A massage therapist s guide to pathology 5e
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A Massage Therapist’s Guide to Pathology, 5e. Chapter 11 Reproductive System Conditions. Introduction. Many reproductive system conditions or treatment options have repercussions for massage therapists

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A massage therapist s guide to pathology 5e

A Massage Therapist’s Guide to Pathology, 5e

Chapter 11

Reproductive System Conditions


Introduction

Introduction

  • Many reproductive system conditions or treatment options have repercussions for massage therapists

  • Not all reproductive system conditions are diseases: pregnancy, menopause are perfectly normal and healthy—but they do change the way people function


Introduction cont

Introduction, cont.

  • Function and Structure, the Female Reproductive System:

    • In healthy, non-pregnant women the ovaries are low in the pelvis

    • Attached to uterus via ovarian ligament

    • Ovaries produce hormones and eggs

      • Eggs enter fallopian tubes (oviducts, uterine tubes) to make 5-day journey to uterus

      • Fertilization happens in oviducts


Introduction cont1

Introduction, cont.

  • Uterus is lined with endometrium

    • If no fertilized egg attaches, endometrium is shed with menses

  • Hormone secretions from ovaries, pituitary determine menstrual cycle, pregnancy

    • Birth control pills, patches, work by introducing hormones to mimic pregnancy:

    • Suppresses ovulation


Introduction cont2

Introduction, cont.

  • Relationship between reproductive and endocrine system is extremely tight

  • Several conditions in this chapter could be listed as endocrine system conditions

  • A history of surgery, inflammation, scar tissue in the pelvis may allow the ovaries to move out of usual location: caution for deep abdominal massage


Introduction cont3

Introduction, cont.

  • Function and Structure, the Male Reproductive System:

    • Testes, epidydimus, spermatic cord, other glands

    • Production of sperm, semen

    • Expelled through urethra through the penis

    • Sperm are smallest human cells; the only ones with flagella

      • Manufactured in testes, stored in epidydimus

      • Leave through R/L vas deferens; go into pelvic cavity

      • Tube joins together to form urethra (double-tasking tube)


Introduction cont4

Introduction, cont.

  • Many male reproductive system conditions involve the prostate gland

    • “Prostate massage” is conducted through the wall of the rectum for diagnostic purposes; not usually considered within the scope of practice for massage

  • Massage may not have impact on conditions, but can improve quality of life of the person who lives with them


Reproductive system conditions

Disorders of the Uterus

Cervical Cancer

Dysmenorrhea

Endometriosis

Fibroid Tumors

Uterine Cancer

Disorders of other Female Reproductive Structures

Breast Cancer

Ovarian Cancer

Ovarian Cysts

Reproductive System Conditions


Reproductive system conditions cont

Reproductive System Conditions, cont.

  • Disorders of the Male Reproductive System

    Benign Prostatic Hypertrophy

    Prostate Cancer

    Prostatitis

    Testicular Cancer

  • Other Reproductive System Conditions

    Menopause

    Pregnancy

    Premenstrual Syndrome

    Sexually Transmitted Infections


Cervical cancer

Cervical Cancer

  • Definition:

    • Growth of malignant cells in cervical lining

    • Can be slow or fast, aggressive, invasive

    • 12,700 diagnoses/year, 4,300 deaths/year in US

      • (rates are falling)


Cervical cancer cont

Cervical Cancer, cont.

  • Etiology: what happens?

    • Related to viral infection with some of HPV group

      • Most HPV infections do NOT lead to cervical cancer

      • Precancerous changes = dysplasia

        • Stimulated by low-risk and high-risk HPV


Cervical cancer cont1

Cervical Cancer, cont.

  • With low-risk viruses no symptoms may ever develop

  • With high-risk infection, cancerous cells can spread through uterus, vagina, pelvic cavity, etc.

  • HPV is STD through skin-to-skin contact

    • Condoms can reduce risk of cervical cancer, but they don’t prevent spread of HPV (more skin touches than is covered by condom)


Cervical cancer cont2

Cervical Cancer, cont.

  • Risk factors:

    • Exposure to HPV

    • Sexual activity at early age, especially with multiple partners

    • Or a woman’s partner has a history of multiple partners

    • Smoking raises risk by 100%

    • Also:

      • DES daughter; immune suppression; co-infection with chlamydia, low socio-economic standing

      • Vaccine now available


Cervical cancer cont3

Cervical Cancer, cont.

Types of Cervical Cancer

  • Squamous cell carcinoma

    • 80%-90%

    • Affects cells of inferior portion on cervix

  • Adenocarcinoma

    • More rare

    • Typically begins at mucus-producing cells of superior cervix

  • Other types

    • Very rare

    • Melanoma, lymphoma, sarcoma


Cervical cancer cont4

Cervical Cancer, cont.

  • Signs and symptoms:

    • No early symptoms

    • Later: bleeding, spotting between periods or after menopause, vaginal discharge, abdominal pain


Cervical cancer cont5

Cervical Cancer, cont.

  • Treatment:

    • Depends on stage

    • Most are found in Stage 0 or I

    • Cryotherapy, electrosurgical excision, laser surgery

    • Can go to surgery, even exenteration

    • Radiation and chemotherapy as necessary

  • Medications:

    • Chemotherapeutic agents if necessary


Cervical cancer cont6

Cervical Cancer, cont.

  • Massage

    • Risks: Advanced cancer patients have many issues that require adjustments in massage, but cervical cancer that is treated early has no specific risks.

    • Benefits: Massage has many benefits for cancer patients, as long as appropriate adjustments are made.


Dysmenorrhea

Dysmenorrhea

  • Definition:

    • Painful menstrual periods

    • Limits activities > 1 day/month

    • Leading cause of lost school/work time for fertile women


Dysmenorrhea cont

Dysmenorrhea, cont.

  • Etiology:

    • Can be freestanding (primary) or a complication of something else (secondary)

    • Emotional stress + ligament laxity and irritation


Dysmenorrhea cont1

Dysmenorrhea, cont.

Types of dysmenorrhea

  • Primary

    • Starts within 3 months of menarche

    • Prostaglandins + pain-spasm cycle + irritation at uterine ligament

  • Secondary

    • Complication of other pelvic disorder


Dysmenorrhea cont2

Dysmenorrhea, cont.

  • Signs and symptoms:

    • Dull ache, sharp pain with cramping

    • Usually early in cycle; may linger through whole period

    • Headache, nausea, vomiting, diarrhea, frequent urination

    • Secondary dysmenorrhea: menstrual flow is irregular or heavy, pain meds may not be effective; infertility


Dysmenorrhea cont3

Dysmenorrhea, cont.

  • Treatment:

    • heat eases cramping; TENS unit

    • Medication or surgery for structural problems

    • Alternative methods:

      • Nutritional analysis

        • Reduce fats, animal proteins; increase fiber, calcium

    • Exercise, stretching

  • Medications:

    • Anti-inflammatories

    • Narcotic analgesics if necessary (especially for secondary)

    • Low-dose birth control suppresses ovulation


Dysmenorrhea cont4

Dysmenorrhea, cont.

  • Massage

    • Risks

      • Deep or intrusive work for an undiagnosed problem should be avoided

    • Benefits

      • Relieves stress

      • Indirectly addresses uterine pain-spasm cycle

      • Relieves tight muscles brought about by ligament laxity

    • Options

      • Gentle work around skin of sacrum to provide reflexive relief

      • Massage to the abdomen when client is not menstruating may minimize abdominal adhesions that contribute to pain


Endometriosis

Endometriosis

  • Definition:

    • Endometrial tissue becomes established elsewhere in the body

    • 5%-20% of women of childbearing age may have it; not all have symptoms


Endometriosis cont

Endometriosis, cont.

  • Etiology:

    • First described in 1921

    • Implantation and growth of cells outside uterus: usually in pelvis

    • Hypotheses:

      • Retrograde flow through uterine tubes

      • Coeliomic metaplasia

      • Circulatory/lymph dissemination

      • Immune abnormalities


Endometriosis cont1

Endometriosis, cont.

  • Rarely, growths are found outside pelvic cavity (lungs, brain)

  • Growths are sensitive to hormonal signals to proliferate;

    • Can’t shed with normal menses, so body encapsulates them with connective tissue

    • Endometriomas form

    • Raises risk of ectopic pregnancy, infertility, anemia


Endometriosis cont2

Endometriosis, cont.


Endometriosis cont3

Endometriosis, cont.

  • Signs and symptoms:

    • Infertility

    • Menstrual irregularities, pain with cycle

    • Diarrhea and rectal bleeding during menstruation

    • Urinary urgency with painful urination

    • Symptoms do not indicate extent of growths


Endometriosis cont4

Endometriosis, cont.

  • Treatment:

    • Four main goals:

      • Relieve pain

      • Stop progression

      • Prevent new growths

      • Maintain/restore fertility (if desired)

      • (Limit symptoms long enough for a successful pregnancy)

    • Lasers, electrocauterization for ablation of growths, to remove adhesions

  • Medications:

    • NSAIDs

    • Narcotic analgesics

    • Oral contraception and other hormonal analogs to suppress estrogen and ovulation


Endometriosis cont5

Endometriosis, cont.

  • Massage

    • Risks

      • Deep abdominal massage should be conservative.

    • Benefits

      • Massage can help with stress, frustration, anxiety related to this condition.

    • Options

      • Special protocols in abdominal and pelvic bodywork may help to relieve pain, reduce scar tissue.


Fibroid tumors

Fibroid Tumors

  • Definition:

    • Also called leiomyoma

    • Benign tumors in or around uterus

    • Vary from microscopic to several pounds


Fibroid tumors cont

Fibroid Tumors, cont.


Fibroid tumors cont1

Fibroid Tumors, cont.

  • Etiology:

    • Probably combination of genetics, environment, hormones

    • Same growth pattern as seen in keloid scars (both are most common among African Americans)

    • Classified by location:

      • Submucosal

      • Intramural

      • Subserosal


Fibroid tumors cont2

Fibroid Tumors, cont.

  • Can cause heavy, painful periods

  • Not usually serious

  • Can cause anemia (blood loss with heavy periods); infertility, failed pregnancy

  • Pedunculate fibroids can twist

  • Tumors may outgrow blood supply, become necrotic


Fibroid tumors cont3

Fibroid Tumors, cont.

  • Signs and symptoms:

    • Often silent

    • May put pressure on nerves, cause bladder or bowel symptoms, interfere with pregnancy


Fibroid tumors cont4

Fibroid Tumors, cont.

  • Treatment:

    • May not be needed

    • Hormones

    • Other procedures:

      • Artery embolization

      • Laser ablation

      • Myomectomy

      • Full hysterectomy

  • Medications:

    • Gonadotropin releasing hormone (to shrink pre-surgery)

    • Progesterone or progestin counteracts estrogen


Fibroid tumors cont5

Fibroid Tumors, cont.

  • Massage

    • Risks

      • No intrusive massage of lower abdomen

    • Benefits

      • Generally not impacted one way or the other: massage for quality of life


Uterine cancer

Uterine Cancer

  • Definition:

    • Cancerous cells in the uterus

      • Endometrial cancer

      • Uterine sarcoma

    • 43,000 diagnosed/yr; 8000 deaths


Uterine cancer cont

Uterine Cancer, cont.

  • Etiology:

    • Mutation in DNA of affected cells

    • Endometrium, connective tissue, or muscle cells

    • Trigger is estrogen exposure (endogenous or exogenous)

    • Other factors:

      • Race, age, history of other cancers


Uterine cancer cont1

Uterine Cancer, cont.

  • Etiology, cont.

    • New growths are fragile, easily disrupted

      • Leads to vaginal bleeding

    • Spreads via

      • Direct contact with other organs

      • Peritoneal fluid

      • Lymphatic circulation

      • Blood circulation


Uterine cancer cont2

Uterine Cancer, cont.

  • Risk Factors

    • Long-term exposure to estrogen

    • Age

    • Race

    • Genetic anomaly for colorectal cancer

    • Type 2 diabetes


Uterine cancer cont3

Uterine Cancer, cont.

Types of uterine cancer:

  • Endometrial cancer

    • Adenocarcinoma: most common, not usually aggressive

    • Adenosquamous carcinoma: squamous + endothelial cells

    • Papillary serous adenocarcinoma: rare, potentially aggressive form

    • Clear cell adenocarcinoma: rarest form, most aggressive


Uterine cancer cont4

Uterine Cancer, cont.

Types of uterine cancer:

  • Uterine sarcoma

    • Stromal cell cancer: at connective tissue

    • Leiomyosarcoma: starts at smooth muscle cells

    • Mixed Mullerian sarcoma: combine features of adenocarcinomas and sarcomas


Uterine cancer cont5

Uterine Cancer, cont.

  • Signs and symptoms:

    • Vaginal spotting, bleeding in post-menopausal women

    • Harder to identify in fertile women: spotting between periods should be investigated

    • Vaginal discharge, pelvic pain, pelvic mass, pain with sex, change in bladder/bowel habits, unintended weight loss


Uterine cancer cont6

Uterine Cancer, cont.

  • Treatment:

    • Hysterectomy, with ovaries and tubes

    • Radiation, hormone therapy

    • D&C with progestin (high risk of recurrence)

  • Medications

    • Chemotherapy agents

    • Hormone therapy


Uterine cancer cont7

Uterine Cancer, cont.

  • Massage

    • Risks

      • Accommodate not only for disease but also for treatment (see Chapter 12)

    • Benefits

      • Same guidelines as other types of cancer: stay within activity levels


Breast cancer

Breast Cancer

  • Definition: what is it?

    • Cancer cells in epithelial or connective tissue of the breast

      • 230,000 new cases of invasive breast are diagnosed in women and about 1,900 cases in men per year in the US

      • 39,000 women and 500 men die per year

      • 2.5 million breast cancer survivors are alive in the US today


Breast cancer cont

Breast Cancer, cont.

  • Etiology: what happens?

    • Most malignancies are in lobes or ducts

    • Many begin as in situ growths that develop malignant characteristics

      • Can take several years

    • Cells invade circulatory or lymph system

      • Proximity of lymph nodes is a problem

    • No dependable profile

      • Risk factors: age (50+), estrogen exposure, HRT, obesity, alcohol, etc.

      • BRCA 1, BRCA 2


Breast cancer cont1

Breast Cancer, cont.

Types of Breast Cancer

  • Ductal carcinoma

    • 70%-80% diagnoses

    • Can occur in situ only affecting epithelial lining

    • Can become invasive

    • Associated with calcified deposits and slight increased risk for invasive breast cancer


Breast cancer cont2

Breast Cancer, cont.


Breast cancer cont3

Breast Cancer, cont.

Types of Breast Cancer, cont.

  • Lobular carcinoma

    • 5%-10% of tumors

    • Can be limited to epithelial lining but carries significant risk of becoming invasive

    • Higher incidence of appearing in both breasts than ductal carcinoma


Breast cancer cont4

Breast Cancer, cont.


Breast cancer cont5

Breast Cancer, cont.

Types of Breast Cancer, cont.

  • Inflammatory breast disease

    • Relatively rare in the West

    • Resembles local infection or insect bite


Breast cancer cont6

Breast Cancer, cont.

Types of Breast Cancer, cont.

  • Other types of breast cancer

    • 10%-15% of diagnoses

    • Paget disease of the breast affects specifically the nipple, and presents with eczema-like changes in the skin

    • Medullary carcinoma is a rare malignancy of the connective tissues

    • Tubular carcinoma refers to the shape the mutated cells

    • Mucinous carcinmoa is rare with good prognosis


Breast cancer cont7

Breast Cancer, cont.

  • Signs and symptoms:

    • Can be subtle; small tumors can hide in roomy tissues

    • Later: asymmetrical growth, skin changes and discharge on affected side

    • Complications with metastasis: bone weakness, weight loss, spinal cord compression, swelling of arm on affected side


Breast cancer cont8

Breast Cancer, cont.


Breast cancer cont9

Breast Cancer, cont.

  • Treatment:

    • Surgery:lumpectomies, partial mastectomy, total mastectomy modified mastectomy

    • Radiation: external or internal

    • Chemotherapy: to reduce size of tumor pre-surgery, or as an alternative to surgery for inoperable tumors

    • Hormone therapy

    • Biologic therapy


Breast cancer cont10

Breast Cancer, cont.

  • Medications

    • Chemotherapy: toxic drugs to shrink tumor for surgery or prevent new growth

    • Hormone therapy: to bind up receptor sites on tumor cells

    • Biologic therapy: to block cell division

    • Biphosphonates to promote bone density

    • Antiemetics to limit chemotherapy induced vomiting


Breast cancer cont11

Breast Cancer, cont.

  • Massage

    • Risks

      • Same as other cancers: accessible tumors, unstable bones, compromised organs, challenges of treatment, surgical equipment

      • See Chapter 12

    • Benefits

      • Improved sleep, soothe anxiety, reduce depression, help manage pain


Ovarian cancer

Ovarian Cancer

  • Definition:

    • Growth of malignant tumors on the ovaries

    • Most begin in the epithelium of these organs

    • Some types can grow quickly, metastasize to the peritoneum, other organs in the abdomen

    • 22,000 diagnosed in the US each year; high mortality rate at 15,000 per year


Ovarian cancer cont

Ovarian Cancer, cont.

  • Etiology:

    • Vulnerable to DNA mutations that can lead to malignancy and metastasis

    • Close contact with several other organs makes malignancy easy through peritoneal cavity or through circulatory or lymph systems

    • Often silent during this process


Ovarian cancer cont1

Ovarian Cancer, cont.

  • Risk factors:

    • Familial history:

      • 1st degree relative has 1:3 chance of developing OC

      • 2nd degree also has increased risk

      • Genetic anomaly for breast or colorectal cancer increases risk


Ovarian cancer cont2

Ovarian Cancer, cont.

  • Reproductive history:

    • No children, no birth control, or multiple miscarriages

    • (May be related to ovulation trauma: wear and tear on ovaries)

  • Hormone replacement therapy:

    • Women with a hysterectomy who took estrogen alone for 10 years +

  • Other:

    • Exposure to radiation, asbestos, talcum powder on genitals, high fat diet, age…


Ovarian cancer cont3

Ovarian Cancer, cont.

Types of ovarian cancer

  • Adenocarcinoma of the ovary

    • 90% of diagnoses

    • Epithelial cell tumors

    • Subtypes can be entirely benign or aggressively invade other abdominal and pelvic organs without major symptoms

  • Germ cell ovarian cancer

    • Rare tumors, generally positive prognosis


Ovarian cancer cont4

Ovarian Cancer, cont.

Types of ovarian cancer, cont.

  • Stromal cell ovarian cancer

    • Rare tumors that can be benign or malignant

    • Grow in connective tissue and hormone producing cells of the ovaries

    • Symptoms often have to do with excessive estrogen or testosterone

    • Prognosis is usually good


Ovarian cancer cont5

Ovarian Cancer, cont.

  • Signs and symptoms:

    • None or subtle early

      • Feeling of heaviness in pelvis; bloating, nausea, diarrhea, constipation, urinary frequency, vaginal bleeding, change in cycle, weight gain/loss

      • This often happens during perimenopause: easy to miss

    • Later

      • Palpable mass, increased girth, ascites


Ovarian cancer cont6

Ovarian Cancer, cont.

  • Treatment:

    • Surgery (oophorectomy, uterus, tubes, “debulking”)

    • Radiation rarely

  • Medications:

    • Chemotherapy

    • Biologic therapies sometimes used but not approved for ovarian cancer treatment


Ovarian cancer cont7

Ovarian Cancer, cont.

  • Massage

    • Risks

      • Carefully gauge capacity for adaptation and general fragility

    • Benefits

      • Respect challenges of cancer, cancer treatments

    • See Chapter 12 for more


Ovarian cysts

Ovarian Cysts

  • Definition:

    • Several types

    • This article: functional cysts

    • Arise from normal ovaries, just before or just after ovulation


Ovarian cysts cont

Ovarian Cysts, cont.

  • Etiology:

    • At ovulation a single follicle ruptures, releasing an egg to uterine tubes

      • Sometimes the follicle doesn’t rupture

      • Sometimes the follicle doesn’t heal normally

    • Estrogen dominance and infertility treatments may play a role

    • Size is the major factor that determines if cysts cause any trouble

      • Interfere with blood flow; rest on bladder

      • Torsion


Ovarian cysts cont1

Ovarian Cysts, cont.

Types of cysts:

  • Follicular cysts:

    • Most common type

    • Follicle doesn’t rupture completely, a blister forms at site

    • May be 2-3 inches, spontaneously resolve within two cycles

  • Corpus luteum cysts:

    • Blister forms over site of released ovum (corpus luteum)

    • Blocks hormones that should flow out

    • Creates pregnancy-like symptoms until resolution (2-3 months)

    • Can rupture and bleed


Ovarian cysts cont2

Ovarian Cysts, cont.


Ovarian cysts cont3

Ovarian Cysts, cont.

  • Polycystic Ovaries:

    • Also called Stein-Leventhal Syndrome

    • Enlarged ovaries with multiple small cysts

    • Changes in hormone secretion →

    • Acne, hirsutism, loss of cycle

    • Can also impact metabolism →

    • Metabolic syndrome


Ovarian cysts cont4

Ovarian Cysts, cont.


Ovarian cysts cont5

Ovarian Cysts, cont.

  • Endometriomas (from endometriosis)

  • Dermoid cysts (teratomas—can contain primitive cells from elsewhere in body; teeth, hair, bone fragments)

  • Cystadenomas (usually benign but can change)


Ovarian cysts cont6

Ovarian Cysts, cont.

  • Signs and symptoms:

    • Often silent unless the cyst is injured

    • May have dull ache, pain with intercourse

    • Large cysts may → back pain, into legs


Ovarian cysts cont7

Ovarian Cysts, cont.

  • Treatment:

    • Watchful waiting for follicular and corpus luteum

    • Surgery if necessary

  • Medications:

    • Oral birth control pills

    • Lutenizing hormone analogs for PCOS

    • Anti-androgenizing hormones if birth control pills are unsuccessful


Ovarian cysts cont8

Ovarian Cysts, cont.

  • Massage?

    • Risks

      • Local contraindication

      • Ovaries may be out of usual location: vulnerable to compression

      • See diabetes and metabolic syndrome risks if PCOS clients present these conditions

    • Benefits

      • Simple precautions can allow clients with this condition to receive the many benefits from body work


Benign prostatic hyperplasia

Benign Prostatic Hyperplasia

  • Definition:

    • Prostate of mature men becomes enlarged

      • Most mature men will have some enlargement

      • 50% of men >60

      • 70% of men >70, etc.

      • 14 million men in the United States have been diagnosed; most have no significant symptoms


Benign prostatic hyperplasia cont

Benign Prostatic Hyperplasia, cont.

  • Etiology:

    • Unclear why mature prostates grow

      • Dihydrotestosterone (DHT)

      • Estrogen dominance

    • Enlargement → mechanical pressure on urethra

      • Affected tissue is usually periurethral (as opposed to prostate cancer which is usually superficial)

      • Enlargement doesn’t always correspond with pressure on urethra

      • Pressure → dysuria, UTI, pyelonephritis, bladder stones


Benign prostatic hyperplasia cont1

Benign Prostatic Hyperplasia, cont.


Benign prostatic hyperplasia cont2

Benign Prostatic Hyperplasia, cont.

  • Signs and symptoms:

    • Difficulties with urination

    • Weak flow, frequency, incomplete emptying, leaking/dribbling

    • Acute urinary retention: medical emergency


Benign prostatic hyperplasia cont3

Benign Prostatic Hyperplasia, cont.

  • Treatment:

    • Depends on severity

    • Cut away sections of prostate gland to relieve pressure

    • Examined for signs of prostate cancer

  • Medications:

    • Hormones to alter cell behavior

    • Alpha-blockers


Benign prostatic hyperplasia cont4

Benign Prostatic Hyperplasia, cont.

  • Massage

    • Risks:

      • Important to guide client to help for signs of UTI, other complications

    • Benefits:

      • Most bodywork is safe as long as they are comfortable receiving the work

    • Options:

      • Visceral manipulation

      • Work knowledgeably and rule out risk of prostate cancer


Prostate cancer

Prostate Cancer

  • Definition:

    • Growth of malignant tumors in prostate

    • 241,000 cases diagnosed per year in US

    • 34,000 men die

    • Most patients are over 65; rare in men under 40


Prostate cancer cont

Prostate Cancer, cont.

  • Etiology:

    • Many older men have BPH; sometimes enlargement is not benign

    • Prostate enlarges, may put pressure on urethra: looks like BPH

      • Signs may be ignored until urethra is seriously restricted

    • Three major red flags found in biopsied tissue:

      • Prostatic intrathelial neoplasia

      • Atypical small acinar proliferation

      • Proliferative inflammatory atrophy


Prostate cancer cont1

Prostate Cancer, cont.

  • Etiology, cont.

    • For tumors to grow, they need access to testosterone

      • Prostate cancer less likely in men who have been physically or chemically castrated

    • Men with prostate cancer and breast cancer in the family are more likely at risk


Prostate cancer cont2

Prostate Cancer, cont.

  • Signs and symptoms:

    • Enlarged, hard prostate

    • Obstruction of urethra

    • Pain with urination, ejaculation

    • Susceptible to UTI and kidney infections

    • Blood in urine

    • Can’t maintain an erection

    • Low back pain and referral to legs: growths put pressure on pelvic nerves

    • Positive PSA test (debatable)


Prostate cancer cont3

Prostate Cancer, cont.

  • Treatment:

    • Watchful waiting (for slow-growing forms in elderly men)

    • Radiation (internal or external)

    • Surgery

  • Medications:

    • Hormone therapy

    • Analgesics

    • Bisphosphonates for bone density

    • Chemotherapy

    • Biologic therapy to sensitize white blood cells to attack cancer cells


Prostate cancer cont4

Prostate Cancer, cont.

  • Massage

    • Risks

      • Delay massage until pellets have been removed if client is being treated with brachytherapy

      • Respect challenges of cancer, treatments

    • Benefits

      • Helps with depression, anxiety, insomnia, general pain

    • See Chapter 12 for more


Prostatitis

Prostatitis

  • Definition:

    • Prostate is painful, possibly inflamed

    • Pain throughout pelvis and groin (different from BPH, prostate cancer)


Prostatitis cont

Prostatitis, cont.

  • Etiology:

    • Draining channels of prostate are on horizontal plane

    • If material doesn’t drain it can become stagnant

    • Bladder reflux can cause damage or direct bacterial exposure to delicate epithelial tissues


Prostatitis cont1

Prostatitis, cont.

Types of prostatitis

  • Type 1: Acute bacterial prostatitis

    • Acute infection, possibly with abscess

  • Type 2: Chronic bacterial prostatitis

    • Recurrent infection


Prostatitis cont2

Prostatitis, cont.

  • Type 3: Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CPPS)

    • Prostate enlargement with no demonstrable infection

      • 3.a: Inflammatory chronic pelvic pain syndrome:

        • White blood cells are found in the semen, expressed prostatic secretions, or urine

      • 3.b: Non-inflammatory chronic pelvic pain syndrome:

        • Most common

        • White cells are not found; if it is a bacterial infection, no pathogen has been found

        • Pain could be a referral from perineal trigger points: a type of myofascial pain


Prostatitis cont3

Prostatitis, cont.

  • Type 4: Asymptomatic inflammatory prostatitis (AIP):

    • No subjective symptoms, white blood cells are found


Prostatitis cont4

Prostatitis, cont.

  • Signs and symptoms:

    • Bacterial looks like UTI: pain and burning on urination, etc., plus pain in pelvis, perineum, testes, discharge, fever; prostate is palpably hot

    • CPPS has no fever or abnormal palpation


Prostatitis cont5

Prostatitis, cont.

  • Treatment:

    • Remove prostate stones, if necessary

    • Type 3 “just in case” anti-inflammatories, frequent ejaculation, sitz baths, biofeedback, dietary supplements, accupuncture

  • Medications:

    • Type 1 responds to antibiotics

    • Anti-inflammatories and analgesics for chronic pain

    • Alpha blockers to improve urine flow

    • Anti-anxiety medication for chronic pain


Prostatitis cont6

Prostatitis, cont.

  • Massage

    • Risks

      • Invasive or rigorous massage is inappropriate when fever and inflammation are present.

    • Benefits

      • No direct impact on prostate irritation

      • Can improve QOL

    • Options

      • Some pain may be due to trigger points, but this area is out of the scope of practice for most massage therapists.


Testicular cancer

Testicular Cancer

  • Definition:

    • Growth of malignant cells in the testicles

    • Diagnosed about 8000 times per year

    • Causes 400 deaths per year

    • Mostly in white men 20-55 years old, but can be any age or race


Testicular cancer cont

Testicular Cancer, cont.

  • Etiology:

    • Mutation of fast-growing cells

    • Few consistent risk factors:

      • Cryptorchidism has slightly higher risk

      • Congenital abnormalities

      • Age

      • Race (mostly Caucasians)

      • History of testicular cancer

      • HIV+


Testicular cancer cont1

Testicular Cancer, cont.

Types of testicular cancer

  • Germ cell tumors:

    • In sperm and hormone-producing cells

    • Two types

      • Seminomas:

        • Most common: 40-45% of all diagnoses

        • Grow slowly, highly sensitive to radiation

      • Nonseminomas:

        • Several types, some more aggressive than others

        • Embryonic carcinomas; yolk sac tumors; teratomas; choriocarcinoma (most aggressive with poorest prognosis)


Testicular cancer cont2

Testicular Cancer, cont.

Types of testicular cancer, cont.

  • Stromal cell tumors:

    • <5% of all testicular cancer

    • Connective tissue cancer


Testicular cancer cont3

Testicular Cancer, cont.

  • Signs and symptoms:

    • Painless lump on testicle

    • Sensation of fullness, heaviness, fluid in scrotum

    • Dull ache in low abdomen or groin; breasts become enlarged, tender

    • Later signs indicate metastasis: coughing, shortness of breath, cervical lymph node lumps if affected


Testicular cancer cont4

Testicular Cancer, cont.

  • Treatment:

    • Surgery to remove affected testicle, other growths

    • Radiation for seminomas

    • Follow-up to look for missed growths, cancer in other testicle

  • Medications:

    • Chemotherapy for nonseminomas


Testicular cancer cont5

Testicular Cancer, cont.

  • Massage

    • Risks

      • Respect challenges of cancer, treatments

    • Benefits

      • Can help with pain, anxiety, depression, and other common cancer symptoms

    • See Chapter 12 for more


Menopause

Menopause

  • Definition:

    • The moment the ovaries permanently stop secreting enough hormones to initiate a menstrual cycle

    • Time leading up to and a year after this = perimenopause

    • Not a disease!

    • Perimenopause symptoms usually begin at about 47.5 years, complete at 51.4 years

    • 46 million women in US are postmenopausal


Menopause cont

Menopause, cont.

  • Etiology:

    • As ovaries age they become less sensitive to FSH and LH;

    • They secrete less estrogen(s), progesterone

    • Because of age or surgery, cycle comes to a stop

    • Effects of hormonal shifts are still being explored

    • Bone density:

      • Estrogen inhibits osteoclast activity

      • Progesterone stimulates osteoblasts

      • With loss of both, women can lose 20% of bone density in first years of fluctuation


Menopause cont1

Menopause, cont.

  • Cardiovascular health:

    • Shift from HDL to LDL predominance

  • Protection from some types of cancer:

    • Varies with subtypes of hormones, areas of cancer

  • Central nervous system functions:

    • Link to mood, cognitive function still being explored; hormone replacement does not affect major depressive disorder

  • In addition to having reduced levels of estrogen and progesterone, menopausal women also have changed balance between them: estrogen dominance


  • Menopause cont2

    Menopause, cont.

    • Signs and symptoms:

      • Short term:

        • Hot flashes (“power surges”)

        • Night sweats

        • Insomnia

        • Mood swings

        • Urinary urgency, loss of continence

        • Decreased sex drive

        • Vaginal dryness

        • Confusion, short term memory loss, poor concentration

      • Long term:

        • Bone thinning, heart disease


    Menopause cont3

    Menopause, cont.

    • Treatment:

      • Hormone replacement therapy, herbal alternatives

    • Medications:

      • Hormone replacement therapy

        • Appropriate for some but not all women; carries risks

      • Meds for bone density, heart disease

      • Herbal preparations:

        • Black cohosh, red clover, dong quai, ginseng, wild yam, kava (all have potential risks and interactions with other meds)


    Menopause cont4

    Menopause, cont.

    • Massage

      • Risks

        • None!

      • Benefits

        • May help mitigate symptoms including mood disruptions, insomnia, and fatigue

      • Options

        • Massage can be a way to reinforce a sense of physical joy and wholeness during a time of great transition


    Pregnancy

    Pregnancy

    • Definition:

      • Carrying a fetus

    • Etiology:

      • Wide ranging and complex physiological changes

      • Most common or dangerous complications will be discussed


    Pregnancy cont

    Pregnancy, cont.

    Types of pregnancy complications

    • Asthma: incomplete control of asthma raises the risk for many problems, including low birth weight, cerebral palsy and others

    • Thromboembolism: DVT + pulmonary embolism; pregnant and post-partum women have 10x the risk of the general population

    • Gestational diabetes: can lead to over-large babies, risk of later obesity, type 2 diabetes


    Pregnancy cont1

    Pregnancy, cont.

    • Pregnancy-induced hypertension

      • Can start slowly, quickly become threatening

      • Three categories:

        • Hypertension

        • Pre-eclampsia (hypertension and proteinuria with systemic edema)

        • Eclampsia: pre-eclampsia and convulsions

      • Can lead to HELLP syndrome, great risks for mother and baby


    Pregnancy cont2

    Pregnancy, cont.

    • Ectopic pregnancy:

      • A fertilized egg implants outside the uterus

      • Usually in uterine tubes

      • Could be on peritoneum, on ovaries, on cervix


    Pregnancy cont3

    Pregnancy, cont.

    • Signs and symptoms:

    • Implications for massage:

      • Loose ligaments:

        • Starts early in pregnancy, can lead to unstable joints and muscle spasm

      • Fatigue:

        • Combination of carrying extra weight and hormones that demand rest

      • Shifting proprioception:

        • Rapid changes in size, shape, weight: clumsiness, vulnerability to injury


    Pregnancy cont4

    Pregnancy, cont.

    • Massage

      • Risks

        • Intrusive work on abdomen contraindicated

        • Some accupressure points should be avoided

        • Positioning guidelines are important

      • Benefits

        • For uncomplicated pregnancies, indicated with caution by trimester

      • Options:

        • Special training available for this population


    Pregnancy cont5

    Pregnancy, cont.

    • 1st trimester:

      • Avoid deep abdominal work

      • Eastern approaches also recommend avoiding heels, Achilles tendons, hoku point of thumb

    • 2nd trimester:

      • Bolsters, other support may become necessary

      • Client may not want to lie prone

    • 3rd trimester:

      • No prone without cushions, no supine (side work may be appropriate)

      • Limited blood return from legs, risk of varicose veins, clotting

      • Watch for fever, dizziness, headache, nausea: pre-eclampsia


    Premenstrual syndrome

    Premenstrual Syndrome

    • Definition:

      • Signs and symptoms that interfere with function during luteal phase of menstrual cycle (between ovulation and menstruation)


    Premenstrual syndrome cont

    Premenstrual Syndrome, cont.

    • Etiology:

      • Hormonal hypersensitivity:

        • Just before period starts estrogen and progesterone levels drop

        • Estrogen dominance puts balance off even more

      • Nutritional deficiencies:

        • Calcium, B6, some essential fatty acids


    Premenstrual syndrome cont1

    Premenstrual Syndrome, cont.

    • Neurotransmitter imbalance:

      • Serotonin, opioid peptides (which influence mood) are low

    • Other factors:

      • Genetic predisposition, cultural expectations, general stress, anxiety


    Premenstrual syndrome cont2

    Premenstrual Syndrome, cont.

    • Signs and symptoms:

      150+ identified; sometimes separated into physical versus emotional

      • Physical symptoms:

        • Bloating, breast tenderness, acne, salt and sugar cravings (along with binge eating), headaches, backaches, insomnia, and digestive upset: diarrhea and/or constipation

        • More rarely: sinus problems, heart palpitations, dizziness, asthma, seizures


    Premenstrual syndrome cont3

    Premenstrual Syndrome, cont.

    • Emotional symptoms:

      • Confusion, depression, anxiety, panic attacks, mood swings, general irritability

      • Premenstrual dysphoric disorder (PMDD) = PMS plus depression/anxiety


    Premenstrual syndrome cont4

    Premenstrual Syndrome, cont.

    • Treatment:

      • Treated by symptom

      • Some medications

      • Get good nutrition, good sleep

      • Alternative recommendations:

        • Low-fat vegetarian diet, avoid salt, sugar, caffeine, alcohol

        • Borage, evening primrose, black cohosh, dong quai


    Premenstrual syndrome cont5

    Premenstrual Syndrome, cont.

    • Medications

      • Hormone supplements to suppress ovulation

      • Diuretics

      • Antidepressants, anti-anxiety meds

      • Herbal remedies


    Premenstrual syndrome cont6

    Premenstrual Syndrome, cont.

    • Massage

      • Risks: Massage has no specific risks for PMS.

      • Benefits: Massage may reduce pain, depression and anxiety, and help with some of the physical symptoms of PMS.


    Sexually transmitted infections

    Sexually Transmitted Infections

    • Definition:

      • Contagious conditions spread through intimate contact

      • Usually vaginal, oral, anal sex

      • Can be mother to fetus through blood, direct contact, breast milk


    Sexually transmitted infections cont

    Sexually Transmitted Infections, cont.

    • Etiology: what happens?

      • Most are spread through sexual activity with an infected partner

      • Some from mother to fetus

      • Transmission can be prevented

        • Barrier forms of birth control provide protection from some but not all

        • Most reliable prevention is to practice abstinence or to limit relations to a non-infected partner


    Sexually transmitted diseases cont

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Bacterial vaginosis:

      • Imbalance in vaginal environment

      • Increased risk of contracting, spreading other STIs

      • Increased risk of pelvic inflammatory disease (PID), infertility

      • Treated with antibiotics


    Sexually transmitted diseases cont1

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Chlamydia:

      • Chlamydia trachomatis invade columnar mucus-producing cells

        • Repro tract, mouth, throat, anus

      • Can be silent, lead to PID, infertility, ectopic pregnancy

        • Risks to baby of infected mother

      • Treatable with antibiotics; partners must also be treated


    Sexually transmitted diseases cont2

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Gonorrhea:

      • Neisseria gonorrhoeae affects mucous membranes of throat, vagina, rectum

      • Can travel to affect joints

      • Often silent, esp in women; in men: burning with urination, penile discharge, orchitis

      • Treatable with antibiotics, although resistance is a growing problem


    Sexually transmitted diseases cont3

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Syphilis:

      • Treponema pallidum spread through sexual contact, mother to fetus

      • Can invade joints, CNS, blood vessels

      • Moves in stages; communicable in stage 1 and 2

        • 1. Primary s: chancre appears (can be inside vaginal canal)

        • 2. Secondary s: rash of brownish sores, soles and palms (can be elsewhere)

        • 3. Tertiary s.: bacteria invades other systems, including the CNS

    • Treatable with penicillin


    Sexually transmitted diseases cont4

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Nongonococcal urethritis (NGU):

      • Bacterial infection of urinary tract

      • Can be chlamydia, other agents

      • Can be STI or related to catheter use, other problems

      • Treatable with antibiotics


    Sexually transmitted diseases cont5

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Trichomoniasis:

      • Protozoan parasite

      • Causes vaginal discharge, pain, itching, increased risk of HIV transmission

      • Treatable with antibiotics


    Sexually transmitted diseases cont6

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Molluscum contagiosum virus (MCV):

      • Usually benign warts

      • In adults it is usually an STI

        • Thighs, buttocks, external genitalia, anus

      • Growths are removed with cryotherapy or topical chemicals


    Sexually transmitted diseases cont7

    Sexually Transmitted Diseases, cont.

    Types of STIs:

    • Genital warts

      • Condylomata acuminata

      • In women, they grow on the vulva, vaginal walls, perineum, cervix;

      • In men they grow on penis, scrotum, anus

      • In both: mouth, throat

      • High transmission rate

      • Some associated with cancer risk

      • Can be removed, not with OTC meds for common warts


    Sexually transmitted diseases cont8

    Sexually Transmitted Diseases, cont.

    • Massage

      • Risks: Most STIs are spread through sexual contact, so communicability to MTs is not an issue, although there are some exceptions where skin-to-skin contact with lesion is possible. Not all lesions are confined to genitalia.

      • Benefits: Clients who are under treatment or who have fully recovered from STIs are good candidates for massage.


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