Dienogest. Profil pięciu pacjentek, u których zastosowano doustną antykoncepcję hormonalną

Od momentu zastosowania pierwszych progestagenów w antykoncepcji hormonalnej nie ustają prace nad ich modyfikacją pod względem jakościowym i ilościowym w celu uzyskania jak największego podobieństwa do naturalnego progesteronu. Nowe progestageny zostały zsyntetyzowane, aby przeciwdziałać androgenizacji czy też wzrostowi aktywności reninowej osocza i stężenia aldosteronu. Celem pracy było zestawienie aktualnego stanu wiedzy na temat mechanizmu działania dienogestu oraz zastosowania w antykoncepcji u pacjentek o konkretnym profilu. Dienogest zapewnia dobrą kontrolę cyklu, zmniejsza intensywność i skraca czas trwania krwawienia miesiączkowego oraz ogranicza dolegliwości związane z bolesnym miesiączkowaniem. Ma on jedynie niewielki wpływ na metabolizm lipidów i węglowodanów, stężenia hormonów nadnerczowych w surowicy oraz parametry ciśnienia krwi. Wydaje się mieć zrównoważony wpływ na układ hemostazy. Preparat ten wykazuje również korzystne oddziaływanie na skórę i włosy oraz wpływa na łagodzenie trądziku pospolitego, co udowodniono w badaniach klinicznych

Factors affecting the choice of drospirenone as the component of combined contraceptive pill in daily clinical practice: the results of nation-wide survey

Objectives: The aim of the multicenter, open-label, post-marketing, observational survey was to assess doctors’ preferences in choosing the progestogen component of the combined contraceptive pill (CCP) and factors affecting this choice in daily clinical practice as well as non-contraceptive reasons use of CCP containing drospirenone (CCPD) and patients’ tolerance and satisfaction with the treatment. Material and methods: This multicenter, open-label, post-marketing, survey was performed nation-wide with the participation of 222 doctors involving and 10,345 patients treated with CCPD. The study questionnaire included questions concerning factors affecting the choice of drospirenone as a component of CCP and assessing prescription pattern of the drug as well as tolerance and satisfaction with the use of CCPD. Results: The doctors frequently declared their choice of drospirenone as the progestogen component of CCP. The most important factors affecting the choice of drospirenone, declared by doctors, were tolerance level, consistent regulation of menstrual cycle and not causing spotting. CCPD was prescribed to patients with irregular menstrual cycles (62.7%) and painful menstruation (46.8%). During follow-up, significantly increased percentage of patients assessed the tolerance of treatment with CCPD as very good (52.5% vs 68.0%; p < 0.01) and very satisfied with its use (61.9% vs 77.8%, p < 0.01). Conclusions: 1) Drospirenone is frequently chosen progestogen component in CCP by Polish gynecologists due to its good tolerance, consistent regulation of the menstrual cycle and no spotting in patients opinion. 2) CCPD was most frequently used in patients with irregular menstrual cycles and painful menstruation. 3) The patients were satisfied with the use CCPD and treatment was well tolerated

Circulating sclerostin levels in relation to nutritional status, sex hormones and selected bone turnover biochemical markers levels in peri- and postmenopausal women

Objectives: Hormonal changes during the peri- and postmenopausal age, especially decreasing estradiol levels as the result of the expired ovarian function, are an established link of the pathogenesis of postmenopausal osteoporosis. The objective of the study was to examine the association between the circulating sclerostin levels and nutritional status, sex hormones and selected bone markers turnover levels in peri- and postmenopausal women. Material and methods: The study enrolled 84 stable-body mass women (31 perimenopausal and 54 postmenopausal). Anthropometric measurements and serum estrone, testosterone, androstenedione, DHEA-S, osteocalcin, β-CTx, 25-OHVitamin D and sclerostin levels were obtained. Results: There were not any differences between body mass, BMI, body fat and waist circumference between the study groups. The serum androstenedione and DHEA-S levels were similar in both study groups. However, estrone and total testosterone levels were observed to be notably higher in the perimenopausal group, unlike in the postmenopausal group (124.1 pg/mL vs. 98.3 pg/mL, p < 0.01 and 0.3 pg/mL vs. 0.22 pg/mL, p < 0.01, respectively). Higher plasma osteocalcin and β-CTx levels were shown in the postmenopausal rather than in the perimenopausal group (19.8 ng/mL vs. 16.8 ng/mL, p < 0.001 and 0.35 ng/mL vs. 0.29 ng/mL, p < 0.05, respectively). Plasma sclerostin and 25-OH-Vitamin D levels were similar. There was not any correlation between plasma sclerostin levels and the other studied parameters. In the multivariate regression analyses, sclerostin levels were proportional to the androstenedione ones (b = 0.06; p < 0.05) but inversely related to the log10(testosterone) levels (b = -0.18; p < 0.05). Conclusions: Circulating sclerostin levels are similar in peri- and postmenopausal women and are related to the androstenedione and testosterone levels regardless of the nutritional status

Funkcjonowanie seksualne i objawy depresyjne u kobiet z różnymi typami stanu przedcukrzycowego — badanie pilotażowe

Introduction: No previous study has investigated sexual functioning in prediabetic women. Aim: This study was aimed at investigating sexual function in young women with various types of prediabetes. Methods: The study included four groups of women: women with isolated impaired fasting glucose (Group A; n=19), isolated impaired glucose tolerance (Group B; n=18), presence of both impaired fasting glucose and impaired glucose tolerance (Group C; n=18), as well as matched healthy controls (Group D; n=19). All participants completed questionnaires evaluating sexual function (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition – BDI-II). Results: The total FSFI and BDI-II scores were lower in Group C than in the remaining groups of women, while the total FSFI score was lower in Groups A and B than in Group D. Patients with both impaired fasting glucose and impaired glucose tolerance had lower scores in all domains (sexual desire, arousal, lubrication, orgasm, sexual satisfaction and dyspareunia). Compared to Group D, Group A was characterized by lower domain scores for sexual desire and sexual satisfaction, while Group B by lower domain scores for desire, arousal and orgasm. In all groups of prediabetic women, the overall FSFI score correlated negatively with the degree of insulin resistance and weakly with the total BDI-II score. Conclusions: Impaired fasting glucose and impaired glucose tolerance may disturb sexual functioning and induce depressive symptoms.Wstęp: W poprzednich badaniach nie oceniano funkcjonowania seksualnego kobiet ze stanem przedcukrzycowym. Badanie miało na celu ocenę funkcji seksualnych u młodych kobiet z różnymi typami stanu przedcukrzycowego. Materiał i metody: Badanie objęło cztery grupy kobiet: kobiety z izolowaną nieprawidłową glikemią na czczo (grupa A, n = 19), izolowaną upośledzoną tolerancją glukozy (grupa B, n = 18), występowaniem zarówno nieprawidłowej glikemii na czczo i upośledzonej tolerancji glukozy (grupa C, n = 18) oraz zdrowe kobiety (grupa D, n = 19). Wszystkie uczestniczki badania wypełniły kwestionariusze oceniające funkcje seksualne (Indeks Funkcji Seksualnych Kobiet — FSFI) oraz obecność i nasilenie objawów depresyjnych (Beck Depression Inventory-Second Edition — BDI-II). Wyniki: Całkowite wartości skal FSFI i BDI-II były niższe w grupie C niż w pozostałych grupach kobiet, podczas gdy całkowita punk­tacja FSFI był niższa w grupach A i B niż w grupie D. Pacjentki z nieprawidłową glikemią na czczo i zaburzeniami tolerancji glukozy miały niższe wyniki we wszystkich podskalach (pożądanie seksualne, pobudzenie seksualne, lubrykacja, orgazm, satysfakcja seksualna i dyspareunia). W porównaniu z grupą D, grupa A charakteryzowała się niższymi wynikami w domenach dla pożądania seksualnego i satysfakcji seksualnej, podczas gdy grupa B miała niższe wyniki w domenach dla pożądania, pobudzenia seksualnego i orgazmu. We wszystkich grupach kobiet ze stanem przedcukrzycowym ogólny wynik FSFI korelował negatywnie ze stopniem insulinooporności i słabo z całkowitym wynikiem skali BDI-II. Wnioski: Nieprawidłowa glikemia na czczo i upośledzona tolerancja glukozy mogą zaburzać funkcjonowanie seksualne i wywołać objawy depresyjne

Paternal engagement during childbirth depending on the manner of their preparation

Objectives: The analysis of the forms of paternal activity depending on the manner of their preparation, including stages of labor. Material and methods: A prospective survey-based study involved 250 fathers who participated in their child’s birth. The fathers included in the study were present during all stages of family-assisted natural labor. The study was conducted one day after childbirth with the use of a survey prepared by the authors. Statistical calculations were conducted using the Statistica PL software. The frequency of individual qualitative features (non-measurable) was assessed by means of a non-parametric χ² (chi-squared) test. The statistical significance level was p < 0.05. Results: A half of the fathers included in the study (52.4%) participated in childbirth with no prior preparation. The dominant form of preparation involved self-education from books, magazines and the Internet (24%). 23.6% of fathers participated in ante-natal classes. The study demonstrated that fathers prepared for childbirth in ante-natal classes more often engaged in the supportive role, provided nursing care and carried out instrumental monitoring during each stage of childbirth. Conclusions: The fathers prepared for childbirth in ante-natal classes more often engage in the supportive role, provide nursing care and carry out instrumental control during each stage of childbirth. Ante-natal classes should be promoted as an optimal form of preparation for active participation in childbirth. Moreover, other forms of paternal ante-natal education as well as continued education in a delivery room should be developed

Sexuality of disabled athletes depending on the form of locomotion

The main purpose of this study was to determine sexuality of disabled athletes depending on the form of locomotion. The study included 170 disabled athletes, aged between 18 and 45. The entire population was divided into 3 research groups depending on the form of locomotion: moving on wheelchairs (n=52), on crutches (n=29) and unaided (n=89). The research tool was a questionnaire voluntarily and anonymously completed by the respondents of the research groups. The questionnaire was composed of a general part concerning the socio-demographic conditions, medical history, health problems, a part dedicated to physical disability as well as the Polish version of the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) evaluating sexual life. STATISTICA 10.0 for Windows was used in the statistical analysis. Subjects moving on crutches were significantly older than ones moving on wheelchairs and unaided (34.41 ±11.00 vs. 30.49 ±10.44 and 27.99 ±10.51 years, respectively) (p=0.018). Clinically significant erectile dysfunctions were most often diagnosed in athletes moving on wheelchairs (70.27%), followed by athletes moving on crutches and moving unaided (60% and 35.42%, respectively; p=0.048). Clinical sexual dysfunctions were diagnosed on a similar level among all female athletes. It was concluded that the form of locomotion may determine sexuality of disabled men. Males on wheelchair revealed the worst sexual functioning. Female athletes moving on wheelchairs, on crutches and moving unaided were comparable in the aspect of their sexual life

Seksualność kobiet z zespołem policystycznych jajników

Objectives: This study aimed to compare sexual function and sexual response, attitude toward sexuality, and relationships with sexual partners in women diagnosed with PCOS and healthy controls. Material and methods: The study included 73 women (aged 23–42 years) diagnosed with PCOS using the Rotterdam criteria and 45 healthy controls. All participants completed a questionnaire assessing socioepidemiological parameters and sexual behavior. Validated instruments were used to assess hirsutism (Ferriman-Gallwey Scale), mental health status (General Health Questionnaire 12 [GHQ 12]), sexuality (Sexuality Scale [SS], Sexual Awareness Questionnaire [SAQ], Multidimensional Sexuality Questionnaire [MSQ], Multidimensional Sexual Self-Concept Questionnaire [MSSCQ]), and sexual function (Polish version of the Mell-Krat Scale [SFK/K Scale]). Results: There were no statistically significant differences in the importance of sexual activity in both groups. Mean scores for the SFK/K Scale, SS, SAQ, MSQ, and MSSQ were similar among women with PCOS and controls, regardless of age. Similarly, sexual needs and reactions were perceived in the same way by both groups. In contrast, women with PCOS rated themselves negatively as sexual partners more frequently than controls. Conclusions: Sexual function and sexual response, attitude toward sexuality, as well as relationships with sexual partners were similar in PCOS subjects and healthy women. However, changes in physical appearance typically associated with PCOS result in deterioration of sexual function. Therefore, it is recommended that all PCOS patients should be referred to a sexual medicine specialist for consultation.Cel pracy: Celem pracy było porównanie funkcji seksualnych i reakcji seksualnych, postawy wobec seksualności, oraz relacje z partnerem seksualnym u kobiet, u których zdiagnozowano zespołem jajników policystycznych (PCOS) i kobiet zdrowych. Materiał i metody: Badaniami objęto grupę 73 kobiet w wieku 23-42 lat, u których zdiagnozowano PCOS wg kryteriów Rotterdamskich oraz grupę kontrolną – 45 zdrowych kobiet. Wszyscy uczestnicy badania wypełnili kwestionariusz zawierający pytania dotyczące parametrów demograficznych, społeczno-kulturowych oraz zachowań seksualnych. Ponadto zastosowano walidowane narzędzia do oceny: hirsutyzmu (Skala Ferriman-Gallwey), stanu zdrowia psychicznego (Kwestionariusze Ogólnego Stanu Zdrowia – GHQ 12), seksualności: Test Postaw Wobec Seksualności – SS, Test Seksualnej Samoświadomości - SAQ, Wielowymiarowy Test Seksualności – MSQ, Wielowymiarowy Test Seksualnego „Ja” – MSSCQ oraz funkcji seksualnych (polska wersja Mell-Krat Scale – SFK/K). Wyniki: Nie stwierdzono statystycznie istotnych różnic w znaczeniu aktywności seksualnej dla badanych kobiet w obu grupach. Średnie uzyskanych wyników dla skal: SFK/K, SS, SAQ, MSQ i MSSCQ były podobne u kobiet z PCOS i tych z grupy kontrolnej niezależnie od wieku. Podobnie, potrzeby seksualne i reakcje były postrzegane w taki sam sposób w obu grupach. Natomiast kobiet z PCOS oceniały siebie gorzej w roli partnerek seksualnych w porównaniu do zdrowych. Wnioski: Funkcje seksualne i reakcji seksualne, postawy wobec seksualności, a także relacje z partnerem seksualnym były podobne u osób z PCOS i zdrowych kobiet. Jednakże zmiany w wyglądzie fizycznym występujące u kobiet z PCOS mogą powodować pogorszenie funkcji seksualnych. Dlatego też zaleca się, aby wszyscy pacjenci z PCOS byli kierowany na konsultacje do specjalistów z dziedziny medycyny seksualnej