Chapter 28
The Reproductive Systems
Sexual reproduction produces new individuals
germ cells called gametes (sperm & 2nd oocyte)
fertilization produces one cell with one set of chromosomes
from each parent
Gonads produce gametes & secrete sex hormones
Reproductive systems
gonads, ducts, glands & supporting structures
Gynecology is study of female reproductive system
Urology is study of urinary system & male reproductive
system
Chromosomes in Somatic Cells & Gametes
Somatic cells (diploid cells)
23 pairs of chromosomes for a total of 46
each pair is homologous since contain similar genes in same
order
one member of each pair is from each parent
22 autosomes & 1 pair of sex
chromosomes
sex chromosomes are either X or Y
females have two X chromosomes
males have an X and a smaller Y chromosome
Gametes (haploid cells)
single set of chromosomes for a total of 23
produced by special type of division: meiosis
Meiosis I -- Prophase I
Chromosomes become visible, mitotic spindle appears, nuclear
membrane & nucleoli disappear
Meiosis I -- Metaphase I, Anaphase I & Telophase I
In metaphase I, homologous pairs of chromosomes line up
along metaphase plate with attached microtubules
In anaphase I, each set of homologous chromatids
held together by a centromere are pulled to opposite
ends of the dividing cell
Telophase I and cytokinesis are similar to mitotic division
Result is 2 cells with haploid number of chromosomes
Meiosis II
Consists of 4 phases : prophase II, metaphase II, anaphase
II and telophase II
Similar steps in this cellular process as in mitosis
centromeres split
sister chromatids separate and
move toward opposite poles of the cell
Each of the daughter cells produced by meiosis I divides
during meiosis II and the net result is 4 genetically unique haploid cells or
gametes.
Male Reproductive System
Gonads, ducts, sex glands & supporting structures
Semen contains sperm plus glandular secretions
Scrotum
Sac of loose skin, fascia & smooth muscle divided into
two pouches by septum
Skin contains dartos muscle causes
wrinkling
Temperature regulation of testes
sperm survival requires 3 degrees lower temperature than
core body temperature
cremaster muscle in spermatic cord
elevates testes on exposure to cold & during arousal
warmth reverses the process
Scrotal Sacs, Dartos & Cremaster Mm
Testes
Paired oval glands measuring 2 in. by 1in.
Surrounded by dense white capsule called tunica albuginea
septa form 200 - 300 compartments called lobules
Each is filled with 2 or 3 seminiferous
tubules where sperm are formed
Descent of Testes
Develop near kidney on posterior abdominal wall
Descends into scrotum by passing through inguinal canal
during 7th month of fetal development
Tunica Vaginalis
Piece of peritoneum that descended with testes into scrotal
sac.
Allows for easier movement of testes within scrotum
Cryptorchidism
Testes do not descend into the scrotum
3% of full-term & 30% of premature infants
Untreated bilateral cryptorchidism
results in sterility & a greater risk of testicular cancer
Descend spontaneously 80% of time during the first year of
life
surgical treatment necessary before 18 months
Formation of Sperm
Location of Stages of Sperm Formation
Seminiferous tubules contain
all stages of sperm development: spermatogonia,
primary spermatocyte, secondary spermatocyte,
spermatid, spermatozoa
Leydig cells in between tubules
secrete testosterone
Spermatogenesis
Spermatogonium (stem cells) give
rise to 2 daughter cells by mitosis
One daughter cell kept in reserve -- other becomes primary spermatocyte
Primary spermatocyte goes through
meiosis I
DNA replication
tetrad formation
crossing over
Spermatogenesis
Secondary spermatocytes are formed
23 chromosomes of which each is 2 chromatids
joined by centromere
goes through meiosis II
4 spermatids are formed
each is haploid & unique
accounts for synchronized release of sperm that are 50% X
chromosome & 50% Y chromosome
Sperm Morphology
Adapted for reaching & penetrating a secondary oocyte
Head contains DNA & acrosome (hyaluronidase and proteinase
enzymes)
Midpiece contains mitochondria to
form ATP
Tail is flagellum used for locomotion
Hormonal Control of Spermatogenesis
Puberty
hypothalamus
increases its stimulation of anterior pituitary with releasing hormones
anterior pituitary increases secretion LH & FSH
LH stimulates Leydig cells to
secrete testosterone
an enzyme in prostate & seminal vesicles converts
testosterone into dihydrotestosterone (DHT-more
potent)
FSH stimulates spermatogenesis
testosterone stimulates final steps spermatogenesis
Hormonal Effects of Testosterone
Testosterone & DHT bind to receptors in cell nucleus
& change genetic activity
Prenatal effect is born a male
At puberty, final development of 2nd sexual characteristics
and adult reproductive system
sexual behavior & libido
male metabolism (bone & muscle mass heavier)
deepening of the voice
Control of Testosterone Production
Negative feedback system controls blood levels of
testosterone
Receptors in hypothalamus detect increase in blood level
Secretion of GnRH slowed
Anterior pituitary (FSH & LH hormones) slowed
Leydig cells of testes slowed
Blood level returns normal
Pathway of Sperm Flow through the Ducts of the Testis
Seminiferous tubules
Straight tubules
Rete testis
Efferent ducts
Ductus epididymis
Ductus (vas) deferens
Epididymis
Comma-shaped organ, 1.5in long along posterior border of
each testis
Head, body and tail region
Tail region continues as ductus
deferens
Ductus (Vas) Deferens
Pathway of 18 inch muscular tube
ascends along posterior border of epididymis
passes up through spermatic cord and inguinal ligament
reaches posterior surface of urinary bladder
empties into prostatic urethra
with seminal vesicle
Lined with pseudostratified
columnar epithelium & covered with heavy coating of muscle
convey sperm along through peristaltic contractions
stored sperm remain viable for several months
Spermatic Cord
All structures passing to and from the testes
testicular artery
autonomic nerves
lymphatic vessels
ductus (vas) deferens
cremaster muscle
Vasectomy
Male sterilization
Vas deferens cut & tied off
Sperm production continues
Sperm degenerate
100% effective
40% reversible
Inguinal Canal & Inguinal Hernias
Inguinal canal is 2 inch long tunnel passing through the
3 muscles of the anterior abdominal wall -- weakens wall
originates at deep inguinal ring and ends at superficial
ring
Indirect hernia -- loop of intestine protruding through deep
ring
Direct hernia -- loop of intestine pushes through posterior
wall of inguinal canal
More common in males
Ejaculatory Ducts
Formed from duct of seminal vesicle & ampulla of vas deferens
About 1 inch long
Adds fluid to prostatic urethra
just before ejaculation
Urethra
8 inch long passageway
for urine & semen
Prostatic urethra (1 inch long)
Membranous urethra (passes through UG diaphragm )
Penile (spongy) urethra (through corpus spongiosum)
Accessory Sex Glands
Seminal Vesicles
Pair of pouchlike organs found
posterior to the base of bladder
Alkaline, viscous fluid
neutralizes vaginal acid & male urethra
fructose for ATP production
prostaglandins stimulate sperm motility & viability
clotting proteins for coagulation of semen
Prostate Gland
Single organ the size of chestnut found inferior to bladder
Secretes milky, pH 6.5 fluid that increases sperm motility
and viability
citric acid for ATP production & enzymes for seminal
liquefaction
Many duct openings
Enlarges with age
Bulbourethral or Cowper’s Gland
Paired, pea-sized gland within the UG diaphragm
Secretes alkaline mucous into spongy urethra
Neutralizes acids and lubricates
Semen
Mixture of sperm & seminal fluid
glandular secretions and fluid of seminiferous
tubules
slightly alkaline, milky appearance, sticky
Typical ejaculate is 2.5 to 5 ml in volume
Normal sperm count is 50 to 150 million/ml
actions of many are needed for one to enter
Semen analysis----bad news if show lack of forward motility,
low count or abnormal shapes
Penis
Passageway for semen & urine
Body composed of three erectile tissue masses filled with
blood sinuses
Composed of bulb, crura, body
& glans penis
Erection & Ejaculation
Erection
sexual stimulation dilates the arteries supplying the penis
blood enters the penis compressing the veins so that the
blood is trapped.
parasympathetic
reflex causes erection
Ejaculation
muscle contractions close sphincter at base of bladder and
move fluids through ductus deferens, seminal
vesicles, & ejaculatory ducts
Glans Penis
Enlarged distal end of corpus spongiosum
External urethral orifice is small slit
Covered by loosely fitting prepuce or foreskin
Circumcision
Removal of prepuce
3 - 4 days after birth
Possibly lowers UTIs, cancer &
sexually transmitted disease
Female Reproductive System
Ovaries produce 2nd oocytes &
hormones
Uterine tubes transport fertilized ova
Uterus where fetal development occurs
Vagina & external genitalia constitute the vulva
Mammary glands produce milk
The Ovary
Pair of organs, size of unshelled almonds found in upper
pelvic region
Regional histology
tunica albuginea is capsule
of dense connective tissue
cortex is region just deep to
tunica, contains follicles
medulla is deeper region
composed of connective tissue, blood vessels & lymphatics
germinal epithelium is simple epithelial covering over the
ovary
Reproductive Ligaments
Broad ligament suspends uterus from side wall of pelvis
Mesovarium attaches ovaries to
broad ligament
Ovarian ligament anchors ovary to uterus
Suspensory ligament covers blood
vessels to ovaries
Round ligament attaches ovaries to inguinal canal
Follicular Stages
Stages of follicular development
primordial
primary
secondary
graafian
ovulation
Corpus luteum is ovulation wound
fills in with hormone secreting cells
Corpus albicans is white scar left
after corpus luteum is not needed
Life History of Oogonia
Germ cells from yolk sac migrate to ovary & become oogonia
As a fetus, oogonia divide to
produce millions by mitosis but most degenerate (atresia)
Some develop into primary oocytes
& stop in prophase stage of meiosis I
200,000 to 2 million present at birth
40,000 remain at puberty but only 400 mature during a
woman’s life
Each month, hormones cause meiosis I to resume in several
follicles so that meiosis II is reached by ovulation
Penetration by the sperm causes the final stages of meiosis
to occur
Review of Oogenesis
Uterine or Fallopian Tubes
Narrow, 4 inch tube extends from ovary to uterus
infundibulum is open,
funnel-shaped portion near the ovary
fimbriae are moving finger-like
processes
ampulla is central region of tube
isthmus is narrowest portion joins uterus
Function of Uterine
Tube
Function -- events occurring in the uterine tube
fimbriae sweep oocyte
into tube, cilia & peristalsis move it along, sperm reaches oocyte in ampulla, fertilization
occurs within 24 hours after ovulation & zygote reaches uterus about 7 days
after ovulation
Lining of the Uterine Tubes
Anatomy of the Uterus
Site of menstruation
& development of fetus
Description
3 inches long by 2 in.
wide and 1 in. thick
subdivided into fundus,
body, isthmus & cervix
Position of Uterus
Anteflexion -- normally projects anteriorly and superiorly over the urinary bladder
Retroflexion -- posterior tilting
of the uterus
Histology of the Uterus
Endometrium
simple columnar epithelium
stroma of connective tissue and
endometrial glands
stratum functionalis
shed during menstruation
stratum basalis
replaces stratum functionalis each
month
Blood Supply to the Uterus
Uterine arteries branch as arcuate
arteries and radial arteries that supply the myometrium
Straight & spiral branches penetrate to the endometrium
spiral arteries supply the stratum functionalis
their constriction due to hormonal changes starts menstrual
cycle
Hysterectomy
Surgical removal of the uterus
Indications for surgery
endometriosis, ovarian cysts, excessive bleeding, cancer of
cervix, uterus or ovaries
Complete hysterectomy removes cervix
Radical hysterectomy removes uterus, tubes, ovaries, part of
vagina, pelvic lymph nodes and supporting ligaments
Vagina
Passageway for birth, menstrual flow & intercourse
Description
4 inch long fibromuscular organ
ending at cervix
mucosal layer
stratified squamous epithelium
& areolar connective tissue
large stores of glycogen breakdown to produce acidic pH
muscularis layer is smooth muscle
allows considerable stretch
lies between urinary bladder and rectum
orifice partially closed with membrane (hymen)
Vulva (pudendum)
Mons pubis -- fatty pad over the
pubic symphysis
Labia majora & minora -- folds of skin encircling vestibule where find
urethral and vaginal openings
Clitoris -- small mass of erectile tissue
Bulb of vestibule -- masses of erectile tissue just deep to
the labia on either side of the vaginal orifice
Perineum
Diamond-shaped area between the thighs in both sexes
bounded by pubic symphysis and
coccyx
urogenital triangle contains
external genitals
anal triangle contains anus
Mammary Glands
Modified sweat glands that produce milk (lactation)
amount of adipose determines size of breast
milk-secreting glands open by lactiferous ducts at the
nipple
areola is pigmented area around nipple
suspensory ligaments suspend
breast from deep fascia of pectoral muscles (aging & Cooper’s droop)
Fibrocystic Disease of the Breasts
Most common cause of breast lumps
Cysts and thickenings of alveoli develop
Cause
hormonal imbalance
excess of estrogen or deficiency of progesterone in the
postovulatory phase
result is lumpy, swollen & tender breast a week before
menstruation begins
Female Reproductive Cycle
Controlled by monthly hormone cycle of anterior pituitary,
hypothalamus & ovary
Monthly cycle of changes in ovary and uterus
Ovarian cycle
changes in ovary during & after maturation of oocyte
Uterine cycle
preparation of uterus to receive fertilized ovum
if implantation does not occur, the stratum functionalis is shed during menstruation
Hormonal Regulation of Reproductive Cycle
GnRH secreted by the hypothalamus
controls the female reproductive cycle
stimulates anterior pituitary to secrete FSH & LH
FSH initiates growth of follicles that secrete estrogen
estrogen maintains reproductive organs
LH stimulates ovulation & promotes formation of the
corpus luteum which secretes estrogens, progesterone,
relaxin & inhibin
progesterone prepares uterus for implantation and the
mammary glands for milk secretion
relaxin facilitates implantation
in the relaxed uterus
inhibin inhibits the secretion of
FSH
Overview of Hormonal Regulation
Phases of Female Reproductive Cycle
Hormonal Changes
Menstrual Phase
Menstruation lasts for 5 days
First day is considered beginning of 28 day cycle
In ovary
20 follicles that began to develop 6 days before are now
beginning to secrete estrogen
In uterus
declining levels of progesterone caused spiral arteries to
constrict -- glandular tissue dies
stratum functionalis layer is
sloughed off along with 50 to 150 ml of blood
Preovulatory Phase
Lasts from day 6 to 13 (most variable timeline)
In the ovary (follicular phase)
follicular secretion of estrogen & inhibin
has slowed the secretion of FSH
dominant follicles survives to day 6
by day 14, graafian follicle has
enlarged & bulges at surface
increasing estrogen levels trigger the secretion of LH
In the uterus (proliferative
phase)
increasing estrogen levels have repaired & thickened the
stratum functionalis to 4-10 mm in thickness
Ovulation
Rupture of follicle & release of 2nd oocyte
on day 14
Cause
increasing levels of estrogen stimulate release of GnRH which stimulates anterior pituitary to release more LH
Signs of Ovulation
Increase in basal body temperature
Changes in cervical mucus
Cervix softens
Mittelschmerz---pain
Postovulatory Phase
Most constant timeline = lasts 14 days
In the ovary (luteal phase)
if fertilization did not occur, corpus albicans
is formed
as hormone levels drop, secretion of GnRH,
FSH & LH rise
if fertilization did occur, developing embryo secretes human
chorionic gonadotropin (hCG) which maintains health of corpus luteum
& its hormone secretions
In the uterus (secretory phase)
hormones from corpus luteum
promote thickening of endometrium to 12-18 mm
formation of more endometrial glands & vascularization
if no fertilization occurs, menstrual phase will begin
Negative Feedback on GnRH
Menstrual Abnormalities
Amenorrhea = absence of menstruation
hormone imbalance, extreme weight loss or low body fat as
with rigorous athletic training
Dysmenorrhea = pain associated
with menstruation
severe enough to prevent normal functioning
uterine tumors, ovarian cysts, endometriosis or intrauterine
device
Abnormal uterine bleeding = excessive amount or duration or intermenstrual
fibroid tumors or hormonal imbalance
Human Sexual Intercourse
4 phases
excitement phase produced by parasympathetic NS
engorgement of blood vessels & cardiovascular changes
plateau phase of variable duration
sexual flush to face & chest
orgasm phase (climax)
rhythmical muscular contractions & pleasure
sympathetic nervous system causes ejaculation
resolution
profound relaxation & return to normal
male refractory period where 2nd ejaculation is impossible
Some male & female physiological differences
Erectile Dysfunction (Impotence)
Consistent inability of adult male to hold an erection long
enough for sexual intercourse
Causes
psychological or emotional factors
physical factors
diabetes mellitus, vascular disturbances, neurological
disturbances, testosterone deficiency, drugs (alcohol, nicotine,
antidepressants, tranquilizers,etc)
Viagra causes vasodilation of
penile arteries and brings on an erection
Birth Control Methods
Surgical
Hormonal
Mechanical barriers
Periodic abstinence
Coitus interruptus
Induced abortion
Surgical Sterilization
Male (vasectomy)
removal of a portion of the vas deferens
incision in posterior scrotal sac
out patient & local anesthesia
sperm can no longer reach the exterior
degenerate and removed by phagocytosis
sexual desire not effected since testosterone levels
unchanged
Female (tubal ligation)
uterine tubes are tied closed and cut
sperm can not reach oocyte
Hormonal Birth Control
Oral contraceptive --- “the pill”
progesterone & estrogen combination pill
negative feedback on the anterior pituitary &
hypothalamus to prevent secretion of FSH & LH
no follicular development or ovulation
no possible pregnancy
other benefits of the pill
regulate menstrual cycle & reduce endometriosis
Risks increased for smokers
increased chances of blood clot formation
Not recommended for people with liver disease, hypertension,
heart disease, migraines
Other Hormonal Methods
Norplant
surgically implanted capsules releasing progestin &
inhibiting ovulation for 5 years
Depo-provera
intramuscular injection of progesterone every 3 months that
changes uterine lining & ovum maturation
Vaginal ring
worn internally releasing progestin or combination of
progestin & estrogen
Intrauterine Devices
Small object made of plastic, copper or steel left in cavity
of uterus
changes uterine lining so is unfavorable for embryo
implantation
approved for 10 year usage
May cause excessive bleeding or discomfort
Spermatocides
Chemical substances in foam, cream, jelly, douche or
suppository that kill sperm upon contact
Available without prescription
Normally used in conjunction with a barrier device
May inactivate HIV virus & decrease incidence of
gonorrhea
Mechanical Barriers
Male & female condoms (vaginal pouch)
covers penis or lines vagina
Diaphragm = dome-shaped cap over cervix
prevents entry of sperm into uterus
does not protect against AIDS or STD
may cause recurrent UTIs
All of the above may offer some protection against sexually
transmitted disease
Physiological Methods of Birth Control
Rhythm method (periodic abstinence)
abstaining from intercourse when secondary oocyte is likely to be viable (3 to 7 days of cycle)
3 days before ovulation, ovulation & 3 days after
few women absolutely regular cycles
will not know it was an irregular cycle until too late
Sympto-thermal method
observe body for signs of ovulation & abstain form
intercourse accordingly
increased basal body temperature & mucus changes
problem is sperm is viable for 48 hours
Coitus interruptus (withdrawal
before ejaculation)
Induced Abortion
Miscarriage is a spontaneous loss of the fetus
Induced abortions
vacuum aspiration (suction)
infusion of saline solution to kill embryo
surgical evacuation (scraping)
`RU 486 is called a nonsurgical
abortion
antiprogestin drug that causes
uterine lining to collapse & embryo is lost (menstruation occurs)
can be taken up to 5 weeks after conception
Early Anatomy -- Male Pattern
Depends upon SRY gene
on Y chromosome
sertoli cells secrete Mullerian
inhibiting substance
leydig cells secrete testosterone
causing mesonephric duct to
develop into male tubes
seminiferous tubules, epididymis
& vas deferens & seminal vesicles
prostate & cowper’s glands are
outgrowths of urethra
testosterone secretion stops at birth when hCG from the placenta stops stimulating leydig
cells
Early Anatomy -- Female Pattern
Females have 2 X chromosomes so SRY gene is absent
Gonads develop into ovaries
no mullerian-inhibiting substance
is produced so female pattern of duct development occurs
paramesonephric duct develops into
vagina, uterus & uterine tubes
mesonephric ducts degenerate
Female pattern depends on the absence of testosterone
Development of External Genitalia
External genitals similar at 8 weeks (genital tubercle)
DHT causes external male structures to develop before birth
Labioscrotal swelling
scrotum or labia majora
Urethral folds
spongy penile urethra or labia minora
Glans area
glans penis or clitoris
Absence of DHT results in development of female
Deficiency of 5 Alpha-Reductase
Rare genetic defect producing a deficiency of 5 alpha-reductase
enzyme that converts testosterone into dihydrotestosterone
(DHT)
At birth, baby looks externally female due to lack of DHT
during development
At puberty, testosterone levels rise
masculine characteristics appear
breasts fail to develop
an internal exam reveals testes & other structures
Aging Female
Reproductive System
Hormone-directed sexual characteristics start to develop at
puberty
Reproductive cycle occurs once/month from menarche (10-14)
until menopause (between 40 & 50)
Fertility declines with age
decreasing number of viable follicles
less frequent ovulation
declining ability of uterus to support young embryo
Menopause is cessation of menstruation
no remaining follicles to stimulate estrogen secretion
osteoporosis, hot flashes, mood swings, organ atrophy
Aging Male Reproductive System
Decline in reproductive function is more subtle (capacity
may remain into 90’s)
Decline in testosterone at 55
reduced muscle synthesis
fewer viable sperm
reduced sexual desire
Enlargement of prostate (benign hyperplasia)
1/3 of males over 60
frequent urination, decreased force of stream, bed-wetting
& sensation of incomplete emptying
Sexually Transmitted Disease
On the increase in the United States
Chlamydia -- bacteria; asymptomatic, leads to sterility from
scar tissue formation
Gonorrhea -- bacteria, discharge common, blindness if
newborn is infected during delivery
Syphilis -- bacteria, painless sores (chancre), 2nd stage
all organs involved, 3rd stage organ degeneration is apparent (neurosyphilis)
Genital Herpes -- virus, incurable, painful blisters
AIDS & hepatitis B --viruses (chapters 22 & 24)
Testicular Cancer
Most common cancer in age group 20-35
one of the most curable
Begins as problem with spermatogenic
cells within the seminiferous tubules
Sign is mass within the testis
Regular self-examination is important
Prostate Cancer
Leading male cancer death
treatment is surgery, radiation, hormonal and chemotherapy
Blood test for prostate-specific antigen (PSA)
enzyme of epithelial cells
amount increases with enlargement (indication of infection,
benign enlargement or cancer)
Over 40 yearly rectal exam of prostate gland
acute or chronic prostatitis is an
infection of prostate causing swelling, tenderness & blockage of urine flow
treat with antibiotics
Premenstrual Syndrome (PMS)
Physical & emotional distress during the postovulatory (luteal) phase
disappear at onset of menstruation
Signs & symptoms are variable
mood swings, depression, headache, fatigue, backache,
constipation, breast tenderness, edema
Since occurs only after ovulation, oral contraceptives are
an effective treatment
careful diet & exercise may help
Endometriosis
Growth of endometrial tissue outside of the uterus
tissue discharged from open-end of uterine tubes during
menstruation
can cover ovaries, outer surface of uterus, colon, kidneys
and bladder
Problem is tissue responds to hormonal changes by
proliferating then breaking down & bleeding
causes pain, scarring & infertility
Breast Cancer
Second-leading cause of cancer death in the U.S.
1 in 8 women affected
rarely before 30, but more common after menopause
5% of cases are
younger women (genetic mutation)
Detection by self-examination & mammography
ultrasound determines if lump is benign, fluid-filled cyst
or solid & possibly malignant
Risk factors
family history, no children, radiation, alcohol &
smoking
Treatment
lumpectomy, radical mastectomy, radiation therapy or
chemotherapy
Ovarian Cancer
Most common cause of gynecological deaths excluding breast
cancer
difficult to detect before metastasizes
Difficult to detect before metastasis
Risk factors
over 50, white, family history, nulliparity,
first pregnancy after 30, diet (high fat, low fiber and lack of vitamin A),
asbestos & talc
Early symptoms unremarkable -- heartburn, nausea, bloating,
loss of appetite, etc
Cervical Cancer
Starts as cervical dysplasia
(change in shape, growth & number of cells)
May progress to cervical cancer
Detected in Pap smear
Linked to genital warts and large number of sexual partners
at an early age
Yeast Infection
Candida albicans is yeastlike fungus that grows on mucous membranes
Causes vulvovaginal candidiasis or vaginitis
inflammation of the vagina
severe itching and pain
yellow discharge with odor
More likely after antibiotic therapy for some other disease