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Диспареуния у женщин в пре- и постменопаузальном периоде
Диспареуния у женщин в пре- и постменопаузальном периоде
Федорова А.И. Диспареуния у женщин в пре- и постменопаузальном периоде. Гинекология. 2016; 18 (1): 13–18.
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Аннотация
В статье представлены современные взгляды на множественные патогенетические механизмы развития диспареунии у женщин в пре- и постменопаузальном периоде с позиции биопсихосоциального подхода. Отмечена важность исследования психического и сексуального статуса пациенток. Обсуждены современные подходы к терапии вульвовагинальной атрофии, лежащей в основе диспареунии. Для смешанных форм диспареунии представлен мультидисциплинарный, патогенетический ориентированный терапевтический подход, гибко сочетающий медикаментозную терапию, психофармакотерапию, психотерапию и сексологическое консультирование.
Ключевые слова: диспареуния, урогенитальные расстройства, вульвовагинальная атрофия, психосоматика, постменопауза, эстриол.
Key words: dyspareunia, urogenital disorders, vulvovaginal atrophy, psychosomatics, postmenopause, estriol.
Ключевые слова: диспареуния, урогенитальные расстройства, вульвовагинальная атрофия, психосоматика, постменопауза, эстриол.
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Key words: dyspareunia, urogenital disorders, vulvovaginal atrophy, psychosomatics, postmenopause, estriol.
Полный текст
Список литературы
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1: 79–86. / Rozanov V.A. Stress i psikhicheskoe zdorov'e (neirobiologicheskie aspekty). Sotsial'naia i klinicheskaia psikhiatriia. 2013;
1: 79–86. [in Russian]
2. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet-Gynecol 1996; 87 (1): 55–8.
3. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: A perpetuating cycle. J Sex Med 2012; 9: 2077–92.
4. Sinha A, Ewies AA. Non-hormonaltopical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric 2013; 16 (3): 305–12.
5. Nappi RE, Kokot-Kierapa M. Women’s voice in the menopause: result froman international survey on vaginal atrophy. Maturitas 2010; 7 (3): 233–8.
6. Palacios S. Managing urogenital atrophy. Maturitas 2009; 63 (4): 305–12.
7. Simon JA, Kokot-Kierapa M, Goldshtein JI, Nappi RE. Vaginal health in the Unated States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2013; 20 (10): 1043–8.
8. Комплексный подход к лечению вульводинии. Акушерство и гинекология. 2014; 8: 112–6. / Kompleksnyi podkhod k lecheniiu vul'vodinii. Akusherstvo i ginekologiia. 2014; 8: 112–6. [in Russian]
9. Междисциплинарный подход к терапии диспареунии. Журн. акушерства и женских болезней. 2006; LV (4): 101–4. / Mezhdistsiplinarnyi podkhod k terapii dispareunii. Zhurn. akusherstva i zhenskikh boleznei. 2006; LV (4): 101–4. [in Russian]
10. Castelo-Branco C, Cancelo MJ, Villero J et al. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005; 52 (Suppl. 1): S46–52.
11. Gardella B, Porru D, Nappi RE et a. Interstitial cystitis is associated with vulvodynia and sexual dysfunction. A case control study. J Sex Med 2011; 8: 1726–34.
12. Pessina MA, Hoyt RF, Goldshtein JI, Traish AM. Differential effects of estradiol, progesterone and testosterone on vaginal structural integrity. Endocrinology 2006; 147: 691–9.
13. Федорова А.И. Эндокринологические аспекты сексуального здоровья женщин Журн. акушерства и женских болезней. 2013; LX (5): 73–84. / Fedorova A.I. Endokrinologicheskie aspekty seksual'nogo zdorov'ia zhenshchin Zhurn. akusherstva i zhenskikh boleznei. 2013; LX (5): 73–84. [in Russian]
14. Bancroft J. The endocrinology of sexual arousal. J Endocrinol 2005; 186: 411–22.
15. Федорова А.И., Новиков Е.И. Диспареуния: междисциплинарный подход к диагностике. Журн. акушерства и женских болезней. 2007; LVI (2): 48–54. / Fedorova A.I., Novikov E.I. Dispareuniia: mezhdistsiplinarnyi podkhod k diagnostike. Zhurn. akusherstva i zhenskikh boleznei. 2007; LVI (2): 48–54. [in Russian]
16. McEwan BS, Kalia M. The role of corticosteroids and stress in chronic pain conditions. Metabolism 2010; 59: S9–15.
17. Ehrström S, Kornfeld D, Rylander E, Bohm-Starke N. Chronic stress in women with localized provoked vulvodynia. J Psychosom Obstet Gynaecol 2009; 30: 73–9.
18. Harlow BL, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001; 185: 545–50.
19. Глазунова А.В., Юренева С.В. Распространенность вульвовагинальной атрофии и ее влияние на качество жизни женщин. Вопросы терминологии и безопасности локальной гормональной терапии. Акушерство и гинекология. 2014; 11: 29–43. / Glazunova A.V., Iureneva S.V. Rasprostranennost' vul'vovaginal'noi atrofii i ee vliianie na kachestvo zhizni zhenshchin. Voprosy terminologii i bezopasnosti lokal'noi gormonal'noi terapii. Akusherstvo i ginekologiia. 2014; 11: 29–43. [in Russian]
20. Labrie F, Archer DF, Bouchard C et al. Intravaginal dehydroepiandrosterone (prasterone), a highly efficient treatment of dyspareunia. Climacteric 2011; 14: 282–8.
21. Bachmann GA, Komi JO. The Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause 2010; 17 (3): 480–6.
22. Kagan R, Williams RS, Pan K et al. H. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause 2010; 17 (2): 281–9.
23. Somboonporn W, Bell RJ, Devis SR. Testosterone for peri and post menopausal women. Cochrane Database Syst Rev 2010; Iss 4: Art.No. CD004509 [PMID: 16235365].
24. Brotto L. Mindfulness applications to women's sexual dysfunction: Applications for low desire, sexual distress, and provoked vestibulodynia. J Sex Med 2011; 8 (Suppl. 3): 94.
25. Терапия психогенных диспареуний. Рос. психиатр. журн. 2007; (5): 60–4. / Terapiia psikhogennykh dispareunii. Ros. psikhiatr. zhurn. 2007; (5): 60–4. [in Russian]
2. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet-Gynecol 1996; 87 (1): 55–8.
3. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: A perpetuating cycle. J Sex Med 2012; 9: 2077–92.
4. Sinha A, Ewies AA. Non-hormonaltopical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric 2013; 16 (3): 305–12.
5. Nappi RE, Kokot-Kierapa M. Women’s voice in the menopause: result froman international survey on vaginal atrophy. Maturitas 2010; 7 (3): 233–8.
6. Palacios S. Managing urogenital atrophy. Maturitas 2009; 63 (4): 305–12.
7. Simon JA, Kokot-Kierapa M, Goldshtein JI, Nappi RE. Vaginal health in the Unated States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2013; 20 (10): 1043–8.
8. Kompleksnyi podkhod k lecheniiu vul'vodinii. Akusherstvo i ginekologiia. 2014; 8: 112–6. [in Russian]
9. Mezhdistsiplinarnyi podkhod k terapii dispareunii. Zhurn. akusherstva i zhenskikh boleznei. 2006; LV (4): 101–4. [in Russian]
10. Castelo-Branco C, Cancelo MJ, Villero J et al. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005; 52 (Suppl. 1): S46–52.
11. Gardella B, Porru D, Nappi RE et a. Interstitial cystitis is associated with vulvodynia and sexual dysfunction. A case control study. J Sex Med 2011; 8: 1726–34.
12. Pessina MA, Hoyt RF, Goldshtein JI, Traish AM. Differential effects of estradiol, progesterone and testosterone on vaginal structural integrity. Endocrinology 2006; 147: 691–9.
13. Fedorova A.I. Endokrinologicheskie aspekty seksual'nogo zdorov'ia zhenshchin Zhurn. akusherstva i zhenskikh boleznei. 2013; LX (5): 73–84. [in Russian]
14. Bancroft J. The endocrinology of sexual arousal. J Endocrinol 2005; 186: 411–22.
15. Fedorova A.I., Novikov E.I. Dispareuniia: mezhdistsiplinarnyi podkhod k diagnostike. Zhurn. akusherstva i zhenskikh boleznei. 2007; LVI (2): 48–54. [in Russian]
16. McEwan BS, Kalia M. The role of corticosteroids and stress in chronic pain conditions. Metabolism 2010; 59: S9–15.
17. Ehrström S, Kornfeld D, Rylander E, Bohm-Starke N. Chronic stress in women with localized provoked vulvodynia. J Psychosom Obstet Gynaecol 2009; 30: 73–9.
18. Harlow BL, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001; 185: 545–50.
19. Glazunova A.V., Iureneva S.V. Rasprostranennost' vul'vovaginal'noi atrofii i ee vliianie na kachestvo zhizni zhenshchin. Voprosy terminologii i bezopasnosti lokal'noi gormonal'noi terapii. Akusherstvo i ginekologiia. 2014; 11: 29–43. [in Russian]
20. Labrie F, Archer DF, Bouchard C et al. Intravaginal dehydroepiandrosterone (prasterone), a highly efficient treatment of dyspareunia. Climacteric 2011; 14: 282–8.
21. Bachmann GA, Komi JO. The Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause 2010; 17 (3): 480–6.
22. Kagan R, Williams RS, Pan K et al. H. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause 2010; 17 (2): 281–9.
23. Somboonporn W, Bell RJ, Devis SR. Testosterone for peri and post menopausal women. Cochrane Database Syst Rev 2010; Iss 4: Art.No. CD004509 [PMID: 16235365].
24. Brotto L. Mindfulness applications to women's sexual dysfunction: Applications for low desire, sexual distress, and provoked vestibulodynia. J Sex Med 2011; 8 (Suppl. 3): 94.
25. Terapiia psikhogennykh dispareunii. Ros. psikhiatr. zhurn. 2007; (5): 60–4. [in Russian]
1: 79–86. / Rozanov V.A. Stress i psikhicheskoe zdorov'e (neirobiologicheskie aspekty). Sotsial'naia i klinicheskaia psikhiatriia. 2013;
1: 79–86. [in Russian]
2. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet-Gynecol 1996; 87 (1): 55–8.
3. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: A perpetuating cycle. J Sex Med 2012; 9: 2077–92.
4. Sinha A, Ewies AA. Non-hormonaltopical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric 2013; 16 (3): 305–12.
5. Nappi RE, Kokot-Kierapa M. Women’s voice in the menopause: result froman international survey on vaginal atrophy. Maturitas 2010; 7 (3): 233–8.
6. Palacios S. Managing urogenital atrophy. Maturitas 2009; 63 (4): 305–12.
7. Simon JA, Kokot-Kierapa M, Goldshtein JI, Nappi RE. Vaginal health in the Unated States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2013; 20 (10): 1043–8.
8. Комплексный подход к лечению вульводинии. Акушерство и гинекология. 2014; 8: 112–6. / Kompleksnyi podkhod k lecheniiu vul'vodinii. Akusherstvo i ginekologiia. 2014; 8: 112–6. [in Russian]
9. Междисциплинарный подход к терапии диспареунии. Журн. акушерства и женских болезней. 2006; LV (4): 101–4. / Mezhdistsiplinarnyi podkhod k terapii dispareunii. Zhurn. akusherstva i zhenskikh boleznei. 2006; LV (4): 101–4. [in Russian]
10. Castelo-Branco C, Cancelo MJ, Villero J et al. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005; 52 (Suppl. 1): S46–52.
11. Gardella B, Porru D, Nappi RE et a. Interstitial cystitis is associated with vulvodynia and sexual dysfunction. A case control study. J Sex Med 2011; 8: 1726–34.
12. Pessina MA, Hoyt RF, Goldshtein JI, Traish AM. Differential effects of estradiol, progesterone and testosterone on vaginal structural integrity. Endocrinology 2006; 147: 691–9.
13. Федорова А.И. Эндокринологические аспекты сексуального здоровья женщин Журн. акушерства и женских болезней. 2013; LX (5): 73–84. / Fedorova A.I. Endokrinologicheskie aspekty seksual'nogo zdorov'ia zhenshchin Zhurn. akusherstva i zhenskikh boleznei. 2013; LX (5): 73–84. [in Russian]
14. Bancroft J. The endocrinology of sexual arousal. J Endocrinol 2005; 186: 411–22.
15. Федорова А.И., Новиков Е.И. Диспареуния: междисциплинарный подход к диагностике. Журн. акушерства и женских болезней. 2007; LVI (2): 48–54. / Fedorova A.I., Novikov E.I. Dispareuniia: mezhdistsiplinarnyi podkhod k diagnostike. Zhurn. akusherstva i zhenskikh boleznei. 2007; LVI (2): 48–54. [in Russian]
16. McEwan BS, Kalia M. The role of corticosteroids and stress in chronic pain conditions. Metabolism 2010; 59: S9–15.
17. Ehrström S, Kornfeld D, Rylander E, Bohm-Starke N. Chronic stress in women with localized provoked vulvodynia. J Psychosom Obstet Gynaecol 2009; 30: 73–9.
18. Harlow BL, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001; 185: 545–50.
19. Глазунова А.В., Юренева С.В. Распространенность вульвовагинальной атрофии и ее влияние на качество жизни женщин. Вопросы терминологии и безопасности локальной гормональной терапии. Акушерство и гинекология. 2014; 11: 29–43. / Glazunova A.V., Iureneva S.V. Rasprostranennost' vul'vovaginal'noi atrofii i ee vliianie na kachestvo zhizni zhenshchin. Voprosy terminologii i bezopasnosti lokal'noi gormonal'noi terapii. Akusherstvo i ginekologiia. 2014; 11: 29–43. [in Russian]
20. Labrie F, Archer DF, Bouchard C et al. Intravaginal dehydroepiandrosterone (prasterone), a highly efficient treatment of dyspareunia. Climacteric 2011; 14: 282–8.
21. Bachmann GA, Komi JO. The Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause 2010; 17 (3): 480–6.
22. Kagan R, Williams RS, Pan K et al. H. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause 2010; 17 (2): 281–9.
23. Somboonporn W, Bell RJ, Devis SR. Testosterone for peri and post menopausal women. Cochrane Database Syst Rev 2010; Iss 4: Art.No. CD004509 [PMID: 16235365].
24. Brotto L. Mindfulness applications to women's sexual dysfunction: Applications for low desire, sexual distress, and provoked vestibulodynia. J Sex Med 2011; 8 (Suppl. 3): 94.
25. Терапия психогенных диспареуний. Рос. психиатр. журн. 2007; (5): 60–4. / Terapiia psikhogennykh dispareunii. Ros. psikhiatr. zhurn. 2007; (5): 60–4. [in Russian]
________________________________________________
2. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet-Gynecol 1996; 87 (1): 55–8.
3. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: A perpetuating cycle. J Sex Med 2012; 9: 2077–92.
4. Sinha A, Ewies AA. Non-hormonaltopical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric 2013; 16 (3): 305–12.
5. Nappi RE, Kokot-Kierapa M. Women’s voice in the menopause: result froman international survey on vaginal atrophy. Maturitas 2010; 7 (3): 233–8.
6. Palacios S. Managing urogenital atrophy. Maturitas 2009; 63 (4): 305–12.
7. Simon JA, Kokot-Kierapa M, Goldshtein JI, Nappi RE. Vaginal health in the Unated States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2013; 20 (10): 1043–8.
8. Kompleksnyi podkhod k lecheniiu vul'vodinii. Akusherstvo i ginekologiia. 2014; 8: 112–6. [in Russian]
9. Mezhdistsiplinarnyi podkhod k terapii dispareunii. Zhurn. akusherstva i zhenskikh boleznei. 2006; LV (4): 101–4. [in Russian]
10. Castelo-Branco C, Cancelo MJ, Villero J et al. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005; 52 (Suppl. 1): S46–52.
11. Gardella B, Porru D, Nappi RE et a. Interstitial cystitis is associated with vulvodynia and sexual dysfunction. A case control study. J Sex Med 2011; 8: 1726–34.
12. Pessina MA, Hoyt RF, Goldshtein JI, Traish AM. Differential effects of estradiol, progesterone and testosterone on vaginal structural integrity. Endocrinology 2006; 147: 691–9.
13. Fedorova A.I. Endokrinologicheskie aspekty seksual'nogo zdorov'ia zhenshchin Zhurn. akusherstva i zhenskikh boleznei. 2013; LX (5): 73–84. [in Russian]
14. Bancroft J. The endocrinology of sexual arousal. J Endocrinol 2005; 186: 411–22.
15. Fedorova A.I., Novikov E.I. Dispareuniia: mezhdistsiplinarnyi podkhod k diagnostike. Zhurn. akusherstva i zhenskikh boleznei. 2007; LVI (2): 48–54. [in Russian]
16. McEwan BS, Kalia M. The role of corticosteroids and stress in chronic pain conditions. Metabolism 2010; 59: S9–15.
17. Ehrström S, Kornfeld D, Rylander E, Bohm-Starke N. Chronic stress in women with localized provoked vulvodynia. J Psychosom Obstet Gynaecol 2009; 30: 73–9.
18. Harlow BL, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001; 185: 545–50.
19. Glazunova A.V., Iureneva S.V. Rasprostranennost' vul'vovaginal'noi atrofii i ee vliianie na kachestvo zhizni zhenshchin. Voprosy terminologii i bezopasnosti lokal'noi gormonal'noi terapii. Akusherstvo i ginekologiia. 2014; 11: 29–43. [in Russian]
20. Labrie F, Archer DF, Bouchard C et al. Intravaginal dehydroepiandrosterone (prasterone), a highly efficient treatment of dyspareunia. Climacteric 2011; 14: 282–8.
21. Bachmann GA, Komi JO. The Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause 2010; 17 (3): 480–6.
22. Kagan R, Williams RS, Pan K et al. H. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause 2010; 17 (2): 281–9.
23. Somboonporn W, Bell RJ, Devis SR. Testosterone for peri and post menopausal women. Cochrane Database Syst Rev 2010; Iss 4: Art.No. CD004509 [PMID: 16235365].
24. Brotto L. Mindfulness applications to women's sexual dysfunction: Applications for low desire, sexual distress, and provoked vestibulodynia. J Sex Med 2011; 8 (Suppl. 3): 94.
25. Terapiia psikhogennykh dispareunii. Ros. psikhiatr. zhurn. 2007; (5): 60–4. [in Russian]
Авторы
А.И.Федорова*
ГБОУ ВПО Северо-Западный государственный медицинский университет им. И.И.Мечникова Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*feanna@inbox.ru
I.I.Mechnikov State Northwestern Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation,
Saint Petersburg, ul. Kirochnaia, d. 41
*feanna@inbox.ru
ГБОУ ВПО Северо-Западный государственный медицинский университет им. И.И.Мечникова Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*feanna@inbox.ru
________________________________________________
I.I.Mechnikov State Northwestern Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation,
Saint Petersburg, ul. Kirochnaia, d. 41
*feanna@inbox.ru
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