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    Unit 7 Endocrine Reproduction Respect

    In this unit learners will explore the endocrine and reproductive systems through the integration and application of biomedical sciences and osteopathic clinical skills. The unit will utilize the holistic osteopathic approach and the recognition of the interdependence of structure and function to engage learners in the art and science of clinical examination, diagnosis, and treatment. Using case-based learning in small and large groups, the learners will examine the underlying normal and abnormal anatomical and physiological processes, and the intervention and management of diseases and disorders associated with the endocrine and reproductive systems.  The learners will investigate the roles of the endocrine system in regulating anabolic and catabolic processes in health and disease. Moreover, the learners will explore the impact of emotions and the brain on hormone production and function.  The dynamic relationship of the endocrine system and reproductive health will be revealed through the study of the life phases of embryonic formation of the reproductive system, puberty, mature sexual function, and age-related decline in sexual function.  Infertility issues, normal and complicated pregnancy, and labor and delivery will be examined as will ethical decision-making regarding reproduction and sexual health issues. Learners will continue to develop their professional identity as compassionate osteopathic physicians through a new focus on exhibiting respect when challenged with difficult and sensitive conversations with patients and their families. Recognition of the social, ethical, and public health impact of endocrine function, sexual concerns, and reproductive health will also be integrated into this unit. 

    Rationale

    A.T. Still said, “We look at the body in health as meaning perfection and harmony, not in one part, but in the whole”.1    The study of the endocrine and reproductive systems certainly illustrates this philosophy.

    The endocrine system is a prominent regulator of our bodies and its proper functioning affects all aspects of our health.  The term hormone is derived from a Greek phrase meaning to set in motion.2 The endocrine system is an integrated network of glands that release hormones into the circulation, which exert their effect on neighboring or distant target organs.  Control of the endocrine system is a dynamic process that functions in concert with the central and peripheral nervous systems as well as with the immune system. Our emotions also may influence the endocrine and reproductive function in response to life events. Primary control of the entire endocrine system is achieved through neuroendocrine integration of the hypothalamus and the pituitary gland to mediate the body’s functions. In fact, the anterior pituitary is often referred to as the master gland.3   Diseases of the endocrine system can affect the functioning of the entire body and these conditions can lead to significant suffering and disability.  Endocrine and metabolic diseases have a significant negative effect on the general health of the population, “at least 11 endocrine and metabolic disorders [are] present in 5% or more of the adult US population, including diabetes mellitus, osteopenia … and thyroiditis.” 4

    Experiences of sexual dysfunction, infertility, pregnancy loss and sexual orientation frequently present as physically and psychologically difficult challenges. Many common chronic diseases also cause sexual dysfunction but physicians are often reluctant to discuss sexual health issues, which result in a failure to deliver optimal health care.  There are many preventable barriers to appropriate sexual health care, which may include an underestimation of sexual concerns by physicians, healthcare provider’s embarrassment or discomfort with sexual health issues, and the patient’s own embarrassment.  “By routinely asking questions about sexual health in an initial history taking, a caregiver shows acceptance of sexual health as an integral part of a person’s well-being.” 5

    References
    1Still, A. T. (2012). Philosophy and Mechanical Principles of Osteopathy. P. 44
    2Jameson J. Approach to the Patient with Endocrine Disorders. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&sectionid=79751331. Accessed April 10, 2017.
    3Melmed S, Jameson J. Anterior Pituitary: Physiology of Pituitary Hormones. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&sectionid=79751425. Accessed April 10, 2017.
    4Endocrine & Reproductive Physiology: Introduction. In: Barrett KE, Barman SM, Boitano S, Brooks HL. eds. Ganong’s Review of Medical Physiology, 25e New York, NY: McGraw-Hill; . http://accessmedicine.mhmedical.com/content.aspx?bookid=1587&sectionid=97163803. Accessed April 10, 2017.
    5Bullard DG, Caplan H, Derzko C. Sexual Problems. In: Feldman MD, Christensen JF, Satterfield JM. eds. Behavioral Medicine: A Guide for Clinical Practice, 4e New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=1116&sectionid=62689799. Accessed April 11, 2017.