Search

Objective: to assess sexual function in female patients with rheumatoid arthritis (RA) and fibromyalgia (FM) and to identify the main risk factors of sexual dysfunction (SD).Patients and methods. 60 patients with FM (mean age 44.2±10.1 years) – Group 1; 69 patients with RA (mean age 45.0±9.6 years) – Group 2; and 100 healthy women controls (mean age 45.1±11.8 years) – Group 3 were enrolled in the study. Medical history, severity of pain at rest and during movement by visual analog scale (VAS), and anxiety and depression symptoms by hospital anxiety and depression scale (HADS) were assessed. Sexual function was evaluated by «Female Sexual Function index (FSFI)».Results and discussion. The overall sexual function score in Group 1 (12.7±9.0) was almost twice lower than in the control group (23.55±8.24, pConclusion. RA and FM have a negative impact on women's sexual function. The inflammatory disease activity is the main driver of SD in RA patients while affective disorders promote SD in FM patients.

The review presents the psychosocial characteristics of young women in todays millennial generation and survey data regarding their hormonal contraceptive requirements. The results of randomized clinical trials and real-life studies of the use of the combined oral contraceptive (COC) Qlaira containing estradiol valerate and dienogest (E2V/DNG) in a dynamic dosing regimen were analyzed, in which the reliability of the contraceptive effect of the drug was identified and confirmed, the restoration of fertility was population level after drug withdrawal, its minimal effect on metabolism and a reduced risk of cardiovascular complications (venous and arterial thrombosis) when using Qlaira COC in comparison with other COCs. The absence of a negative effect of COC E2V/DNG on body weight, sexual function and vaginal microbiocenosis in most women has been proven. The data on satisfactory characteristics of menstrual bleeding (lighter and shorter) in users of Qlaira COC and a decrease in symptoms associated with a hormone-free interval, which often occur when taking other COCs in the 21/7 regimen, are presented. The favorable efficacy and safety profile of COC E2V/DNG in real conditions, the advantages of estrogen bioidentical to the endogenous, in the composition of the drug, the dosage regimen 26/2, the positive effect on the lifestyle, determine the significant satisfaction of young women, including young women with children, and the ability to use the drug for a long time until menopause.

Aim: to study the severity of surgical menopause (postovariectomy syndrome), anxiety, depression and sexual function in patients with borderline ovarian tumors (BOTs) after radical treatment, depending on management in the rehabilitation period.Materials and Methods. There were examined 62 women of reproductive age (42.0 ± 4.1 years) after radical treatment of BOTs: Group I - 29 patients were observed during rehabilitation period according to the standards and the National Clinical Guidelines and underwent a 12-month Comprehensive Personalized Rehabilitation Program; Group II - 33 non-participating rehabilitation program patients. The Modified Menopausal Index (MMI) and all related constituent subscales, the level of anxiety and depression according to the HADS (Hospital Anxiety and Depression Scale), as well as sexual function according to the FSFI (Female Sexual Function Index) scale were assessed prior to surgery as well as 1, 6, and 12 months afterwards.Results. All study participants noted significantly aggravated symptoms related to surgical menopause as early as 1 month after treatment: the total MMI increased from 10.9 ± 2.2 score (lacked manifestations of surgical menopause) up to 37.0 ± 6.3 score (moderate manifestations) in Group I and from 10.5 ± 2.0 score (lacked manifestations of surgical menopause) up to 35.8 ± 4.3 score (moderate manifestations) in Group II. By the 12 months, MMI decreased down to 22.2 ± 4.6 score (mild manifestations) in Group I and remained almost unchanged in Group II - 36.9 ± 8.0 (moderate manifestations). In 93.1 % and 81.8 % women from Group I and Group II, respectively, 1 month after antitumor therapy, disorders of the psycho-emotional sphere were observed. In Group I, after 12 months parameters returned to preoperative baseline magnitude, whereas in Group II 87.9 % of patients noted their significant altered values. A twofold decrease in anxiety values according to the HADS was observed in Group I after 12 months of rehabilitation therapy, whereas in Group II, it was also decreased, but to a lower degree. While assessing level of depression, it was found to gradually increase in Group II within the first year after the operation, whereas in Group I it was steadily decreased. Within 1 month after radical treatment of BOTs, a significant decrease in sexual function and the FSFI index was observed in all women of reproductive age (from 23.7 ± 5.5 to 4.0 ± 1.2 score in Group I and from 23.4 ± 5.3 up to 4.0 ± 1.3 score in Group II). After 12 months of comprehensive rehabilitation, sexual function was almost completely recovered in Group I (22.5 ± 5.4 score), whereas in Group II sexual dysfunction was markedly evident (14.9 ± 6.4 score).Conclusion. Comprehensive personalized rehabilitation can reduce the negative symptoms of surgical menopause, normalize the psycho-emotional state, increase sexual function, and hence, improve the quality of life of patients with BOTs of reproductive age after radical treatment.

Aim: to evaluate the quality of life parameters dynamics in patients with vulvar cancer I and II stages during postoperative rehabilitation.Materials and Methods. A prospective comparative randomized study included 47 women with vulvar cancer I–II stages, aged 38 to 70 years, with an average age of 56.3 ± 3.9 years. Patients were randomized into 2 groups: 24 of them underwent postoperative rehabilitation and 23 were included in the comparison group. Quality of life and sexual function, as well as psycho-emotional state were assessed using a set of questionnaires: quality of life of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, Functional Assessment of Cancer Therapy-General (FACT-G) with an extension for vulvar cancer, Female Sexuality Index (FSFI) and WAM (well-being, activity, mood).Results. Patient who receiving postoperative rehabilitation even during the first three months, a reliable positive dynamics of all parameters of FSFI and EORTC, except cognitive function, was noted. At the same time, in the patients not undergoing postoperative rehabilitation program there was no reliable difference in the results of the questionnaires, except for FSFI, but the severity of changes was significantly less than in the patients of the research group. Dynamics in the EORTC parameters in women in postoperative rehabilitation averaged 14.8 points with 7.8 points in the comparison group. In the FACT-G questionnaire, the dynamics were even more pronounced with 19.9 and 6.8 points respectively. There was a reliable positive trend in improving the quality of sexual life and a decrease in the percentage of women suffer from pain and discomfort during sexual intercourse: from 25,0 % (n = 6) to 4,2 % (n = 1) in the study group and from 21,7 % (n = 5) to 13,0 % (n = 3) in the comparison group. Improvement in sexual desire and satisfaction during the year was noted in 5 (20.8 %) women in the study group and only 2 (8.7 %) in the comparison group.Conclusion. The developed program of postoperative rehabilitation of patients with vulvar cancer, which includes individual and group psychotherapy, "anti-cancer diet therapy", dosed physical activity, dynamic correction of vaginal biocoenosis showed high efficiency already during the first 6 months. All patients with vulvar cancer in the postoperative period should receive active rehabilitation aimed at correction of psycho-emotional state and sexual function, which will improve the quality of life and improve further prognosis.

In this review we summarize current data on prevalence, etiology and pathogenesis resulting in premature ovarian insufficiency (POI). In particular, genetic, autoimmune, metabolic, iatrogenic disorders as well as unfavorable impact of environmental factors represent key pathogenetic mechanisms underlying POI development. Clinical picture of this disease is mainly manifested by oligo- and amenorrhea as well as genitourinary menopausal syndrome (GUMS). Special attention is paid to a link between such clinical signs and psychosocial discomfort not being a life-threatening condition but still able to markedly lower quality of woman’s life and considered as a comorbidity with type 2 diabetes mellitus, osteoporosis and cardiovascular diseases. Hormone replacement therapy (HRT) serves as the first-line therapeutic approach for treating POI, which is performed according to the principles similar to those used to perform menopausal hormone therapy (MHT) in case of natural menopause that should be continued until reaching at least the average age for the onset of menopause. Topical estriol therapy eliminates GUMS symptoms, which in turn positively affects sexual function and woman’s psychosocial status and contributes to improved quality of life. The data from recent studies examining topical estriol therapy in POI demonstrated high efficacy and safety. Finally, we also discuss diverse strategies to support reproductive function in women with POI.

Kraurosis vulvae or vulvar lichen sclerosus (VLS) is a non-neoplastic skin disease that affects the female genital area. It is characterized by hypoplastic dystrophy, itching, pain, changes in the vulva appearance, narrowing of the vaginal opening, dysuria and dyschezia. Psychosexual disorders often occur in patients with VLS and can significantly impact their quality of life. In addition, there is a risk of malignization of the process. That is why such patients need timely treatment to prevent the development of a malignant disease, restore the quality of life, maintain the physical and mental status, and correct the sexual dysfunction.

Introduction. Urogenital and anorectal functional disturbances associated with the pelvic autonomic nerve damage are common complications of rectal cancer surgery. the search for methods of intraoperative identification of the autonomic nerve plexus is currently one of the key tasks in modern surgery of rectal cancer. the purpose of our study is to evaluate the role of intraoperative neuromonitoring in rectal cancer surgery.Material and methods. In 2017 we performed intraoperative neuromonitoring during rectal cancer surgery in two cases. the superior hypogastric plexus and the inferior hypogastric plexus were identified and the pelvic autonomic nerve was preserved in both patients. urogenital and anorectal functional outcomes were assessed in the postoperative period.Results. Satisfactory functional outcomes in the late postoperative period and at the 12-month follow-up suggest that intraoperative neuromonitoring may be useful in identification and prevention of the pelvic autonomic nerve damage in patients with rectal cancer.Conclusion. This method would be difficult to use routinely for intraoperative identification of the autonomic nerve plexus but could be especially useful for the study of pelvic physiology. With further development, the method of intraoperative neuromonitoring could help discover a technique that will improve the surgical treatment of rectal cancer. Further research using intraoperative neuromonitoring is needed to more precisely determine its value in the preservation of urinary, anorectal and sexual function.

Aim. Examine the impact of combined oral contraceptive on sexuality and the quality of women’s life. Materials and methods. The article presents a review of Electronic literature databases MEDLINE, PubMed, EMBASE, Cochrane Library and Elibrary. Results. Since its first introduction in the 1960s, hormonal contraception has been widely used as a highly effective birth control method. However, the hormonal components of oral contraceptives affect the neuroendocrine system of women, exerting various effects on mood, libido, on sexuality and quality of life in general. Based on literature data the effect of contraception on sexuality, the physiological and emotional state of women are various. It is known that the hormonal supplementation of sexual desire is associated with ovarian hormones. At the same time, a high concentration of estrogen and testosterone receptors has been determined in the hypothalamus, which controls sexual function and mood. The mechanisms to implement the effects of androgen and progesterone on sexual desire are ambiguous. It was found a positive relationship between a sexual interest, sexual response, sexual fantasy, frequency of sexual intercourse and a testosterone level. At the same time, it is known that estradiol can increase the ability of women to orgasmic response and sexual satisfaction by acting on specific brain structures. Conclusion. The effect of contraception on women’s sexual life is an important factor when choosing a method of contraception and an integral part in the obstetrician-gynecologist’s practice, which requires further research in this direction.

Background. Combined oral contraceptives (COCs) are the most common method of prevention of unwanted pregnancies in women from the early reproductive period to perimenopause, therefore their impact on quality of life, sexual function and general well-being remains the subject of active discussion. Some studies revealed various manifestations of sexual dysfunction in patients receiving COCs, therefore such questions, as well as the advantages / disadvantages of individual components (their type and dose) of drugs, are of interest to the clinician. Aim. Assess mechanisms of influence of COCs on female sexual function. Materials and methods. In order to write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, elibrary, etc.) for the last 2-15 years. Relevant articles from the peer-reviewed literature were included. Results. Many studies proved a beneficial effect of estradiol valerate (E2V) which is estrogen identical to natural one in a combination with dienogest (DNG) which is 4th generation progestin in a dynamic dosing regimen on quality of life and sexual function. This beneficial effect is achieved due to combined effects of both components of the drug as well as its reception mode. Conclusion. The combination of estradiol valerate (E2V) which is estrogen identical to natural one with dienogest (DNG) which is 4th generation progestin may be the optimal method of contraception for women of any age, including the young, with decreased libido while taking other COCs.

Purpose. To investigate the effect of the development of erectile dysfunction (ED) in patients with prostate cancer after radical prostatectomy (RPE) on the assessment of these patients’ quality of life and their psychological state and the influence on these parameters of ED treatment by implantation of the prosthesis of the penis.Materials and methods. The material of the study was analysis of the questionnaire data of 30 patients with PC with the postoperative ED before the postoperative period and after the falloprosthesis. In the long-term postoperative period (2–3 years) patients (n = 30) with an ED stand, who wanted to restore sexual function, were installed a 3-component prosthesis of the penis. The comparison group consisted of 38 patients, examined 3 years after RPE. The second comparison group consisted of 28 patients who were examined prior to surgical treatment. The questioning of patients was carried out using the questionnaire MIEF-5, which characterizes the state of sexual function, and the psychological test of Spielberger-Khanin for assessing anxiety.Results. Itwasshownthatthesumofthepointsofsituationalanxietyafterprostheticsofthepenisdecreasedfrom 32.4 ± 3.6 to 17.4 ± 1.5 points (p = 3.74-5), and personal anxiety – from 43.7 ± 2.2 to 33.0 ± 1.2 points (p = 1.71-5); and, these differences are statistically highly reliable. Accordingly, the evaluation of sexual function shifted in a positive direction (all patients confirmed satisfaction with the restored sexual function).Сonclusion. The results attest to the high rehabilitation efficiency of correction of ED, which developed after RP, by installing a falloprosthesis.

Study of the efficacy and safety of natural complex multi-component biologically active additives (BAA) to food Spermstrong and Testogenona in the diagnosis and treating 63 men with reproductive disorders after illness, sexually transmitted diseases (STDs). During the 12 weeks 41 patients the primary group assigned Spermstrongom combination therapy in combination with Testogenonom, 22 patient control group received only Spermstrong. Immediate treatment results evaluated through 4 weeks and distant through 12 weeks after stopping treatment. It has been established that the appointment of a combination therapy of complex components Spermstrong and Testogenon was statistically significantly increases the effectiveness of treatment. In the main group was marked by a more pronounced positive clinical effect through 12 weeks after treatment in 84.5 % of patients receiving combination therapy (increase the concentration and mobility of spermatozoa to normozoospermii, increase testosterone levels to normal values, improving the quality of erections, improve blood flow in the prostate gland, testes), in the control group who received Spermstrong, the effect is achieved in two times fewer patients, i. e. normozoospermija in 40.9 % have patients. The results confirm that the components of the Spermstrong complexes and Testogenon in combination therapy is effective, safe, have no side effects and can be used in complex treatment of reproductive disorders in men who have STDs, as well as for prophylaxis of incremental sexual glands: prostate, testicules and improve sexual function.

Was carried out the analysis of basic somatic and reproductive disorders at adults’ epilepsy, as well as the role of valproates in the epilepsy therapy at the modern stage. The individual therapy of adults’ epilepsy along with forms of epilepsy/types of epileptic attacks, should mandatory take into account such things as somatic pathology, sexual function and the condition of the emotional-volitional sphere. The valproic acis remains the substance, referred to the first choice group in the treatment of idiopathic (generalized/focal) cryptogenic/symptomatic focal and non-differentiated epilepsies at patients from different age groups with broad spectrum of the accompanying somatic pathology and at men. The valporate is the selection choice at renal failures, kidney transplantation, heart diseases, pulmonary pathologies, brain tumors, different psychic disorders. The substance is not recommended in case of liver diseases with its decompensation, of the bone marrow and liver transplantation, porphyria, adiposity and during pregnancy. For women the valproic acid is applied with reserve in case of the inefficiency of other AED with mandatory information of the patient on possible consequences of the substance application.

The paper describes the main pathogenetic mechanisms of forming persistent neurogenic voiding and sexual function in patients with acute and chronic cerebrovascular disease. Neuroanatomy and neurophysiology described urination and sexual function in normal and vascular disease of the brain. Possibilities different centers urination brain to reorganize functions by associative or contralateral areas of innervation. The role of lower urinary tract symptoms and sexual disorders in the diagnosis level and nature of damage to the central nervous system. Revealed the most important clinical and pathogenetic correlation between urinary and reproductive disorders, the most common in acute and chronic ischemia centers urination and sexual function. The possible common ways of pharmacological correction of functional disorders.

Выбор контрацепции, и обеспечение достойного качества сексуальной жизни является одной из важных задач в работе акушера-гинеколога. Целью нашей работы явилось выяснение особенностей сексуальной жизни женщин в поздней фазе менопаузального перехода. Под наблюдением находилось 569 женщин 46-49 лет, начиная с поздней фазе менопаузального перехода: наличие проявлений климактерического синдрома у 485 женщин (85,2%), а у остальных (84 женщины; 14,8%) – менопаузальные нарушения не выявлены; среди всех женщин проводилось анкетирование по их сексуальной активности в ближайшие 6 месяцев; выяснялась необходимость контрацепции и ее влияние на качество сексуальной жизни. Среди женщин, находящихся в период поздней фазы менопаузального переходы избегание половых контактов встречается у 61,4% опрошенных, что может быть связано с существующими у них менопаузальными расстройствами (у 90,1%), в том числе определяющими и наличие физических причин отказа от половых контактов (у 78,9%), и диспареунию и сухость при половых контактах (у 36,2%), и (возможно, частично) отсутствие эмоционального контакта с половым партнером (у 41,6%.). Существенный вклад в отклонения в сексуальной жизни пациенток вносит и наличие сексуальных расстройств у их партнеров (у 38,5%). При выборе метода контрацепции и средств коррекции менопаузальных расстройств необходимо учитывать их возможное влияние на сексуальную сферу женщин., The choice of contraception, and ensuring a decent quality of sexual life is one of the important tasks in the work of an obstetrician-gynecologist. The purpose of our work was to elucidate the characteristics of the sexual life of women in the late phase of the menopausal transition. 569 women aged 46-49 years were under observation, beginning with the late phase of the menopausal transition: the presence of manifestations of a climacteric syndrome in 485 women (85.2%), and the rest (84 women, 14.8%) - menopausal disorders were not detected; among all women, a survey was conducted on their sexual activity in the next 6 months; the necessity of contraception and its influence on the quality of sexual life was clarified. Among women who are in the late phase of menopausal transitions, the avoidance of sexual contact occurs in 61.4% of the respondents, which may be due to their existing menopausal disorders (in 90.1%), including the physical causes of renunciation of sexual (in 78.9%), and dyspareunia and dryness during sexual intercourse (in 36.2%), and (possibly in part) the absence of emotional contact with the sexual partner (41.6%). Significant contribution to the deviations in the sexual life of patients makes the presence of sexual disorders among their partners (in 38.5%). When choosing a method of contraception and means of correction of menopausal disorders, it is necessary to take into account their possible influence on the sexual sphere of women., №05(160) (2018)

Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary menopausal syndrome and has been shown to prevent bone loss and destruction. This circumstance makes it possible to consider menopausal hormone therapy as the main method for the treatment of premature and surgical menopause. It is important to note that despite the similarity of the long-term consequences bilateral oophorectomy and premature fading in ovarian function differ significantly in the dynamics of the hormones concentration decrease. The risks of menopausal hormone therapy vary depending on the type, dose, duration of use, route of administration, timing of onset, and the use of estrogens and progestins. Treatment should be individualized by selecting the most appropriate formulation, dose, route of administration and duration of use, and also using the best data on maximizing benefits and minimizing possible risks with periodic reassessment of the benefits and risks of continuing or stopping the use of menopausal hormone therapy. Key recommendations of American Association of clinical endocrinologists and the American college of endocrinology (2017) are: for women with early menopause and primary ovarian failure, there are health risks that can include persistent vasomotor symptoms, bone loss, mood changes and an increased risk of cardiovascular diseases, dementia, stroke, Parkinson’s disease, ophthalmic disorders and overall mortality. The results of studies in older women do not apply to women with early menopause, and recent evidence suggests that such patients should use menopausal hormone therapy at least until the middle age of menopause. Transdermal oestrogen preparations are less likely to develop thrombotic risk and, possibly, the risk of developing stroke and coronary heart disease compared to oral oestrogens. If a progestagenic component is required, a more safest alternative is micronized progesterone.

Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary menopausal syndrome and has been shown to prevent bone loss and destruction. This circumstance makes it possible to consider menopausal hormone therapy as the main method for the treatment of premature and surgical menopause.It is important to note that despite the similarity of the long-term consequences bilateral oophorectomy and premature fading in ovarian function differ significantly in the dynamics of the hormones concentration decrease. The risks of menopausal hormone therapy vary depending on the type, dose, duration of use, route of administration, timing of onset, and the use of estrogens and progestins. Treatment should be individualized by selecting the most appropriate formulation, dose, route of administration and duration of use, and also using the best data on maximizing benefits and minimizing possible risks with periodic reassessment of the benefits and risks of continuing or stopping the use of menopausal hormone therapy.Key recommendations of American Association of clinical endocrinologists and the American college of endocrinology (2017) are: for women with early menopause and primary ovarian failure, there are health risks that can include persistent vasomotor symptoms, bone loss, mood changes and an increased risk of cardiovascular diseases, dementia, stroke, Parkinson’s disease, ophthalmic disorders and overall mortality. The results of studies in older women do not apply to women with early menopause, and recent evidence suggests that such patients should use menopausal hormone therapy at least until the middle age of menopause. Transdermal oestrogen preparations are less likely to develop thrombotic risk and, possibly, the risk of developing stroke and coronary heart disease compared to oral oestrogens. If a progestagenic component is required, a more safest alternative is micronized progesterone., Менопаузальная гормональная терапия остается наиболее эффективным методом лечения вазомоторных симптомов и генитоуринарного менопаузального синдрома и, как было показано, предотвращает потерю и разрушение костной ткани. Данное обстоятельство позволяет рассматривать менопаузальную гормональную терапию в качестве основного метода лечения преждевременной и хирургической менопаузы.Важно отметить, что несмотря на схожесть отдаленных последствий, билатеральная оофорэктомия и преждевременное угасание функции яичников существенно отличаются по динамике снижения концентрации гормонов. Риски менопаузальной гормональной терапии различаются в зависимости от типа, дозы, продолжительности использования, пути введения, сроков начала, а также использования эстрогенов и прогестинов. Лечение должно быть индивидуализировано путем выбора наиболее подходящего состава, дозы, пути введения и продолжительности применения гормональных препаратов, а также использования наилучших данных о максимизации преимуществ и сведения к минимуму возможных рисков с периодической переоценкой преимуществ и рисков продолжения или прекращения использования менопаузальной гормональной терапии.Ключевые рекомендации от 2017 г. Американской ассоциации клинических эндокринологов и Американского эндокринологического колледжа таковы: для женщин с ранней менопаузой и первичной овариальной недостаточностью существуют риски для здоровья, которые могут включать постоянные вазомоторные симптомы, потерю костной массы, изменения настроения и повышенный риск сердечно-сосудистых заболеваний, деменции, инсульта, болезни Паркинсона, офтальмологических расстройств и общей смертности. Результаты исследований у пожилых женщин не распространяются на женщин с ранней менопаузой, а последние данные свидетельствуют о том, что такие пациентки должны использовать менопаузальную гормональную терапию как минимум до среднего возраста менопаузы. Трансдермальные эстрогенные препараты имеют меньшую вероятность развития тромботического риска и, возможно, риска развития инсульта и ишемической болезни сердца по сравнению с пероральными эстрогенами. В случае необходимости применения прогестагенного компонента более безопасной альтернативой является микронизированный прогестерон., Менопаузальна гормональна терапія залишається найбільш ефективним методом лікування вазомоторних симптомів і генітоурінарного менопаузального синдрому та, як було показано, запобігає втраті і руйнуванню кісткової тканини. Дана обставина дозволяє розглядати менопаузальну гормональну терапію як основний метод лікування передчасної і хірургічної менопаузи.Важливо відзначити, що незважаючи на схожість віддалених наслідків, білатеральна оофоректомія і передчасне згасання функції яєчників істотно відрізняються за динамікою зниження концентрації гормонів. Ризики менопаузальної гормональної терапії розрізняються залежно від типу, дози, тривалості використання, шляхів уведення, термінів початку, а також використання естрогенів і прогестинів. Лікування має бути індивідуалізоване шляхом вибору найбільш підходящого складу, дози, шляху введення і тривалості застосування гормональних препаратів, а також використання найкращих даних щодо максимізації переваг і мінімізації можливих ризиків з періодичною переоцінкою переваг і ризиків продовження або припинення використання менопаузальної гормональної терапії.Ключові рекомендації від 2017 р. Американської асоціації клінічних ендокринологів та Американського ендокринологічного коледжу є такими: для жінок із ранньою менопаузою і первинною оваріальною недостатністю існують ризики для здоров’я, які можуть включати постійні вазомоторні симптоми, втрату кісткової маси, зміни настрою і підвищений ризик серцево-судинних захворювань, деменції, інсульту, хвороби Паркінсона, офтальмологічних розладів і загальної смертності. Результати досліджень у літніх жінок не поширюються на жінок із ранньою менопаузою, а останні дані свідчать про те, що такі пацієнтки повинні використовувати менопаузальну гормональну терапію щонайменше до середнього віку менопаузи. Трансдермальні естрогенні препарати мають меншу ймовірність розвитку тромботичного ризику і, можливо, ризику розвитку інсульту та ішемічної хвороби серця в порівнянні з пероральними естрогенами. В разі необхідності застосування прогестагенного компоненту безпечнішою альтернативою є мікронізований прогестерон.

The article describes the importance of the problem of consequences of traumatic brain injury. The study included men with long-term consequences of traumatic brain injury with sexual dysfunction. The study used sexological, psychopathological, psychometric, statistical techniques and additional methods. All patients were divided into three groups depending on the time of the injury. All rehabilitation aimed at restoring lost functions, taking into account the identified sexual dysfunction symptoms. Drug therapy, psychotherapy, logotherapy, massage, physiotherapy effects, acupuncture is used in rehabilitation. Symptomatic treatment was aimed at correcting the underlying psychopathology (affective disorders, asthenic conditions, seizures). Much attention is paid to the psychotherapeutic work, because traumatic brain injury not only leads to a change in the functioning of the human, but also entails a number of social, communication problems, resulting in developing family and sexual disharmony. The basic stages of therapy, taking into account the peculiarities of social functioning, relationships, sexual function of patients and their sexual constitution. The results of evaluation of the effectiveness of the therapy in the study group compared with the control group of patients who were not receiving specific therapy.

The hormone therapy remains the most effective method for treating of the vasomotor symptoms and genitourinary syndrome in menopause. The evidence available to date suggests that for women younger than 60 and with a postmenopause no more than 10 years without contraindications, the benefits of administering systemic hormone therapy for the treatment of vasomotor symptoms, sleep disorders and prevention of bone loss exceed possible risks. In addition, the data about statistically significant reduction in all-cause mortality in women who initiate hormone therapy before the age of 60 and/or 10 years after the onset of menopause have been obtained. Menopausal hormone therapy (MHT) includes a wide range of hormonal drugs and administration routes that potentially have different risks and benefits, and therefore the term “class effect” is misleading and inappropriate. The risks of menopausal hormone therapy vary depending on the composition, dose and route of administration of hormones, as well as the timing of the onset and duration of use of both estrogens and progesterone. The use of transdermal estrogens in combination with progesterone seems safer for venous thromboembolism, especially in high-risk women. The use of transdermal estrogen drugs in comparison with oral estrogens is associated with a lesser likelihood of developing thrombotic risk, and possibly the risk of developing stroke and coronary heart disease. If progesterone is needed, micronized progesterone is a safer alternative. MHT requires a periodic reassessment of the benefits and risks for deciding whether to continue or stop using it. The use of postmenopausal hormone therapy in women with menopausal disorders should be based on an assessment of all risk factors for cardiovascular disease, age and time from the onset of menopause. The duration of therapy should be motivated by the indications, and the decision should be taken in conjunction with the doctor.

The hormone therapy remains the most effective method for treating of the vasomotor symptoms and genitourinary syndrome in menopause. The evidence available to date suggests that for women younger than 60 and with a postmenopause no more than 10 years without contraindications, the benefits of administering systemic hormone therapy for the treatment of vasomotor symptoms, sleep disorders and prevention of bone loss exceed possible risks. In addition, the data about statistically significant reduction in all-cause mortality in women who initiate hormone therapy before the age of 60 and/or 10 years after the onset of menopause have been obtained.Menopausal hormone therapy (MHT) includes a wide range of hormonal drugs and administration routes that potentially have different risks and benefits, and therefore the term “class effect” is misleading and inappropriate. The risks of menopausal hormone therapy vary depending on the composition, dose and route of administration of hormones, as well as the timing of the onset and duration of use of both estrogens and progesterone. The use of transdermal estrogens in combination with progesterone seems safer for venous thromboembolism, especially in high-risk women. The use of transdermal estrogen drugs in comparison with oral estrogens is associated with a lesser likelihood of developing thrombotic risk, and possibly the risk of developing stroke and coronary heart disease. If progesterone is needed, micronized progesterone is a safer alternative.MHT requires a periodic reassessment of the benefits and risks for deciding whether to continue or stop using it. The use of postmenopausal hormone therapy in women with menopausal disorders should be based on an assessment of all risk factors for cardiovascular disease, age and time from the onset of menopause. The duration of therapy should be motivated by the indications, and the decision should be taken in conjunction with the doctor., Гормональная терапия остается наиболее эффективным методом лечения вазомоторных симптомов и генитоуринарного синдрома при менопаузе. Имеющиеся на сегодняшний день доказательства свидетельствуют, что для женщин моложе 60 лет и с длительностью постменопаузы, не превышающей 10 лет, не имеющих противопоказаний, преимущества назначения системной гормональной терапии с целью лечения вазомоторных симптомов, нарушений сна и профилактики потери костной ткани превышают возможные риски. Кроме того, получены данные о статистически значимом снижении смертности от всех причин у женщин, которые инициируют гормональную терапию в возрасте моложе 60 лет и/или в течение 10 лет после начала менопаузы.Менопаузальная гормональная терапия включает широкий спектр гормональных препаратов и путей введения, которые потенциально имеют различные риски и преимущества, в связи с чем термин «эффект класса» вводит в заблуждение и является неуместным. Риски менопаузальной гормональной терапии различаются в зависимости от состава, дозы и пути введения гормонов, а также сроков начала и продолжительности использования как эстрогенов, так и прогестерона. Использование трансдермальных эстрогенов в комбинации с прогестероном представляется более безопасным в отношении венозной тромбоэмболии, особенно у женщин с высоким риском. Применение трансдермальных эстрогенных препаратов по сравнению с пероральными эстрогенами связано с меньшей вероятностью развития тромботического риска, и, возможно, риска развития инсульта и ишемической болезни сердца. В случае необходимости применения прогестерона более безопасной альтернативой является микронизированный прогестерон.Менопаузальная гормональная терапия требует периодической переоценки преимуществ и рисков для принятия решения о продолжении или прекращении ее использования. Применение гормональной терапии в постменопаузе у женщин с менопаузальными нарушениями должно основываться на оценке всех факторов риска сердечно-сосудистых заболеваний, возраста и времени с момента наступления менопаузы. Продолжительность терапии должна быть мотивирована показаниями, решение должно приниматься совместно с врачом., Гормональна терапія залишається найбільш ефективним методом лікування вазомоторних симптомів і генітоурінарного синдрому при менопаузі. Наявні на сьогоднішній день докази свідчать, що для жінок, молодших за 60 років і з тривалістю постменопаузи, що не перевищує 10 років, які не мають протипоказань, переваги призначення системної гормональної терапії з метою лікування вазомоторних симптомів, порушень сну і профілактики втрати кісткової тканини перевищують можливі ризики. Крім того, отримані дані про статистично значуще зниження смертності від усіх причин у жінок, які ініціюють гормональну терапію у віці, молодшому за 60 років та/або протягом 10 років після початку менопаузи.Менопаузальна гормональна терапія включає широкий спектр гормональних препаратів і шляхів введення, які потенційно мають різні ризики і переваги, через що термін «ефект класу» вводить в оману і є недоречним. Ризики менопаузальної гормональної терапії розрізняються залежно від складу, дози і шляху введення гормонів, а також термінів початку і тривалості використання як естрогенів, так і прогестерону. Використання трансдермальних естрогенів у комбінації з прогестероном видається безпечнішимстосовно венозної тромбоемболії, особливо в жінок із високим ризиком. Застосування трансдермальних естрогенних препаратів у порівнянні з пероральними естрогенами пов’язано з меншою ймовірністю розвитку тромботичного ризику, і, можливо, ризику розвитку інсульту та ішемічної хвороби серця. В разі необхідності застосування прогестерону безпечнішою альтернативою є мікронізований прогестерон.Менопаузальна гормональна терапія вимагає періодичної переоцінки переваг і ризиків для прийняття рішення про продовження або припинення її використання. Застосування гормональної терапії в постменопаузі в жінок із менопаузальними порушеннями має ґрунтуватися на оцінці всіх факторів ризику серцево-судинних захворювань, віку та часу з моменту настання менопаузи. Тривалість терапії повинна бути мотивована показаннями, рішення має прийматися спільно з лікарем.

Цель исследования: анализ эффективности имплантации протезов полового члена в лечении эректильной дисфункции (ЭД) с акцентом на удовлетворенность обоих половых партнеров.Материалы и методы. В исследовании приняли участие 80 пар (мужчинам была диагностирована ЭД тяжелой степени органической формы), впоследствии мужчинам была проведена пенильная имплантация. Пациенты были разделены на две группы: 1-я группа – 40 пар, в которых мужчинам был установлен пластический имплант; 2-я группа – 40 пар, в которых мужчинам был установлен гидравлический имплант. Для диагностики органической формы ЭД использовали допплерографию сосудов полового члена, тест с локальным отрицательным давлением, динамическую кавернозографию ангиографию.Результаты. После проведенного оперативного вмешательства у 5,0% пациентов 1-й группы и у 12,5% 2-й группы отмечали незначительные осложнения, которые не требовали замены импланта. Половая жизнь возобновлялась не ранее чем через 6 нед. В результате исследования было выявлено, что частота половых актов в подгруппах 1а и 2а составила в среднем 10±2,2 раза в месяц, в подгруппах 1б и 2б – всего 4±1,2 раза в месяц.Заключение. Психологическое консультирование повышает возможности межличностной адаптации сексуальных партнеров после пенильной имплантации с 65% до 95%., Мета дослідження: аналіз ефективності імплантації протезів статевого члена у лікуванні еректильної дисфункції (ЕД) з акцентом на задоволеність обох статевих партнерів.Матеріали та методи. У дослідженні взяли участь 80 пар (чоловікам була діагностована ЕД важкого ступеня органічної форми), згодом чоловікам була проведена пенільна імплантація. Пацієнти були розподілені на дві групи: 1-а група – 40 пар, в яких чоловікам було встановлено пластичний імплант; 2-а група – 40 пар, в яких чоловікам було встановлено гідравлічний імплант. Для діагностики органічної форми ЕД використовували допплерографію судин статевого члена, тест з локальним негативним тиском, динамічну кавернозографію, ангіографію.Результати. Після проведеного оперативного втручання у 5,0% пацієнтів 1-ї групи і у 12,5% 2-ї групи відзначали незначні ускладнення, які не вимагали заміни імпланта. Статеве життя поновлювалося не раніше ніж через 6 тиж. У результаті дослідження було виявлено, що частота статевих актів у підгрупах 1а і 2а становила у середньому 10±2,2 разу на місяць, у підгрупах 1б і 2б – усього 4±1,2 разу на місяць.Заключення. Психологічне консультування підвищує можливості міжособистісної адаптації сексуальних партнерів після пенільної імплантації з 65% до 95%., The objective: analysis of the effectiveness of implantation of the prosthesis of the penis in the treatment of erectile dysfunction (ED) with an emphasis on the satisfaction of both sex partners. Materials and methods. The study involved 80 couples (men were diagnosed with ED of severe degree of organic form), later men underwent penile implantation. Patients were divided into two groups: 1st group - 40 pairs, in which the male was implanted with a plastic implant; 2nd group - 40 pairs, in which the male was fitted with a hydraulic implant. To diagnose the organic form of ED, dopplerography of the penis vessels, a test with local negative pressure, dynamic cavernosography, angiography was used.Results. After the surgical intervention, 5.0% of the patients of the 1st group and 12.5% of the 2-nd group had minor complications that did not require replacement of the implant. Sexual life was resumed no earlier than 6 weeks later. As a result of the study, it was found that the frequency of sexual acts in subgroups 1a and 2a averaged 10 ± 2.2 times a month, in subgroups 1b and 2b – only 4 ± 1.2 times a month.Сonclusion. Psychological counseling increases the possibility of interpersonal adaptation of sexual partners after penile implantation from 65% to 95%.

Objective: to study orgasmic function (OF) in patients undergoing radical prostatectomy (RPE).Subjects and methods. Seventy-nine patients who had undergone RPE for locally advanced prostate cancer without hormone and radiation therapies were examined. The patients’ mean age was 59.3 years. The mean EF-IIEF domain score was 24.4. OF was estimated by IIEF question 10 and the authors’ questionnaire. The Spearman rank correction coefficient and Mann-Whitney U-Wilcoxon tests were used.Results. After RPE, there was a reduction in the mean IIEF question 10 score from 3.9 (confidence interval 3.7–4.1) to 3.3 (3–3.5) (p = 0.000). The following changes were found in orgasm intensity: no changes in 43 %, mild worsening in 42 %, severe worsening in 8 %, and enhancement in 4 %; orgasm could not be achieved in 4 % of the patients. Pain usually of low intensity was reported by 8.8 %. The poor factors for preserving OF were its low baseline level, elderly age, or severe post-RPE erectile dysfunction.Conclusion. There were significant OF changes after RPE, which should be kept in mind while treating this category of patients.

In 171 patients with prostate cancer before radical prostatectomy assessed the frequency and nature of sexual disorders using the IIEF and hardness scale member. Erectile function was normal in only 73 (42,7%) respondents, 96 (57,3%) had reduced erection varying degrees, and in 74 (43,8%) patients had severe erectile dysfunction. A similar trend noted by studying the hardness of erection: 86 (54,9%) patients had an erection sufficient for sexual intercourse, but only 36 (21,1%) had erectile dysfunction at all. Orgasmic function was preserved in 111 (64,9%) of the surveyed patients, and in 89 (52%) of them was high. Level of erectile function depends on the patient's age and the presence of a concomitant cardiovascular disease, such as atherosclerosis and hypertension. Only 50,9% of patients show a high interest in restoring erectile function after surgery.