Background. Sexual dysfunction is a common problem in women with multiple sclerosis (MS). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a specific instrument to evaluate sexual dysfunction in MS patients. The purpose of the study was to translate and validate the Ukrainian version of the MSISQ-19. Materials and methods. The original version of MSISQ-19 was translated under a standard procedure. A sample of 126 females with MS completed the questionnaire. Internal consistency was evaluated using Cronbach's alpha. Convergent validity was established using correlation with the Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Expanded Disability Status Scale (EDSS). Results. Total scale reliability (Cronbach's α = 0.943) and reliability for the primary (Cronbach's α = 0.901), secondary (Cronbach's α = 0.875), and tertiary subscales (Cronbach's α = 0.918) were high. Disability level, measured with the EDSS, and quality of life, measured with the MSQOL-54, significantly correlated with MSISQ-19 total score. Both physical and mental health-related quality of life on the MSQOL-54 significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Satisfaction with sexual function significantly correlated with MSISQ-19 total score, and with primary, secondary, and tertiary sexual dysfunction. Conclusions. The study findings suggest that the Ukrainian version of the MSISQ-19 is a reliable and valid instrument for sexual function assessment in Ukrainian women with MS. It can be used during routine counseling to introduce the theme of sexuality, to detect sexual dysfunction, provide treatment, and prevent the development of more severe problems and therefore preserve the proper quality of life for MS patients.
The objective: to increase the effectiveness of local therapy for recurrent nonspecific vaginitis associated with cervicitis in women of reproductive age on the basis of a comparative evaluation of combined drugs Terzhinan and Neo Penotran Forte. Materials and methods. A prospective, open comparative study included 56 women aged 27.5±2.8 years with recurrent nonspecific vaginitis and cervicitis who were randomized to the main group and comparison group. Patients of the main group (n=28) received the drug Terzhinan® (1 vaginal tablet in the evening, before bed, for 10 days). The comparison group included 28 patients who received Neo-Pentran Forte (1 vaginal suppository in the evening, before bedtime, for 10 days), one vaginal suppository containing 750 mg of metronidazole and 200 mg of miconazole nitrate. The complex clinical-paraclinical examination included the determination of the state of the vaginal microbiota using several methods in parallel: a bacterioscopy of vaginal smears stained by Gram, a bacteriological rapid method using AFGENITAL SYSTEM (Liofilchem®, Italy), real-time PCR (Florocenosis) with detection antigens of chlamydia, herpes simplex virus, human papillomavirus, trichomonads. Results. The main reason for the treatment of patients were abundant pathological discharge from the genital tract (73.2%), pruritus (37.5%) and burning (23.2%) in the vulva, pain during sexual intercourse (8.9%), while 33.9% of women expressed combined complaints. Attention was drawn to the significant frequency of dyshormonal pathology among women with recurrent cervico-vaginal infections. In the examined women, uterine leiomyoma was diagnosed (28.6%), genital endometriosis (19.6%), fibrocystic breast disease (37.5%), combined benign dyshormonal diseases of the genital organs (14.3%). About 21.4% of patients treatment of thyroid gland dysfunction (hypothyroidism). According to the comprehensive examination, in all patients of clinical groups, decompensated vaginal dysbiosis was diagnosed, which was manifested by a sharp decrease in the absence of Lactobacillus spp strains in 39.3% of patients and an increase in the number of isolated opportunistic and pathogenic microorganisms to 1011 CFU/ml with an increase in the number of microorganisms in microbial associations (from 2–3 to 5–6 conditionally pathogenic and pathogenic pathogens) in all the cases analyzed. When using the genital express system in vaginal contents, women of the main group identified Escherichia coli (17.9%), Pseudomonas spp. (10.7%), Gardnerella vaginalis (39.3%), Staphylococcus aureus (17 9%), Enterococcus faecalis (25.0%), Streptococcus Group B (10.7%), Candida spp. (46.4%), Mycoplasma spp./Ureaplasma ur. in the title > 105 (14.0%). In the comparison group, the spectrum of detected pathogenic and conditionally pathogenic microorganisms did not differ significantly from the data of the main group. 92.6% of patients in the main group had a pronounced positive clinical effect, and a positive microbiological effect was achieved in 96.4% of cases that persisted during the next two months of follow-up. Without additional prescription of antifungal agents, a positive effect was achieved in 84.6% of patients in the main group with mixed bacterial-candidiasis vaginitis at 54.5% in the comparison group. The independent recovery of the lactobacilli pool to a titer of 107–109 CFU/ml in 17.9% of patients with a lack of detection of lactobacilli before treatment. A similar effect was not observed in the comparison group. Сonclusion. In a comparative study of the results of the use of Terzhinan and Neo-Penotran Forte in monotherapy in patients with inflammatory diseases of the lower genitalia (nonspecific recurrent vaginitis and cervicitis), the high clinical and microbiological efficacy of Terzhinan has been demonstrated. Key words: mixed vaginitis, cervicitis, Terzhinan, Neo-Penotran Forte.
The objective: evaluating the effectiveness and safety of the drug complex hinekit during preconception preparation for women with complicated pregnancy loss history and uncomplicated mixed genital infections. Patients and methods. The study involved 65 women with reproductive losses in history, who turned over the abnormal vaginal discharge. Diagnosis of sexual transmitted infections (C. trachomatis, T. vaginalis, HSV-II, HPV), assessment of vaginal microbiota was performed by PCR with detection results in real time. Bacterial Vaginosis verified by the Amsel system. Results. All the examinees in the history have miscarriage in the first (56.9%) or the second (43.1%) trimester of pregnancy. According to the results of the patient survey were divided into clinical groups. In 26.2% of women infectious pathology of the lower genital tract has not been confirmed, 26.2% of patients did not give consent to participate in the study and were formed in the control group that received therapy according to existing clinical settings. 31 patients with mixed genital infection (study group) received complex preparation gіnekit. This positive trend was observed in all the patients of the main group (the disappearance of subjective sensations on average 2.2±0.3 hours). After treatment T. vaginalis, BV were not detected in one patient, active mycotic process in the absence of complaints remained at 4.8% of women, complete eradication of C. trachomatis was achieved in 92.3% of patients. Conclusions. Reducing the duration of treatment of mixed genital infections at the preconception in women with reproductive losses in the history is achieved in terms of clinical, microbiological and pharmaco-economic benefits by prescribtion an gіnekit preparation. Summary of clinical and microbiological effects of the proposed approach is 96.0 ± 0.9%, which corresponds to all requirements for multimodal therapy of genital infections, and no side effects, short course of treatment provides a high compliance of patients (9.2±0.7 points). Key words: mixed genital infections, miscarriages, gіnekit, azithromycin, fluconazole, seknidazol.
Lviv national medical University named Danylo Galitsky In the article there are the lighted up questions of terminology, classification, diagnostics and treatment of syndrome of chronic pelvic pain. The features of diagnostics and differentiation process are considered in relation to the syndrome of chronic pelvic pain in gynecological practice. An accent is done, that treatment of chronic pelvic pain is fully determined a verification of basic disease, if it be impossible to find out primary cause (idiopathic genesis of chronic pelvic pain), symptomatic therapy is conducted. Key words: chronic pelvic pain, pelvic venocongestion, genital endometriosis, dysmenorrhea, pelvic inflammatory diseases.
The document was approved at an expanded meeting of the Ukrainian Society of Gynecological Endocrinology with the involvement of all board members and representatives of the Association of Obstetricians-Gynecologists of Ukraine, the Association of Pharmacologists of Ukraine, the Association of Anesthesiologists of Ukraine, as well during the Third Ukrainian School of Gynecological and Reproductive Endocrinology with international participation ISGE 19–20.03.21.The COVID-19 pandemic has significantly impacted medical practice, in terms of organizational and clinical practices, posing a number of complex and contradictory challenges for professionals.This document is the result of the systematization of scientific data available by March 2021 and recommendations of international medical and specialized professional societies on controversial clinical issues in gynecological practice caused by the COVID-19 pandemic, as well as certain issues of safety and ratio of using hormonal drugs. The involvement of experts from professional associations of the obstetric and gynecological field, pharmacology, anesthesiology and vascular surgery and phlebology in the working group made it possible to formulate clinically justified provisions of the position.The position includes three thematic sections: “On the use of estrogen-containing combined hormonal contraceptives (CHC) during the COVID-19 pandemic”; “On the use of menopausal hormone therapy (MHT) during the COVID-19 pandemic”; “On the issue of unregistered compounded bioidentical hormones”. At the beginning of each thematic section, the main conclusions of the consensus position of professional medical associations are presented. According to the data available by March 2021, there is no reason to limit the use of CHC or MHT in healthy women (currently not having COVID-19). The question of CHC or MHT discontinuing or switching to other forms by women with COVID-19 should be decided depending on the severity of the disease, the total set of risk factors for thromboembolic complications and other individual characteristics of the clinical situation. Further research will provide elaboration of more detailed algorithms. Physicians need to be vigilant about the safety of compounded Bioidentical Hormonal Therapy (cBHT) in any dosage form (including pellets), especially during the COVID-19 pandemic, given the unexplored systemic effects and therefore the potential risks. Preference should be given to officially licensed medicinal products with a well-studied safety profile and clinical effects, the use of which is authorized by doctor's prescription and supported by clinical protocols and guidelines.
The article highlights diagnostic and therapeutic approaches in the syndrome of hyperprolactinemia. General information about the secretion of prolactin, its isoforms, the issues of diagnostic and therapeutic tactics for different genesis of hyperprolactinemia, aspects of monitoring patients, including during pregnancy and breastfeeding, are presented. Key words: hyperprolactinemia, dopamine, prolactinoma, reproductive health, hyperprolactinemic hypogonadism, cabergoline, pregnancy.
Diseases of thyroid gland, according to world statistics, are found in almost 30% of the world’s population. Thyroid dysfunctions, according to many epidemiological studies, are quite widespread in the population. Normal development of the reproductive system occurs under the influence of gonadotropic hormones of the pituitary gland and during normal functioning of the thyroid gland. In turn, the state of the reproductive system has a pronounced effect on the function of the thyroid gland, as evidenced by changes in its function during pregnancy and lactation, in patients with abnormal uterine bleeding, in girls during puberty and women during the menstrual cycle. The objective: is to evaluate the prevalence and effectiveness of diagnosis of dysfunction of thyroid dysfunction in women with reproductive health disorders to improve treatment and rehabilitation activities and quality of life. Materials and methods. In the first stage of a prospective study, 989 women of reproductive age were put through the method of continuous sampling. Based on the results of verifying the gynecological pathology, 350 patients who gave informed consent for participation in the second stage of the study, were divided into clinical groups for further comparative analysis of the prevalence of dysfunction of thyroid gland: I group – 159 (51.3%) patients with combined non-hormonal non-inflammatory pathology of reproductive organs and dyshormonal pathology of the mammary glands (genital endometriosis, adenomyosis / uterine leiomyoma in combination with endometrial hyperplasia), II group – 31 (8.9%) female with PCOS, III – 53 (15.1%) with endometriotic disease, IV group – 57 (16.3%) women with uterine leiomyoma. Absence of gynecological pathology and pathology of mammary glands at the time of the survey was found in 50 (14.3%) of women, which amounted to V group. Results. Structural and functional changes of the thyroid gland were found in 53.4% of women, while the frequency of detection of diffuse goiter I–II st. did not differ between clinical groups (p>0.05). The prevalence of autoimmune thyroiditis was higher in patients with dyshormonal pathology of the reproductive system than in healthy women (p=0.0001). The euthyroid state with combined dyshormonal and proliferative pathology occurred 1.5 to 1.9 times less frequently than in patients of other groups (p≤0.0005). Subclinical hypothyroidism was diagnosed in 39,6% of the I group of women at 12.9%, 15.1% and 14.0% in the II, III and IV groups, respectively. At the same time, the incidence of subclinical hypothyroidism was 60.6% for the I group in women who had diffuse goiter and / or autoimmune thyroiditis, with 8.6% of the manifest hypothyroidism that was absent in women with PCOS, and the prevalence of endometriosis disease and uterine leiomyomies were 1.9% and 3.5%, respectively. Conclusion. Thus, the results of a two-stage study of thyroid gland thyroid dysfunction in women with dyshormonal pathology of reproductive organs of non-inflammatory genesis confirm that dysfunction of the thyroid gland, especially hypothyroidism, is a serious problem for reproductive health, requiring changes in diagnostic and therapeutic approaches. Key words: thyroid gland, autoimmune thyroiditis, hypothyroidism, reproductive health, non-inflammatory dyshormonal diseases of reproductive organs.
Vaginal flora plays an important role in the functioning of the reproductive system. The objective: was to evaluate the efficacy and tolerability of vaginal suppositories of Florica (producer «Lekhim-Kharkiv») in maintaining a normal balance of vaginal microbiota to prevent recurrences of bacterial vaginosis, aerobic and mixed vaginal dysbiosis. Materials and methods. 45 women of reproductive age (from 22 to 35 years) with burdened reproductive (miscarriage, premature birth) and obstetric (postpartum purulent-septic diseases) history were under observation. Results. Application to maintain a normal balance of the vaginal microbiota and prevent the development of dysbiotic processes after the completion of the main course of treatment of BV and aerobic vaginitis of vaginal suppositories Florica, which contain a specially treated mass of live lactic bacteria in optimal quantities to maintain a healthy balance of the microflora of the female sexual sphere (5107 Lactobacillus acidophilus and Bifidobacterium) allows to reduce the frequency of recurrence of BV in 2.9 times. Conclusion. The frequency of recurrence of BV in routine clinical practice is 35.0% during 6 months of observation, which indicates the need to develop effective measures to prevent the recurrence of vaginal dysbiotic processes. Key words: vaginal microbiota, vaginal dysbiosis, bacterial vaginosis, aerobic vaginitis, topical therapy.
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