The genitourinary system encompasses two major organ systems: the reproductive and the urinary systems. Successful reproduction requires interaction between two sexually mature individuals. Xenobiotic exposures to either individual can have an adverse impact on fertility, which is the successful production of children, and fecundity, which is an individual's or a couple's capacity to produce children. The role of occupational and environmental exposures in the development of infertility is difficult to define.10,37,89,93 Well-designed and conclusive epidemiologic studies are lacking due to the following factors: laboratory tests used to evaluate fertility are relatively unreliable; clinical endpoints are unclear; xenobiotic exposure is difficult to monitor; and indicators of biologic effects are imprecise. The negative impact on fertility as an adverse effect of xenobiotics is often ignored, but the evaluation of infertility is incomplete without a thorough xenobiotics and occupational history. Differences in the toxicity of xenobiotics in individuals may be sex- and/or age-related. Xenobiotic-related, primary infertility may be the result of effects on the hypothalamic-pituitary-gonadal axis or of a direct toxic effect on the gonads.78 Fertility is also affected by exposures that cause abnormal sexual performance. Table 28–1 lists xenobiotics associated with infertility.
Table 28–1. Xenobiotics Associated with Infertility |Favorite Table|Download (.pdf)
Table 28–1. Xenobiotics Associated with Infertility
|Anabolic steroids||↓ LH, oligospermia|
|Androgens||↓ testosterone production|
|Combination chemotherapy (COP, CVP, MOPP, MVPP)||Oligospermia|
|Carbon disulfide||↓ FSH, ↓ LH, ↓ spermatogenesis|
|Dibromochloropropane (DBCP)||Azoospermia, oligospermia|
|Ethanol||↓ Testosterone production, Leydig cell damage, asthenospermia, oligospermia, teratospermia|
|Ethylene oxide||Asthenospermia (in monkeys), oligospermia|
|Glycol ethers||Azoospermia, oligospermia, testicular atrophy|
|Ionizing radiation||↓ Spermatogenesis|
|Opioids||↓ LH, ↓ testosterone|
|Lead||↓ Spermatogenesis, asthenospermia, teratospermia|
|Combination chemotherapy (MOPP, MVPP)||Amenorrhea|
|Ethylene oxide||Spontaneous abortions|
|Lead||Spontaneous abortions, still births|
|Oral contraceptives||Affect hypothalamic-pituitary axis, end-organ resistance to hormones, amenorrhea|
|Thyroid hormone||↓ Ovulation|
Aphrodisiacs are used to heighten sexual desire and to counteract sexual dysfunction. Historically, humans have continued to search for the perfect aphrodisiac. Efficacy is variable, and toxic consequences occur commonly. Various treatments have been available for male sexual dysfunction, or erectile dysfunction.
Although many people search for a cure for impotence or infertility, others explore xenobiotics that can be used as abortifacients. Routes of administration used include oral, parenteral, and intravaginal, with an end result of pregnancy termination. Toxicity results not only in the termination of pregnancy but also from the systemic effects of the various xenobiotics.
This chapter examines these issues, as well as the impact of xenobiotics on the urinary system, specifically, urinary retention and incontinence, and abnormalities detected in urine specimens. Renal (Chap. 27), teratogenic, (Chap. ...