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Reproductive System Diseases and Disorders 397
■ Prevention. Avoid intimate contact with infected
individuals.
Trichomoniasis
■ Description. Trichomoniasis is a fairly common STD.
It affects women more than men, and older women
are more likely than younger women to be infected.
Approximately 3% of women ages 14-49 in the United
States are infected (Centers for Disease Control and
Prevention, 2021).
■ Etiology. Trichomoniasis is caused by a protozoan,
Trichomonas vaginalis.
■ Symptoms. Most infected individuals are asymp
tomatic, resulting in extensive spread of the infec
tion. If symptoms occur in the male, they commonly
include urethritis, epididymitis, and prostatitis. Infected
females, when symptomatic, have itching and burning
of the genital area and a green, frothy vaginal drainage.
■ Diagnosis. Diagnosis is made on the basis of micro
scopic examination of vaginal or penile secretions
revealing the presence of the causative organism.
■ Treatment. Treatment with an anti-parasitic medica
tion is usually very effective.
■ Prevention. Avoid intimate contact with infected
individuals.
Genital Warts
■ Description. Genital warts, or venereal warts, are one
of the most common types of STDs. As the names sug
gest, these warts affect the warm, moist tissues of the
genital area.
■ Etiology. Genital warts are due to infection with
HPV (Figure 17-33). Mode of transmission is usu
ally through sexual contact, but autoinoculation, or
self-inoculation, is also possible. These viral lesions
commonly appear 1 to 6 months after exposure to an
infected individual.
Figure 17-33 Genital warts.
Healthy Highlight
Some Facts
About Human
Papillomavirus
(HPV)
T
he human papillomavirus is the most common sexually transmitted disease in the
United States. It is spread through oral, anal, or vaginal sex. Although some types
can be prevented by vaccine, it cannot be cured, but it can be treated. The chronic form
can continue throughout one’s lifetime. Anyone who is sexually active can get HPV.
Some experts report that 80% of all sexually active individuals will have HPV at some
time, but many will not have untoward symptoms. An HPV infection can go away on
its own. Some types cause genital warts, and other types cause cancer. HPV infections
are now the cause of most oropharyngeal cancers. Many times the infected person has
no symptoms so it can be passed on to others unknowingly. Some strains of HPV are
not harmful, but there are many strains that produce problems from mild to severe in
the infected person. A few HPV infections do not produce symptoms for many years.
Getting vaccinated is the best preventive strategy for HPV. All boys and girls ages
11-12 should be vaccinated but it can be done as early as age 9. The latest recommen
dation from the CDC is for a “catch-up HPV vaccination that should be given to all
persons through age 26 who have not been fully immunized against HPV. For adults
age 27-45 the benefit for vaccination is minimal. There are no approved tests for HPV,
but there are tests to screen for cervical cancer.
Source: Centers for Disease Control and Prevention (CDC) (2020)
398 Chapter 17
■ Symptoms. Warts can be asymptomatic or cause ten
derness in the affected area. The amount of discomfort
is related to the size, location, and number of warts
present. Size of genital warts might be very small, about
the size of a ballpoint pen tip, or they might multiply
into large clusters as wide as 3 or 4 inches in diameter.
They can appear as small, flesh-colored bumps or have
a stacked-up, cauliflower-like appearance.
In the male, warts are usually located on the head
of the penis but also can be found along the penile
shaft and around the anus. In the female, these lesions
commonly appear around the vaginal opening and can
spread to the perianal area.
Pregnancy tends to cause the warts to grow more
rapidly and even reach a point of occluding the vagi
nal canal, thus making a C-section necessary. Cervical
cancer is also more common in females with genital
warts.
■ Diagnosis. Diagnosis is made on the basis of visual
ization of the warts and biopsy to rule out carcinoma.
■ Treatment. Treatment is commonly surgical or chem
ical removal of the infected tissue. Surgical removal
does not mean cure because recurrence of genital warts
is common.
■ Prevention. Avoid intimate contact with infected
individuals.
Sexual Dysfunction
A brief description of the most common sexual dysfunc
tions is provided in this section. Sexual dysfunction,
whether due to physical or psychological conditions,
can limit the ability of the individual to reproduce and
to develop a close, nurturing sexual relationship with a
significant other.
The human sexual cycle progresses through stages
of arousal, sexual intercourse, and climax and ends
with feelings of pleasure and relaxation. Any disorder
that interrupts this cycle can be considered a sexual
dysfunction.
Diagnosis of sexual dysfunction depends on gen
eral examination including a complete medical history,
a sexual history including details of the dysfunction,
a physical examination, and laboratory testing as
indicated.
Psychological disorders leading to sexual dysfunc
tion might need treatment by psychological counselors.
Success in counseling often depends on both partners
participating and maintaining a patient and sensitive
attitude toward each other.
Dyspareunia
■ Description. Dyspareunia is a condition of experi
encing pain or discomfort with sexual intercourse. It
can affect both males and females, although it is more
common in women. Dyspareunia is not considered a
disease but, rather, a symptom of a psychological or
physical disorder.
■ Etiology. Dyspareunia for both sexes can be related to
physical or psychological conditions. In females, com
mon physical conditions causing dyspareunia include
an intact hymen, vaginal deformity, insufficient lubri
cation, sensitivity to spermicide, presence of an STD,
bladder infection, pelvic inflammatory disease, and
endometriosis.
In the male, common physical conditions causing
dyspareunia include penile deformity, presence of an
STD, phimosis (figh-MOH-sis, an abnormally tight
foreskin) (Figure 17-34), prostatitis, and epididymitis.
Psychological conditions in both sexes that might
lead to dyspareunia include a history of past sexual
abuse, anxiety, guilt, and fear of pregnancy.
■ Symptoms. The pain can be mild or severe and appear
in the pelvis, genitals, or low back. Females might feel
pain specifically in the clitoris, labia, or vagina.
■ Diagnosis. Diagnosis is made on the basis of general
examination including a description of the type of pain
and the time of occurrence.
■ Treatment. Treatment depends on cause and can
include instructions on extended foreplay, use of lubri
cating jelly, and manual stretching of the vaginal open
ing prior to intercourse. Infections need to be treated
Figure 17-34 Phimosis.
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Reproductive System Diseases and Disorders 399
appropriately. Surgery might be needed to correct
deformities, remove tumors, and treat endometriosis.
Psychological conditions might need to be addressed
with counseling.
■ Prevention. Some dyspareunia, like that caused by
sexual trauma or abuse, is not preventable. Activities
that reduce risk for the female include avoiding vaginal
yeast infections, STDs, bladder infections, and sex on
days near menstruation due to increased tenderness.
Female Arousal-Orgasmic Dysfunction
■ Description. Female arousal-orgasmic dysfunc
tion, also called frigidity, is the lack of sexual desire or
responsiveness in a female.
■ Etiology. Frigidity is seldom caused by physical
conditions, but neurologic disturbances such as those
experienced with diabetes mellitus and multiple scle
rosis can produce this condition. More commonly,
frigidity is due to psychological conditions, including
stress, depression, fatigue, past sexual abuse, guilt,
and anxiety.
■ Symptoms. Common signs include the inability to
produce and maintain adequate vaginal lubrication and
vasocongestive response indicative of sexual arousal.
The primary symptom is an inability to reach orgasm.
■ Diagnosis. Diagnosis is based on the history or com
plaint of an inability to reach orgasm.
■ Treatment. A physical examination to rule out phys
ical disorders or disease is the first step in treatment.
Psychological disorders might require the couple to visit
a qualified specialist in sex therapy to identify and treat
the cause.
■ Prevention. Education on healthy sex attitudes and
sexual stimulation techniques will minimize problems.
Couples who are able to communicate feelings and sex
ual needs effectively to one another are most likely to
prevent this disorder.
Impotence
■ Description. Impotence, more recently called erectile
dysfunction (ED), is the inability of the male to achieve
or maintain an erection sufficient to complete sexual
intercourse. Impotence does not affect fertility or the
ability to produce offspring. It is a common disorder,
affecting approximately half of all men over 40 years
of age.
Interestingly, recent research has shown that ED
might be the first indicator of cardiovascular disease,
making it a helpful early warning for impending heart
attacks, stroke, and death. There is a strong relationship
between ED and high cholesterol, high blood pressure,
and angina.
■ Etiology. ED is primarily caused by vascular insuf
ficiency in the penis. Common causes are physical
problems caused by endocrine disorders affecting
Complementary and Alternative Therapy
Alternative Ways to
Boost Testosterone
Levels
T
estosterone is a hormone found in both men and women. It can control sex drive,
promote muscle mass development, and increase energy. The level of testosterone
in the body decreases as one ages and for some men, this affects the quality of life. Low
testosterone levels can affect the skin, bones, heart, fat metabolism, erectile function,
and is a risk factor for early death. Testosterone levels decrease about 1% per year start
ing at age 30-40. Some alternative methods for boosting testosterone levels include
eating a diet focused on fresh vegetables and healthy fats such as the Mediterranean diet
plan. Along with the fruits and vegetables, seafood, poultry, beans, olive oil, and nuts
with limitations on red meats are the basis for this diet. Another strategy that is rec
ommended is increase the time spent exercising, especially in aerobic exercises. Some
herbal products have been recommended to boost testosterone levels such as ashwa-
gandha extract or Malaysian ginseng (Eurycoma longifolia). Yohimbe and puncturevine
have also been used to treat low testosterone levels. Caution is recommended when
using herbal products because a standard dosage has not been established.
Source: Stengler (2020)
400 Chapter 17
testosterone levels; drug and alcohol abuse; neurologic
disorders; spinal cord injury; urologic disorders; exten
sive pelvic surgery such as radical prostatectomy; diabe
tes mellitus; arteriosclerosis, which reduces blood flow;
and certain medications such as diuretics, antihyperten
sives, and vasodilators.
Impotence is also caused by psychological fac
tors, but these are not as common as physical prob
lems. Psychological factors include depression, stress,
guilt, sexual anxiety, sexual trauma, and disagreeable
relationships.
■ Symptoms. The only symptom is the inability of the
male to achieve or maintain an erection sufficient to
complete sexual intercourse.
■ Diagnosis. Diagnosis is made on the basis of a med
ical history, sexual history, and physical examination
including review of medications and laboratory testing.
■ Treatment. Treatment is based on diagnosis and
might be as simple as a change in current medications.
Treatment may also include addition of an erectile
dysfunction medication. Or treatment may be more
involved and include psychological counseling and
behavior modification. Systemically untreatable phys
ical disorders can be treated with implantation of an
inflatable penile implant. Erections also can be achieved
artificially by use of external vacuum devices and injec
tions into the penis with vasodilator medications.
■ Prevention. In some cases, ED is not preventable.
However, preventive activities are those that control car
diovascular disease and diabetes, including not smok
ing, eating a healthy diet, maintaining a healthy body
weight, and exercising.
Premature Ejaculation
■ Description. Premature ejaculation, also known as
rapid ejaculation or rapid climax, is expulsion of semi
nal fluid during foreplay, prior to complete erection or
immediately after the beginning of sexual intercourse.
Some researchers define premature ejaculation with
time limits such as within two minutes of penetration,
whereas others do not use time and simply state that
premature ejaculation occurs any time a lack of con
trol interferes with emotional and sexual well-being of
both partners. This disorder is the most common sexual
problem in males, especially in young males.
■ Etiology. The cause of this disorder is usually psy
chological rather than physical in nature. Common psy
chological causes include, but are not limited to, guilt,
anxiety, and negative feelings or dislike for the sexual
partner. Physical causes are rare but can include neuro
logic disorders, prostatitis, and urethritis.
■ Symptoms. The only symptom is premature
ejaculation.
■ Diagnosis. Diagnosis is made on the basis of a med
ical history, sexual history, and a physical examination.
Clinicians will consider factors that might lead to pre
mature ejaculation such as duration of excitement, age
of client, and frequency of sexual activity. Although the
client’s complaint of premature ejaculation might not
meet all definitions, many clinicians diagnose prema
ture ejaculation based on the client’s feeling that the
lack of control interferes with emotional and sexual
well-being.
■ Treatment. Treatment is based on the diagnosis and
can include sex therapy and instruction for both part
ners in techniques that help delay ejaculation. Control
of male stimulation is important during lovemaking to
allow the female time to reach orgasm and allow pen
etration into the vagina before ejaculation occurs. It
is important for both partners to understand that this
condition is reversible with treatment. In some cases,
various medications might help slow arousal and thus
delay ejaculation.
■ Prevention. Premature ejaculation can be prevented
by masturbating and achieving orgasm several hours
prior to intercourse.
Infertility
■ Description. Infertility is the inability of a couple to
achieve pregnancy after one year of unprotected sexual
intercourse.
■ Etiology. Infertility can be due to male or female dis
orders or a combination of both. It was once thought
that female disorders were the primary cause of infer
tility, but currently, male, female, and combination dis
orders are fairly equal in occurrence. Approximately
12% of females in the United States have difficulty get
ting pregnant or carrying a pregnancy to term (CDC,
2019).
Common causes of infertility in the female include:
■ Presence of STD
■ Hormonal disorders
■ Abnormality of reproductive organs
■ Endometriosis
■ Scarring from PID or blockage of fallopian tubes
■ Development of vaginal antibodies that kill sperm
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Reproductive System Diseases and Disorders 401
Common causes of infertility in the male include:
■ Presence of STD
■ Chronic genitourinary infection or blockage of
the tract
■ Structural abnormalities
■ Hormone imbalances
■ Diagnosis. Diagnostic testing for the female can
include a complete medical and gynecologic history
and examination. Hormone levels are determined by
blood testing. Ovary function and ovulation can be
evaluated by recording daily basal body temperatures.
The structure of the uterus and patency (openness) of
the fallopian tubes can be determined by a hysterosal-
pingogram. Endometriosis and other pelvic conditions
can be assessed by visualization during a laparoscopy.
Diagnostic testing for the male can include a com
plete medical history and physical examination with
semen analysis. Blood testing for endocrine or hormone
imbalances can be beneficial. A urinalysis might assist
in determination of the presence of infection.
■ Treatment. Treatment is based on cause with the
common goal of achieving pregnancy. Treatment can
include surgery to correct anatomical abnormalities
or remove blockages or medication therapy to correct
endocrine or hormone imbalances and treat infection.
Fertility drugs, artificial insemination with husband
sperm (AIH), artificial insemination with donor semen
(AID), and in vitro fertilization (IVF) can be beneficial
in complicated cases.
■ Prevention. Many cases of infertility cannot be
prevented. The following activities, however, might
improve the chance of pregnancy:
■ Do not smoke. Smoking reduces sperm count and
increases miscarriage.
■ Do not drink. Alcohol is toxic to sperm, disrupts hor
mone balances, and increases risk of miscarriage.
■ Eat a healthy diet. Females should increase folic acid
intake through dietary selection or supplements.
■ Avoid excessive exercise. Excessive exercise can
cause low sperm counts in men due to increased heat
around the testicles and can lead to menstrual disor
ders in the female.
■ Check with your physician to ensure that any medi
cations, including herbal remedies, are not affecting
fertility.
■ Avoid STDs. These diseases can damage the repro
ductive system and cause infertility.
■ Maintain proper body weight to reduce the possibil
ity of hormone imbalance.
Trauma
Rape
Rape is sexual intercourse (vaginal or anal) without
consent or against the will of the involved individual.
Victims of rape can be any age and of either sex, but it
is primarily an act violating females. The crime of rape
occurs at an alarming rate, but many cases are unre
ported because the victim often feels embarrassed,
ashamed, and guilty. Rape is a crime of violence more
than of sexual passion. An acquaintance, date, spouse,
or an unknown individual can carry out rape. Recent
publicity has been devoted to date-rape drugs or
medication that is placed in a drink and renders the
individual unconscious to the point of becoming an
easy victim.
Signs and symptoms of rape can include, but are
not limited to, torn clothing, disheveled appearance,
bruises, and lacerations around the mouth, breasts, gen
itals, and rectum. Semen might be found on the inner
thighs, in the vaginal cavity, and around the genital
and rectal area if the victim has not bathed, showered,
or douched after the act.
Diagnosis is made on the basis of history and phys
ical examination. Special attention should be given
to the emotional condition of the victim. Emergency
guidelines are aimed at protecting the victim against
disease and pregnancy and collecting legal evidence if
the victim decides to press charges against the perpetra
tor. Gathering of criminal evidence is best if the indi
vidual has not bathed, showered, or douched, although,
often, because the victim feels dirty and violated, these
cleansing activities are performed immediately and
prior to reporting the crime.
Sex crime evidence gathering can involve collecting
samples of clothing, hair, scrapings from under finger
nails, pubic hair, and semen, and taking pictures of areas
of trauma. Sexual assault nurse examiners (SANEs) are
often called in to collect the evidence and counsel the
victim. These nurses are educated and certified in the
forensic specialty of sexual assault.
Recovery from rape is difficult. Crisis intervention
counselors are needed, and follow-up is very import
ant. Individuals involved with the victim need to be
nonjudgmental, affirm that the individual is a victim,
and assure the individual that this act of violence was
not deserved.
402 Chapter 17
Rare Diseases
Vaginal Cancer
Vaginal cancer is a rare form of cancer that occurs in
the daughters of mothers who used the synthetic hor
mone diethylstilbestrol (DES) to prevent spontaneous
abortion. Symptoms include leukorrhea and bloody
vaginal drainage. Diagnosis is made on the basis of a
Pap smear and biopsy. Treatment usually consists of
surgery, chemotherapy, and radiation.
Puerperal Sepsis
Puerperal (pyou-ER-pier-al; after childbirth) sepsis is
an infection of the endometrium, usually with Strepto
coccus bacteria, following childbirth. Other names for
puerperal sepsis include puerperal fever and childbed
fever. In the 1800s, the cause and spread of this infec
tion were unknown, and it was common for puerperal
sepsis to sweep through maternity wards and kill most
of the new mothers.
Symptoms of puerperal sepsis include chills, fever,
and abdominal and pelvic pain. The modern use of asep
tic technique has made this infection uncommon in most
of the world except for special instances when asepsis is
not properly carried out. Without prompt and effective
antibiotic treatment, this condition is often fatal.
Hydatidiform Mole
Hydatidiform mole is the formation of grape-like cysts
in the uterus that fill the uterus and give indications of
pregnancy (Figure 17-35). There is no fetus, although
Figure 17-35 Hydatidiform mole.
human chorionic gonadotropin levels get abnormally
high. The cause of hydatidiform mole may be a genetic
abnormality.
Toward the end of the third month, the affected
individual might have symptoms of bright red vaginal
bleeding, nausea, and vomiting. Diagnosis is made on
the basis of symptoms and no fetal heart tones. Treat
ment is a surgical D&C to remove the abnormal tis
sue. Because individuals affected with hydatidiform
mole are at higher risk for a certain type of carcinoma
(choriocarcinoma), the individual should have frequent
follow-up examinations.
Effects of Aging on the System
As the female ages, changes in the reproductive system
might seem more distinct than in the male. The pubic
hair becomes thin and gray, and the external structures
become less elastic and appear more wrinkled and sag
ging. The internal organs shrink in size, vaginal secre
tions diminish, and there is less elasticity of the vagina.
Although sexual stimulation is still important, as in the
male, it can take increased stimulation and the aid of a
vaginal lubricant to enhance sexual intercourse. Using
vaginal hormone cream might be recommended to
reduce the dryness and improve the mucosal tone of
the vagina. Some cancers of the female reproductive
system, such as cancer of the uterus and ovaries, are
more common in the older adult. Women over age 65
should be screened regularly for these disorders.
As the female enters menopause, the breasts also
begin to atrophy and become more relaxed with a
reduction in size. Women over age 50 are at increased
risk for breast cancer. They should have yearly clinical
exams as well as a mammogram.
As the male ages, production of testosterone and
the formation of sperm decrease. The size of the testes
also can diminish, but the functional ability of the male
for sexual intercourse and reproduction continues.
There is some loss of elasticity of the penis and scrotum,
causing them to appear more wrinkled and sagging, and
some thinning and graying of the pubic hair. Although
the male is still able to have an erection, sometimes it
takes greater stimulation to achieve this. The ejacula
tion amount also might be diminished. The prostate
slowly enlarges in most men, beginning around age 50.
This prostatic hypertrophy can cause problems with
urination. The prostate is also a common site for cancer
development in the older male. Routine rectal examina
tion of the prostate and laboratory levels of PSA should
be completed by all adult males over age 50.
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Reproductive System Diseases and Disorders 403
Summary
T
he reproductive system is a highly complex, multifunction system. It has important physiologic functions but is also
very important in social relationships between individuals. Both procreation and the relationship and intercourse
aspects of the system can be altered when disorders develop in the system. Common disorders of the system in the female
include infections, inflammation, infertility, fibrocystic disease, pregnancy abnormalities, STDs, and cancer. In the male,
common disorders include infections, STDs, impotence, and cancer. Signs and symptoms of reproductive disorders in
both sexes can include pain, discharge, lesions, and abnormal enlargement of tissue. Changes occurring in the system
in the older adult often affect the individual’s ability to perform sexual intercourse satisfactorily. Other changes include
decrease in hormone secretion, loss of elasticity of tissues, diminished lubricating secretions, and increased risk for
cancer development.
Review Questions
Short Answer
1. What are some of the common reproductive system disorders in the:
a. Female?
b. Male?
2. What are the common signs and symptoms of reproductive system disorders in the:
a. Female?
b. Male?
3. Describe the typical course and management of common reproductive disorders in the:
a. Female.
b. Male.
True or False
4. T F Endometriosis is an ectopic occurrence of endometrial tissue.
5. T F A hernia of the bladder into the vagina is called an urethrocele.
6. T F Vaginal infections are very uncommon.
7. T F TSS is characterized by high fever.
8. T F Intermittent painless bleeding is the most common symptom of cervical cancer.
9. T F Leiomyoma is a metastatic tumor of the uterus.
10. T F A pap smear should be performed routinely as a preventive measure for cervical cancer.
11. T F PMS is probably caused by a hormone imbalance.
12. T F Phimosis is a narrowed opening of the prepuce.
404 Chapter 17
13. T F Epididymitis is usually caused by an infection from the bladder.
14. T F STDs are not common in the male reproductive system.
15. T F The best preventive measure for testicular cancer is the monthly self-examination.
16. T F One of the symptoms of BPH is urinary retention.
17. T F An orchiectomy is the removal of the prostate gland.
18. T F The PSA test is a screening test for cancer of the prostate.
19. T F The testosterone hormone is secreted by the prostate gland.
20. T F There is some loss of elasticity of the penis and scrotum during the aging process.
21. T F Increased stimulation and the aid of a vaginal lubricant may be needed to enhance sexual intercourse
between the older adult male and female.
Case Studies
■ Charles Roberts is a 63-year-old man who has been having difficulty urinating. He states he often gets up
twice a night to void and has some difficulty getting the stream started. Is this a problem? He is basically quite
healthy and does not have a family physician. He asks for your advice about this. What should you tell Mr. Rob
erts? Are there other questions you should ask him before giving him any information? How could you explain
the effects of aging to him? Should he make an appointment with a physician?
■ Janice Simmonds is a 53-year-old first-grade school teacher. At the present time, she is single but dates on
a fairly regular basis. She has been an active person all of her life. Janice has played on a tennis team for 20
years and works out at the local athletic club. She considers herself to be in great shape for her age and has
never been concerned about any possible health problems. Her past laboratory history includes an average
routine cholesterol level, normal blood sugar, and normal blood pressure. Her mother is still living and well, but
her aunt died at age 69 of breast cancer. Her father is also living and well. Janice does not consider herself at
risk for any major health problems. Do you agree with her? Would you consider her at risk for breast cancer? If
so, what risk factors can you identify? Is she also at risk for cervical cancer? What routine clinical examinations
should she have based on her age and gender?
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18
Integumentary
System Diseases
and Disorders
Key Terms
Abrasion (p. 434)
Alopecia (p. 433)
Avulsion (p. 435)
Blunt trauma (p. 434)
Comedones (p. 421)
Contusion (p. 434)
Erythema (p. 407)
Exacerbation (p. 409)
Frostbite (p. 438)
Hirsutism (p. 433)
Incision (p. 435)
Keratin (p. 407)
Laceration (p. 435)
Lesion (p. 407)
Paronychia (p. 433)
Pilonidal cyst (p. 422)
Pruritus (p. 407)
Pustules (p. 412)
Sebum (p. 406)
Ulcer (p. 414)
Vesicles (p. 410)
Wheals (p. 424)
Xerosis (p. 442)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Define the terminology common to the integumentary
system and the disorders of the system.
2. Discuss the basic anatomy and physiology of the
integumentary system.
3. Identify the important signs and symptoms
associated with common integumentary system
disorders.
5. Identify common disorders of the integumentary
system.
6. Describe the typical course and management of
the common integumentary system disorders.
7. Describe the effects of aging on the integumentary
system and the common disorders associated with
aging of the system.
4. Describe the common diagnostics used to determine
the type and cause of integumentary system disorders.
Overview
T
he integumentary system is composed of all the skin and its layers. The skin is also known as the largest
organ of the body. It makes up about 15% of the total body weight. The skin is the first line of defense
against disease. Many diseases of the integumentary system are the result of other body or system disorders.
For instance, measles is a viral disease of the respiratory system, but it is characterized by the maculopapular
rash seen on the skin. Skin disorders such as psoriasis are traumatic to the individual because of the obvious
lesions and the effect it has on body image. Skin disorders range from mild to severe and acute to chronic. ■
405
406 Chapter 1 8
Anatomy and Physiology
The skin is the largest organ of the body. It is a large,
durable, and pliable organ and is the first line of pro
tection for the body against invading organisms. The
skin also provides a sense of touch, heat and cold, and
pain and helps stabilize temperature and fluid and elec
trolyte balance. The skin is composed of two layers: the
epidermis and the dermis, with a subcutaneous (hypo
dermis) level (Figure 18-1).
the others are melanocytes that produce melanin, the
pigment that darkens the skin and gives it color. The
dermis is the deeper layer, consisting of connective tis
sue and a variety of cell types. Blood vessels traverse the
dermal layer to provide nutrients and oxygen, regulate
heat, and remove waste products. Nerves also form a
network in the dermis to provide the sensations of heat,
cold, pain, and touch.
Consider This...
Consider This...
1
There are approximately 45 miles of nerves
in the skin of the average human.
The average person’s skin weighs about 8
pounds and has the surface area of approx
imately 25 square feet.
The epidermis, or outer layer, is composed of five
layers: the stratum corneum, stratum lucidum, stratum
granulosum, stratum spinosum, and stratum basale.
The cells of the epidermis are called stratified squa
mous epithelial cells. Most of these are keratinocytes;
The subcutaneous layer is composed of connective
tissue containing fat cells and blood vessels and protects
the body against cold. The amount of fat varies consid
erably with the individual.
Embedded in the dermis and extending to the
epidermis are the sebaceous, apocrine, and eccrine
sweat glands. The sebaceous glands produce oil called
sebum. The apocrine sweat glands are located in the
underarms (axillae), around the nipples of the breasts,
Dermal papilla
Arrector pili muscle
Hair shaft
Sensory nerve
ending for touch
Sweat pore
Epidermis
Dermis
Subcutaneous
fatty tissue
(hypodermis)
Sweat gland
(eccrine)
Artery
Vein /
Nerve
Hair follicle
Sebaceous (oil) gland
Papilla of hair
Figure 18-1 The structures of the skin.
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