iu tr)

Cc tuyn ph thuc: ti tinh, tuyn tin lit

S ct dc gia y chu nam

Xng mu R dng vt Thn dng vt

Tin lit tuyn Tuyn hnh niu o

Tinh hon Quy u dng vt

Cc Tiu thy (cha ng sinh tinh)

Tin lit tuyn

TIN LIT TUYN

Tin lit tuyn Tuyn hnh niu o

Cu to bn trong: 2 vt hang Vt xp: di 2 vt hang, gia c niu o

Chc nng ca tinh hon

Sn xut tinh trng: t lc dy th sut i.

Chc nng ca tinh hon

Hot ng sinh dc nam

Hot ng sinh dc nam

Mi trng thch hp cho tinh dch : kim, 370C

Tinh dch c vai tr g

Hot ng giao hp nam

Cc bin php trnh thai nam

Tm thi Vnh vin

Ri lon hot ng sinh dc nam

Lit dng Xut tinh sm Xut tinh mun

U x tin lit tuyn

Ung th tin lit tuyn

Suy gim chc nng sinh dc

Bm sinh: - Tinh hon bt hot - Thiu testosteron.

Trc tui dy th: tinh hon mt/ bt hot khng dy th

Sau tui dy th: gim Testosterone

3. Cc bin php trnh thai 4. Mt s bnh l thng gp h SD n

S ct dc gia vng chu

Mng trinh Tuyn Bartholin

CC DNG MNG TRINH

Kch thc t cung

Trc-sau (DAP) 1-2cm

Biu m: tr gi tng c lng chuyn

Slinh l SD n, c 2 chu k quan trng

chu k bung trng

Non th cp Ngy 6 1 s non

NangDe Graaf Ngy 14 Phng non

Ngy 1 Nhiu non

chu k bung trng

S ieu hoa hoat ong buong trng bi

CHU K KINH NGUYT

Chu k kinh nguyt

Chu k kinh nguyt

V sinh kinh nguyt

Cc bin php nga thai an ton v hiu qu ??

Trong vng 72 gi QHTD khng an ton

C 28 vin/ 21 vin, dng ng gi mi ngy

Cc bin php nga thai

Whiff test (+): Pht m o:

Ung 2 ln/ ngy x 7 ngy

75% ph n b nhim nm m o 1 ln trong i

Dng khng sinh ph rng: penicillin, cephalosporin, tetracyclin

Suy gim MD: dng thuc c ch MD (cortisol),AIDS

Yu t ti ch: m o nng m, mc qun b cht.

Miconazol/ clotrimazol 100mg t m o 1 vin

Miconazol/ clotrimazol 200mg t m o 1 vin

Fluconazol 150mg Itraconazol 100mg