Sexual infantility

Description:

The sexual or genital infantility stated aged is more senior than 15 years at individuals with a female genotype, is characterized by an anatomic and histologic underdevelopment of generative organs and their hypofunction. If sexual infantility is followed by the general infantility (and it happens in half of all observations), then there is an opportunity to establish the specified  diagnosis  at    earlier  age  (13-14 years).

The called pathology is found in 4-16% of the girls who had routine inspection.

Distinguish two options of genital infantility:

a) followed by ovarian insufficiency,

b) not followed by a hypo-ovaria.

At sexual infantility cases of an inborn refraktornost or a hyposensitivity of ovaries to gonadotrophins, and the derivative paramezonefralny courses - to steroid hormones are not rare at all.

Reasons of sexual infantility:

To Algodismenorey at infantility connect, first, with insufficient elasticity of a uterus which has an effect during premenstrual inflow of blood to it; secondly, with difficulty of passing of menstrual blood and fragments of an endometria on long and narrow (with an excess because of a giperantefleksiya) to the cervical channel; thirdly, with the anomalies of an innervation leading to a diskoordination of reductions of various departments of a uterus and to a pathological impulsation in TsNS.

Symptoms of sexual infantility:

The infantile girl usually low (or above an average) growth, thin-boned; obtuse epigastric angle. Basin is so peculiar that in obstetric classifications it is allocated as "children's".

At 3 girls from 4 late approach of menarche takes place (after 16 years). Algodismenorey at genital infantility meets unusually often - to 80%. Pain arises in 2 - 3 days prior to monthly and proceeds during them. With age альгодисменорея decreases, and after the delivery disappears at all.

In a symptom complex of sexual infantility the leading place is taken by the condition of a uterus called by a hypoplasia. Distinguish three degrees of a hypoplasia of a uterus. Rudimentary, or germinal, a uterus (uterus foetalis) - its length on the probe makes less than 3,5 cm, and the most part a neck. This option meets seldom; it adjoins rather actually anomalies of development, than an underdevelopment. The resistant amenorrhea is characteristic. Small menstrualnopodobny allocations are sometimes observed.

The infantile uterus (uterus infantilis) - length on the probe makes 3,5-5,0 cm; the ratio of a neck and body is expressed as 3:1, i.e. same, as at the girl who did not enter the pubertal period yet. Besides, by additional methods of a research state a uterus giperantefleksiya, weak expressiveness of vaults of the vagina, high location of ovaries, excess crimpiness of uterine tubes. Periods are rare, painful.

The hypoplastic uterus (uterus hypoplastics) - the cavity length measured by the probe reaches 5-7 cm; a ratio of a neck and body correct - 1:3. The hypoplastic uterus is regarded not only as a result of the damaging influences taking place in antenatal and early post-natal the periods but also as result postponed in the recent past (in the prepubertatny period) local inflammatory processes or hardest general diseases. This pathology quite often independently disappears after the beginning of sex life and emergence of pregnancy.

Diagnosis:

At children's age, as a rule, no complaints arise. The most typical complaints at pubertal age - late emergence, frustration (on hypomenstrual type) and morbidity monthly. Sometimes concern passes an opinion on lack of interest in representatives of an opposite sex.

At survey the typical "infantile" constitution attracts attention: growth deviations, insufficiently created thorax, hypoplastic mammary glands, the narrowed basin, scanty pilosis on a pubis and in axillary areas. Small pudental lips are given ahead of big, the clitoris seems increased because of some hypoplasia of outside genitalias. The underdevelopment of outside sexual parts with sufficient constancy is combined with sexual infantility; at the same time between a condition of outside and internal generative organs of direct dependence is not present. By the way, at partial sexual infantility mammary glands are developed enough, and in 37% - is excessive. At some girls suffering from infantility tendency to obesity is noted.

Apply to diagnosis of infantility also additional methods of a research. Low indicators of physical development of the girl in 35,4% of cases demonstrate also lag of sexual development. Sizes of the outside sizes of a basin, in particular conjugata externa which to 14-year age hardly reaches 17,5 cm then its gain is slowed down are especially indicative in this respect.

Tests of functional diagnosis the anovulatory cycle comes to light, as a rule. At infantility excretion of gonadotrophins is raised, and sexual steroids - is lowered to 4 - 8 mkg/days; level 17-KC meets age standard.

At a rectal bryushnostenochnom (or vulval брюшностеночном) a research lag of size of a uterus, dominance of length of a neck, an excess inclination of a uterus of a kpereda are defined. Quite often good help in diagnosis are results of uterine probing (carefully!).

Among radiological methods the pnevmoginekografiya and a rentgenogisterografiya have the greatest diagnostic value, and the last allows to track a condition of an internal pharynx (there is no smykaniye), the cervical channel (long, the expressed palmlike folds), uterine tubes (thin, gyrose). Lag of the bone age defined, for example, by a brush X-ray analysis from calendar reaches in case of infantility of 1-4 years.

The maintenance of a sex chromatin and karyotype are not changed.

Perspective are represented registration of biopotentials of a uterus (are reduced) also a reografiya of pelvic bodies (an insufficient krovenapolneniye).

Treatment of sexual infantility:

Therapy of sexual infantility is in most cases successful. Whenever possible the prime cause of lag of generative organs in development is eliminated. If at the adult women suffering from infantility the replaceable or stimulating hormonal therapy, then at the girls who are in the pubertal or teenage periods is undertaken, hormonal therapy is shown not always (at least not at once). Previously within 3 months it is necessary to create "a readiness background" what it is provided to apply the substances (vitamins E, C, B1, B6) intended for a sensitization of generative organs to impact on them further of sex hormones to. Gangleronum course (on 0,04 g once a day) or Dimedrol or tavegil in the minimum single dose of the same duration is at the same time conducted.

Starting hormonal therapy, it is necessary to be convinced once again of lack of vicious gonads with a blastomatous potentiality: men's false hermaphroditism, testicular feminization, gormonprodutsiruyushchy tumor of an ovary, etc. Within the next 3-4 months undertake cyclic administration of estrogen and progesterone (or Pregninum) in the minimum doses. Both drugs are appointed sublingual.

Approximate scheme: from 1st to the 5th day of a cycle on a half of a tablet (0,01 mg) of Methyloestradiolum once a day; from the 6th to the 10th day of a cycle - on one tablet (0,02 mg) of Methyloestradiolum once a day; from the 11th to the 15th day of a cycle - on Methyloestradiolum tablet 2 times a day (0,05 mg a day); from the 16th to the 20th day of a cycle - on 2-2,5 tablets of Methyloestradiolum 2 times a day (0,1-0,02 mg a day); from the 18th to the 20th day of a cycle - Pregninum on one tablet (10 mg) once a day; from 21st to the 25th day of a cycle - Pregninum on one tablet 3 times a day (30 mg a day).

After a course of hormonal treatment it is necessary to take a three-months break; the following course is appointed only in case of need, i.e. at preservation of an irregularity of a spontaneous cycle, algomenorrhea, infantile look. 3-4 three-months courses can be most conducted.

More powerful hormonal influence is not physiologic and fraught with a number of the direct and delayed complications. For increase in sensitivity of fabrics to estrogen from 1st to the 20th day of a cycle appoint Thyreoidinum (on 0,025 g a day) which is especially shown at obesity.

Parallel to hormonal therapy it is recommended to carry out physical therapy (paraffin); electroreflexotherapy (acupuncture, an electropuncture, an intranasal electrophoresis with B1 vitamin, a collar on Shcherbaka, electrostimulation of receptors of a neck of uterus, an abdominal decompression, remedial gymnastics). The principles of a balneofizioterapiya according to V. M. Strugatsky, differentially applied concerning the persons suffering from infantility deserve attention.

Such types of treatment as mud, the gynecologic massage, fabric therapy, introduction of an intrauterine spiral, introduction of gonadotrophins which are so widely applied to treatment of infantility at adults do not enjoy popularity at specialists in gynecology of children and teenagers. Care is dictated by fear to cause irreversible disturbances of specific functions of a female body or blastomatous growth.