Features of the reproductive system. Features of the female reproductive system
It is generally recognized and natural that one of the main functions of the female body, which by and large determines the role of a woman in any society, is the childbearing function, i.e. reproductive ability. And this function, as you know, is limited by age limits. But having stepped over a certain age limit, a woman does not cease to be a woman, and she still needs the harmony of the spiritual and physiological principles in the body.
As a rule, the culture of our health does not extend beyond the childbearing function and, having fulfilled our “obligations” on this point, we safely forget about further regular visits to the antenatal clinic. Meanwhile, women's health needs care and attention not only in the phase of active reproductive age, but throughout life.
This material is addressed to all women and girls, regardless of age, but most likely it will be read more carefully by women who have entered that wonderful time when the happy difficulties of bearing a child and childbirth are long behind and thoughts about the natural completion of their mission as a continuer of the family appear. .
In this regard, I would like to talk about the changes, features of the female body in different age periods - what to expect, what to pay attention to, what is considered the norm, and what is considered a reason for a visit to your doctor.
In general, at any age, the first place in the structure of gynecological diseases is occupied by inflammatory diseases (more than 60%), which often cause not only a violation of a woman’s ability to work and a violation of her reproductive function, but also affect other functions of the female body. Nevertheless, great importance in the specifics of diseases of the female sphere have certain periods of a woman's life. This age specificity is mainly determined by the anatomical and physiological characteristics of the female body in certain periods of life. Let's figure out together what characteristic features and changes these time periods bring to the female body.
So, in the life of a woman it is customary to distinguish between:
1) the period of intrauterine development;
2) the period of childhood (from the moment of birth to 9-10 years);
3) the period of puberty (from 9-10 years to 13-14 years);
4) adolescence (from 14 to 18 years);
5) the period of puberty, or childbearing (reproductive), age from 18 to 40 years;
6) the period of transition, or premenopause (from 41 years to 50 years);
7) the period of aging, or postmenopause (from the moment of persistent cessation of menstrual function).
puberty is the longest in a woman's life. Reproductive age is characterized by the formation of stable relationships in the hypothalamic-pituitary-ovarian system and cyclic changes in the woman's body, most pronounced in the genital area. The woman's body is ready for fertilization, pregnancy and childbirth, lactation. Regular cyclic changes throughout the body are outwardly manifested by stable menstruation - this is the main indicator of the well-being of the female body. Of course, you should not focus solely on this indicator, and nevertheless, the regularity, stability, painlessness of the cycle is what is considered to be the norm. Of course, there are special cases when this or that diagnosis is not typical for a certain age group, but, in general, a modern woman should be guided in those manifestations and symptoms that can expect her and which need to be paid the closest attention.
For example, the most common complaints and specific problems of this age period are: inflammatory diseases of the genital organs, menstrual irregularities of various origins, cysts, infertility. Closer to 40 years, the frequency of benign and malignant tumors of the genital organs increases.
In general, you need to understand that it is the reproductive age that is the most risky and critical in relation to the impact of harmful factors. These include: early onset of sexual activity, a large number of sexual partners, infection with various infectious agents, early pregnancies including those ending in abortion.
In addition to the frequent violations already described, one can also talk about various pathologies of the cervix. The cervix has its own clinical and functional features at different age periods of a woman's life. IN last years there has been an increase in the number of cases of cervical disease in young women. According to statistics, the peak incidence of papillomavirus infection also falls on the reproductive age of women, and it is due to this that the incidence of cervical cancer is growing.
Well, another “scourge” of the reproductive period, which is worth mentioning separately, is fibroids. Uterine fibroids is a benign tumor that develops in the myometrium - the muscular membrane of the uterus. Fibroids increase in size under the influence of female sex hormones - estrogens, and therefore it is generally accepted that this disease is hormone-dependent. Women with uterine fibroids lengthen the period of ovarian functioning. Regular menstruation can last up to 55 years. With the onset of menopause (cessation of menstruation), there is a regression (regression) of the tumor. Talking about the prevention and prevention of fibroids can be quite arbitrary. But risk factors for the development of fibroids need to be identified. These include hereditary predisposition (the presence of uterine fibroids in direct relatives), menstrual dysfunction, reproductive dysfunction (infertility, miscarriage), metabolic disorders (obesity, diabetes mellitus).
We will try to give the most common manifestations and symptoms in women of this age group, the manifestation of which may indicate gynecological diseases: irregular, painful menstruation and cycle disorders; change in the nature of the discharge; the appearance of uncomfortable sensations; sexual disorders, disharmony of sexual relations; no pregnancy for more than 1 year with regular sexual activity; the appearance of pain, volumetric formations in the pelvic and abdominal cavity.
premenopausal period characterized by a transition from the state of puberty to the cessation of menstrual stability. During this period, women often experience violations of the central mechanisms that regulate the function of the genital organs, and as a result, a violation of cyclicity. This age line somewhat shifts the emphasis - for example, inflammatory processes of the genital organs are less common, but significantly the frequency of tumor processes and menstrual disorders (climacteric bleeding) increases. Also at this age there is a progressive depletion of the ovarian follicular apparatus. Well, and, probably, the main thing that is characteristic of this period is a change in the hormonal background, namely, the production of progesterone and a decrease in the secretion of estrogens stop. All this leads to changes in internal organs and body systems and in the absence of timely correction significantly reduce the quality of life of a woman.
40-60% of women during perimenopause may develop symptoms of menopausal syndrome, urogenital and sexual disorders. All this is expressed in the following unpleasant sensations: hot flashes, sweating, increase or decrease in blood pressure, headache, sleep disturbance, depression and irritability, frequent urination, both day and night, urine leakage.
Many women are approaching the menopause period and existing diseases of the endocrine system, in particular with thyroid disorders. About 40% of women have nodules and hypothyroidism. Menopause in women with thyroid pathology, unlike women without it, occurs earlier
The next important stage in a woman's life isafter 50 years. This period is characterized by a general extinction of the female reproductive system, in which female body continues to lose estrogen. Therefore, at this age, various pathological conditions, and therefore during this period it is especially necessary to be observed by a gynecologist to select an individual correction of age-related changes in hormonal status. What can alert or frankly "spoil life"? This is rapid aging and dry skin, frequent headaches and sleep disturbance, memory loss and irritability, a sharp decrease or excess weight. In fact, no matter how sad it is, this is a phase aging, which fits into the overall aging process of the entire female body.
In the postmenopausal period, prolapse and prolapse of the genital organs, as well as malignant tumors, are more common than before. Gradually, there is a complete extinction of ovarian function (lack of ovulation, cyclic changes in the body), and a decrease in estrogen levels can lead to late metabolic disorders - osteoporosis, atherosclerosis, cardiomyopathy.
What can be done? How can we ourselves reduce the risks of the described age-related disorders to a minimum? Of course, this is primarily prevention, which comes from a well-formed culture of health (see the material on Culture women's health on our website http://endometriozu.net/informaciya-o-zabolevanii).
In no case should you underestimate the importance of preventive examinations during the period when, it would seem, the childbearing function is performed. Life doesn't just go on. During this period, a woman who is correctly tuned to the perception of her age truly flourishes. And to “help” your body to be in shape is our duty to ourselves.
In addition to regular visits to your doctor (is it worth reminding you that by adulthood this doctor should be a priori?), the prevention of inflammatory diseases of the internal genital organs consists in careful observance of personal hygiene and the culture of sexual relations, as well as in the timely detection and treatment of inflammatory diseases other organs and systems. By the way, there is a close relationship between diseases of the mammary glands and genital organs, which is confirmed by the high frequency of the combination of these diseases, so you should not forget about timely visits to the mammologist either. After all, any organism is a well-coordinated, interconnected mechanism, where there are no working individual systems .
So, for example, it has already been said about the frequency of disorders in the endocrine system. In this case, we can help ourselves by reflecting the need for early diagnosis and treatment of various thyroid dysfunctions.
In addition, one of the important links in the prevention of acute inflammatory diseases in women is the timely detection of a specific infection, sexually transmitted diseases.
Prevention of gynecological diseases pursues the main goal - the health of a woman in all periods of her life! And you need to start it from childhood. After the onset of sexual activity, it is recommended to undergo a routine examination by a gynecologist once a year. Unscheduled examinations are necessary when any complaints appear, or when a sexual partner changes. Indeed, diseases in gynecology often occur without pronounced symptoms and, in a neglected state, can lead to oncological pathology, infertility, ectopic pregnancy and other unpleasant consequences.
We must not forget that in any period of life, regular exercise stress extremely useful, and on the approach to menopausal changes - especially. It reduces the risk of heart disease and osteoporosis. Physical activity stimulates the brain, causing the release of endorphins that make you feel good. Reduces depression, relieves physical pain.
In order for parenthood to be responsible, for desirable and healthy children to be born, each modern man should know how to maintain their reproductive health:
The optimal age for having children is 20-35 years. It has been proven that if pregnancy occurs earlier or later, then it proceeds with a large number of complications and the likelihood of health problems in the mother and child is higher;
Abortion is the most unsafe method of birth control, it can be avoided with the help of modern methods of contraception;
if an unwanted pregnancy does occur and the woman decides to have an abortion, you should consult a doctor as soon as possible - this will reduce the risk possible complications during and after an abortion;
After childbirth and abortion, you can become pregnant before the arrival of the first menstruation, so it is necessary to choose a reliable method of contraception before the resumption of sexual activity;
· sexually transmitted infections often cause infertility in men and women;
contraception does intimate life more harmonious, eliminates unnecessary worries and anxieties.
it is a state of complete physical, mental and social well-being in the absence of diseases of the reproductive system at all stages of life.
this is a set of organs and systems of the body that provide the function of reproduction (childbirth).
The state of reproductive health is largely determined by a person's lifestyle, as well as a responsible attitude towards sexual life. In turn, all this affects the stability family relations, the general well-being of the person.
The foundations of reproductive health are laid in childhood and adolescence. There is an opinion: everything connected with the birth of a future life depends entirely on the health of the future mother. Actually it is not. It has been proven that out of 100 childless couples, 40-60% do not have children due to male infertility, which is associated with sexually transmitted infections, the impact on male reproductive health of harmful factors environment, working conditions and bad habits. These facts convincingly prove the importance of careful attitude to the reproductive health of not only the future woman, but also the man.
Reproductive system of a woman
The organs of the female reproductive system are the ovaries, fallopian tubes, uterus, and vagina (Fig. 29). The reproductive system is a delicate mechanism that carries out a periodic process called the menstrual cycle. It is the menstrual cycle that creates on the part of the woman the prerequisites for the reproduction of offspring.
The main process of the menstrual cycle is the maturation of an egg capable of fertilization. In parallel, the mucous layer of the uterus (endometrium) is being prepared for the adoption of a fertilized egg (implantation). In order for both processes to occur in the desired sequence, hormones exist.
Rice. 29. Organs of the female reproductive system
The process of egg formation - oogenesis (ovogenesis) and the synthesis of female sex hormones occurs in female gonads- ovaries. The ovaries vary in size, shape, and mass depending on age and individuality. In a woman who has reached puberty, the ovary looks like a thickened ellipsoid weighing from 5 to 8 g. The right ovary is somewhat larger than the left. In a newborn girl, the mass of the ovary is approximately 0.2 g. At 5 years old, the mass of each ovary is 1 g, 8-10 years old - 1.5 g, 16 years old - 2 g. The ovary consists of 2 layers: cortical and cerebral. In the cortical layer, eggs are formed (Fig. 30).
Rice. 30. Human egg
The medulla is made up of connective tissue containing blood vessels and nerves. Female egg cells are formed from primary egg germ cells - oogonia, which, together with nourishing cells - follicular - form primary egg follicles. Each egg follicle is a small egg cell surrounded by a row of flat follicular cells. In newborn girls, they are numerous and almost adjacent to each other, and in old age they disappear. In a 22-year-old healthy girl, 400,000 primary follicles can be found in both ovaries. During life, only 500 primary follicles mature and produce eggs capable of fertilization, while the rest atrophy.
Follicles reach their full development during puberty, from about 13 to 15 years of age, when some mature follicles secrete the hormone estrone.
The period of puberty (puberty) lasts in girls from 13 - 14 to 18 years.
Under the influence of FSH of the pituitary gland in the ovarian follicles, the maturation of the egg occurs. Maturation consists in an increase in the size of the egg. Follicular cells multiply intensively and form several layers. The growing follicle begins to sink deep into the cortical layer, is surrounded by a fibrous connective tissue membrane, filled with fluid and enlarges, turning into a Graafian vesicle. In this case, the egg with the surrounding follicular cells is pushed to one side of the bubble. A mature Graafian vesicle adjoins the very surface of the ovary. Approximately 12 days before the onset of Graafian menstruation, the vesicle bursts and the egg cell, together with the follicular cells surrounding it, is thrown into the abdominal cavity, from which it first enters the funnel of the oviduct, and then, thanks to the movements of the ciliated hairs, into the oviduct and into the uterus. This process is called ovulation (Fig. 31).
Rice. 31. Ovum maturation
If the egg is fertilized, it attaches to the wall of the uterus (implantation occurs) and the embryo begins to develop from it.
After ovulation, the wall of the Graafian vesicle collapses and in its place a temporary endocrine gland, the corpus luteum, forms on the surface of the ovary. The corpus luteum hormone - progesterone prepares the uterine mucosa for the implantation of a fertilized egg, stimulates the development of the mammary glands and the muscular layer of the uterus. It regulates the normal course of pregnancy in its initial stages (up to 3-4 months). The corpus luteum of pregnancy reaches a size of 2 cm or more and leaves behind a scar for a long time. If fertilization does not occur, then the corpus luteum atrophies after 10-12 days and is absorbed by phagocytes (periodic corpus luteum), after which a new ovulation occurs. The egg implanted in the wall of the uterine mucosa, together with the torn parts of the mucosa, is removed with a blood stream.
The first menstruation appears after the maturation of the first egg, the bursting of the Graafian vesicle and the development of the corpus luteum. The menstrual cycle begins in a girl at 12-13 years old and ends at 50-53 years old, while the ability to bear children appears by 15-16 years old and the ovaries cease to function actively at 40-45 years old (Fig. 32).
Rice. 32. Ovarian-menstrual cycle of a woman
On average, the sexual cycle lasts 28 days and is divided into 4 periods:
1) restoration of the mucous membrane of the uterus within 7 - 8 days, or a period of rest;
2) proliferation of the uterine mucosa and its increase within 7-8 days, or preovulation, caused by increased secretion of the pituitary folliculotropic hormone and estrogen;
3) secretory - secretion, rich in mucus and glycogen, in the uterine mucosa, corresponding to the maturation and rupture of the Graafian vesicle, or ovulation;
4) rejection, or post-ovulation, lasting an average of 3-5 days, during which the uterus contracts tonically, its mucous membrane is torn off in small pieces and 50-150 ml of blood is released. The last period occurs only in the absence of fertilization.
Cyclic processes associated with the maturation of the egg, are reflected in the physical performance of women. In the ovulation period, as well as on the eve of menstruation, sports performance decreases. Maximum physical performance is noted in the pre- and post-ovulation period.
The female reproductive system is a reproductive system and shows functional activity only at a certain (childbearing) age. The optimal age for the implementation of the childbearing function is 20-40 years old, when the woman's body is perfectly prepared for conception, bearing, giving birth and feeding a child.
In the life of a woman, several age periods are distinguished, which differ significantly from each other: the intrauterine period, the period of childhood, the period of puberty, the mature reproductive period, the premenopausal period, perimenopause and postmenopause. Unlike other functional systems of the body, the activity of the reproductive system is maintained only at a certain age, which is optimal for the implementation of the basic functions of the reproductive system: conception, bearing, giving birth, and feeding a child.
The period of puberty, the actual reproductive period, lasts about 30 years, from 15-17 to 45-47 years. During this period, the entire reproductive system functions in a stable mode, which ensures the continuation of the family. In a healthy woman, during the reproductive period, all cycles are ovulatory, and 350-400 eggs are maturing throughout. Unlike other functional systems of the human body, the reproductive system is active upon reaching physical, intellectual, psycho-emotional and social maturity, upon reaching the optimal age for conceiving, bearing, giving birth and feeding a child. This age is 20-40 years.
The formation and extinction of the reproductive system occurs according to the same mechanisms, but in reverse order. Initially, during puberty, secondary sexual characteristics appear as a manifestation of steroigenesis in the ovaries (thelarche - 10-12 years, pubarche - 11-12 years, adre - six months before the first menstruation). Then menstruation appears, while at first the menstrual cycle is anovulatory, then ovulatory cycles with insufficiency of the luteal phase appear, and, finally, a mature, reproductive type of functioning of the entire system is established. When the reproductive system is turned off, depending on age or on various stress agents, ovulatory cycles first appear with hypofunction of the corpus luteum, then anovulation develops, and with severe inhibition of the reproductive system, amenorrhea occurs.
The reproductive system (PC) is active at five functional levels, the adequate interaction of which ensures the maintenance of steroid-producing and generative functions.
male reproductive system
The male reproductive system is a set of male internal and external genital organs located in the lower part of the abdominal cavity and outside, in the lower abdomen (Fig. 33). The male reproductive organs are represented by the penis and gonads: testes, vas deferens, prostate and seminal vesicles.
male gonad is the testicle (testicle), having the shape of a somewhat compressed ellipsoid. The testicles are the place where the process of spermatogenesis takes place, resulting in the formation of spermatozoa. In addition, male sex hormones are synthesized in the testes. In an adult, the weight in middle age is approximately 20-30 g. In children 8-10 years old - 0.8 g; 12-14 years old - 1.5 g; 15 years - 7 g. The testicles grow intensively up to 1 year and from 10 to 15 years.
Outside, the testis is covered with a fibrous membrane, from the inner surface of which, along the posterior edge, a proliferation of connective tissue is wedged into it. From this expansion, thin connective tissue crossbars diverge, which divide the gland into 200-300 lobules. The lobules are distinguished: seminiferous tubules; intermediate connective tissue.
Rice. 33. Reproductive system of a man.
The wall of the convoluted tubules consists of two types of cells: those that form spermatozoa and those that participate in the nutrition of developing spermatozoa. Spermatozoa enter the epididymis through the direct and efferent tubules, and from it into the vas deferens. The epididymis has a head, a body and a tail. In the epididymis, spermatozoa mature and become motile. From the epididymis, the vas deferens leaves, which, together with the vessels, is called the spermatic cord.
Above the prostate gland, both vas deferens pass into the vas deferens, which enter this gland, penetrate it and open into the urethra.
Prostate- This is an unpaired organ that is located under the bladder, covering its neck and forming part of the muscular sphincter of the bladder. The shape of the prostate gland resembles a chestnut. It is a muscular-glandular organ. The prostate gland has a membrane, from which the septa extend deep into the septum, dividing the gland into lobules. The lobules of the prostate gland contain glandular tissue that produces prostate secretions. This secret flows through the ducts into the urethra and forms the liquid part of the semen. The prostate gland (prostate) finally develops around the age of 17. Its mass in an adult is 17-28 g.
male penis is the organ through which the urethra passes. It serves to expel urine outside and to perform sexual intercourse. back it is attached to the pubic bones, followed by the body of the penis and ends with the head, in which the neck of the head is distinguished - the narrower part, and the crown of the head - the wider part. The skin on the penis is thin, easily mobile, forming a fold on the anterior section, which is able to cover the head. On the head, the skin passes into the mucous membrane. Internally, the penis consists of three bodies. Below is a spongy body through which the urethra passes, opening with an opening on the head, from above the right and left cavernous bodies. During sexual arousal, the cavernous bodies fill with blood, due to which the penis increases in size, becomes hard (an erection occurs), which allows you to have sexual intercourse and deliver sperm to the woman's cervix.
During ejaculation (ejaculation), due to muscle contraction, spermatozoa are released outward through the vas deferens and urethra. Each portion of semen contains 300-400 million spermatozoa. Such a large number of necessary because only a few hundred sperm actually reach the egg in the fallopian tube. Spermatozoa have a head, neck and tail (Fig. 34).
Rice. 34. The structure of the sperm.
The head of the spermatozoon contains the father's genetic material. In case of successful fertilization, it is he who determines the sex of the child (Fig. 35).
Rice. 35. Determination of the sex of the child.
The neck of the spermatozoon is a kind of battery that supplies energy for the movement of the spermatozoon. The "motor" is the tail of the spermatozoon. Due to movements in different directions, which, like a whip, the tail makes, the spermatozoon moves forward.
Intrasecretory functions of the female and male gonads
Before puberty, male and female sex hormones are formed in approximately equal amounts in girls and boys. By the time of puberty, girls produce several times more female sex hormones than boys. In young men, the secretion of male sex hormones increases. Premature puberty is inhibited by the thymus (goiter) gland. It functions as an endocrine until puberty.
In the female glands - the ovaries - estrogen is synthesized, as well as a small amount of testosterone, which is a precursor of estrogen. Progesterone, the female sex hormone, is synthesized by the corpus luteum of the ovary, which is formed and carries out its functional activity after the onset of ovulation. Female sex hormones - estrogens(estrol, estriol and estradiol) act as regulators of the ovarian-menstrual cycle, and when pregnancy occurs, they regulate its normal course. Estrogens affect:
The development of the genital organs
The production of eggs
determine the preparation of the eggs for fertilization, the uterus - for pregnancy, the mammary glands - for feeding the child;
regulate the formation female figure and features of the skeleton;
Provide intrauterine development at all stages.
In addition, estrogens increase the synthesis of glycogen in the liver and the deposition of fat in the body.
Estrogens, getting from the ovaries into the blood, are transported throughout the body with the help of carrier proteins. Estrogens are broken down in the liver by liver enzymes and excreted in the urine. Progesterone or corpus luteum hormone is synthesized in the ovaries and placenta during pregnancy. It helps to maintain pregnancy, prepares the inner mucosa of the uterus for implantation of a fertilized egg, suppresses the action of estrogen and uterine contraction, promotes the development of glandular tissue of the mammary glands, and under its influence, the basal temperature rises. Progesterone is broken down in the liver and excreted in the urine. In addition, a certain amount of androgens is produced in the ovaries.
Just like in women, the regulation of reproductive function in men is carried out by hormones. The highest authority is the brain, which controls the release of FSH and LH into the blood. Both hormones regulate the processes in the testicles. For example, FSH is mainly involved in the regulation of sperm maturation. LH stimulates the production of the male hormone testosterone.
male sex hormones androgens(testosterone, androstenediol, etc.) are formed in Leydig cells located in the interstitial tissue of the testes, as well as in the spermatogenic epithelium. Testosterone and its derivative androsterone cause:
The development of the reproductive apparatus and the growth of the genital organs;
The development of secondary sexual characteristics: coarsening of the voice, change in physique, the appearance of hair on the face and body;
· affect the level of protein and carbohydrate metabolism, for example, reduce the synthesis of glycogen in the liver.
Androgens and estrogens, interacting with other hormones, affect bone growth, practically stopping it.
The development of the gonads
The gonads develop from a single embryonic germ at the 5th week of intrauterine development. Sexual differentiation occurs at the 7-8th week of the embryonic period of development.
male gonads. Male gonads begin to produce testosterone at the end of the 3rd month of intrauterine life. At the 11-17th week, the level of androgens in the male fetus reaches the values characteristic of an adult organism. Due to this, the development of the genital organs occurs according to male type. The weight of the testicle in a newborn is 0.3 g. Its hormonally producing activity is reduced. Under the influence of GnRH from the age of 12-13, it gradually grows and by the age of 16-17 reaches the level of adults. The rise in hormone-producing activity causes a pubertal growth spurt, the appearance of secondary sexual characteristics, and after 15 years, activation of spermatogenesis.
Female gonads. Starting from the 20th week of the intrauterine period, the formation of primordial follicles occurs in the ovary. Estrogens begin to be synthesized towards the end of the prenatal period. Ovarian hormones do not affect the formation of the genital organs, it occurs under the influence of maternal gonadotropic hormones, placental estrogens and fetal adrenal glands. In newborn girls, during the first 5-7 days, maternal hormones circulate in the blood, then their concentration decreases. By the time of birth, the mass of the ovary is 5-6 g, in an adult woman it is 6-8 g. At the beginning of postnatal ontogenesis, three periods of activity are distinguished in the ovary: neutral (from birth to 6-7 years), prepubertal (from 8 years to the first menstruation) , puberty (from the moment of the first menstruation to menopause). At all stages, follicular cells produce estrogens in varying amounts. A low level of estrogen up to 8 years creates the possibility of differentiation of the hypothalamus according to the female type. Estrogen production in puberty is already sufficient for the puberty jump (skeletal growth, as well as for the development of secondary sexual characteristics). Gradually, an increase in estrogen production leads to menarche and the formation of a regular menstrual cycle.
In women, the internal genital organs consist of the gonad (ovaries), uterus, fallopian tubes and vagina, and the external genital organs consist of the labia majora and labia minora and the clitoris.
Ovary- a steam gland, which in shape is an oval, laterally flattened body weighing 5-6 g. It is located in the pelvic cavity on the sides of the uterus. In a newborn girl, the ovary has a cylindrical shape, at 8–12 years old it is ovoid. The length of the ovary varies from 1.5–3 cm in a newborn girl to 5 cm in adolescence, and the weight is from 0.16 to 6 g. In women after 40 years, the mass of the ovaries decreases, and after 60–70 years, their atrophy occurs.
The ovaries of the newborn are located outside the pelvic cavity, above the pubic symphysis, and are strongly inclined forward. By the age of 3–5 they take a transverse position, and by 4–7 years they descend into the cavity of the small pelvis. In the ovary, the upper (tubal) end, facing the fallopian tube, and the lower (uterine), connected to the uterus through a ligament, are distinguished. The ovary has free and mesenteric margins. The latter is attached to the mesentery, here the vessels and nerves enter the organ, therefore it is called the gate of the ovary.
The ovary is covered with a membrane consisting of connective tissue and epithelium. On a section in the ovary, the medulla and cortex are distinguished. The medulla is composed of loose connective tissue through which blood vessels and nerves run. In the cortical substance of the ovary there are a large number of follicles (vesicles). The follicle is shaped like a sac that contains the female germ cell. In a sexually mature woman, the follicles are in varying degrees of maturation and have a different size.
In a newborn girl, the ovary contains from 40,000 to 200,000 primary immature follicles. Their maturation begins with the onset of puberty (12–15 years). However, throughout a woman's life, no more than 500 follicles mature, the rest are absorbed.
In a newborn girl, the surface of the ovaries is smooth; in adolescence, irregularities and tuberosities appear on the surface due to swollen follicles and the presence of corpus luteum in the ovarian tissue.
Royal or Fallopian tubes are two thin tubes in a mature woman 8-18 cm each, connecting the ovaries to the uterus. Every month, a follicle bursts in one of them (a vial filled with liquid), a mature egg comes out of it and goes straight into the fallopian tube, along which it actively moves towards the uterus. It is in this tube that she meets with the very first successful spermatozoon. As a result of their merger, a new life begins.
In the wall of the fallopian tube, a mucous membrane is isolated, covered with a single-layer cylindrical ciliated epithelium, a muscle layer consisting of smooth muscle tissue, and a serous layer, represented by the peritoneum. The fallopian tube has two openings: one of them opens into the uterine cavity, the other into the peritoneal cavity, near the ovary. In this place, the end of the fallopian tube has funnels and ends with outgrowths called fringes. Through these fringes, the egg, after leaving the ovary, enters the fallopian tube. In drinking, fertilization takes place. The fertilized egg divides and travels through the fallopian tube to the uterus. This movement is facilitated by vibrations of the cilia of the ciliated epithelium and contraction of the walls of the fallopian tubes. The fallopian tubes of a newborn girl are curved and do not come into contact with the ovaries. In adolescence, they lose their tortuosity, descend downward and approach the ovaries. The length of the fallopian tube in a newborn is 3.5 cm, during puberty it increases rapidly. In old age, the walls of the fallopian tubes become thinner due to atrophy of the muscular layer, the folds of the mucous membrane are smoothed out.
Uterus- a muscular organ that serves for the maturation and bearing of the fetus and is located in the pelvic cavity. In front of the uterus lies bladder, behind - the rectum. Up to 3 years, the uterus has a cylindrical shape and is flattened in the anteroposterior direction. By the age of 7, the uterus becomes rounded, its bottom expands, by adolescence it takes on a pear-shaped shape. The length of the uterus in a newborn girl is 3.5 cm, about 2/3 of it falls on the neck. By the age of 10, the length of the uterus increases to 5 cm, and in an adult woman it reaches 6–8 cm. -80 g) the uterus is at the age of 30-40 years, after 50 years its mass decreases.
cervical canal in a newborn it is wide and contains a mucous plug. The mucous membrane forms folds, which disappear by the age of 6–7. The uterine glands develop only by puberty. The muscular layer thickens after 5-6 years. In newborn girls, the uterus is tilted forward, located high above the pubic symphysis. The cervix is directed downward and backward. The ligaments are poorly developed, the uterus is easily displaced. After 7 years, a lot of connective and adipose tissue appears around it. As the size of the pelvis increases, the uterus descends into the small pelvis. In old age, due to a decrease in adipose tissue in the pelvic cavity, the mobility of the uterus increases again.
The wall of the uterus consists of the inner, middle and outer layers. The inner layer (endometrium) is a mucous membrane lined with a cylindrical epithelium. Its surface in the uterine cavity is smooth, in the cervical canal it has small folds. In the thickness of the mucous membrane there are glands that secrete a secret into the uterine cavity. With the onset of puberty, the uterine mucosa undergoes changes associated with the processes occurring in the ovary (ovulation, formation of the corpus luteum). At the time when the developing embryo from the fallopian tube should enter the uterus, its mucous membrane grows and swells. The embryo is immersed in such a loosened mucous membrane. If fertilization of the egg does not occur, then most of the uterine mucosa is shed, and the blood vessels rupture, bleeding from the uterus occurs - menstruation, which lasts 3-5 days. After that, the uterine mucosa is restored and the whole cycle of its changes is repeated after 28-30 days. The middle layer (myometrium) is the most powerful, it consists of the outer longitudinal, the middle circular and the inner longitudinal layer.
During pregnancy smooth muscle fibers increase 5-10 times in length and 3-4 times in width. The size of the uterus and the number of blood capillaries increase accordingly. After childbirth, the mass of the uterus reaches 1 kg, and then its reverse development occurs, which ends after 6–8 weeks. Due to the muscular contractions of the uterus during childbirth, the fetus comes out of its cavity to the outside. The outer layer of the uterus (perimetry) is represented by a serous membrane - the peritoneum, which covers the entire uterus, with the exception of the cervix. From the uterus, the peritoneum passes to other organs and the walls of the small pelvis.
Vagina is a tube about 8-10 cm long, connecting the uterine cavity with the external genitalia. The wall of the vagina consists of mucous, muscular and connective tissue membranes. The mucous membrane on the anterior and posterior walls of the vagina has folds, is covered with stratified squamous epithelium and is abundantly supplied with blood vessels and elastic fibers. The outer shell consists of loose connective tissue. Before the onset of sexual activity, the outlet is covered with a fold of mucous membrane - the hymen.
external genitalia. The labia majora is a paired fold of skin containing a large amount of adipose tissue. They limit the space called the genital gap. The posterior and anterior ends of the labia are connected by posterior and anterior adhesions (see Fig. 9.4).
Small labia are also a paired fold of skin. The gap between the small lips is called the vestibule of the vagina. It opens the external opening of the urethra and the opening of the vagina. At the base of the lesser lips are two glands of the vestibule - the Bartholynian glands, the ducts of which open onto the surface of the lesser lips in the vestibule of the vagina. The Bartholin glands secrete a thick mucous secretion that moistens the vaginal vestibule.
Clitoris is located on the eve of the vagina and has the form of a slight elevation (see Fig. 9.4). It consists of two cavernous bodies, similar in structure to the cavernous bodies of the male penis. From above, the clitoris is covered with stratified squamous epithelium and contains a large number of sensitive nerve endings.
In a newborn girl, the labia majora are loose, the labia minora are not completely covered by the large ones. The vestibule of the vagina is deep, with poorly developed glands. Hymen dense. The vagina is short (2.5–3.5 cm), arched, narrow, the anterior wall is shorter than the posterior one, the vagina changes little up to 10 years, it grows in adolescence.
Before puberty, the vaginal mucosa is a squamous epithelium, which is replaced by a cylindrical epithelium during puberty. Therefore, in girls before puberty, the protective functions of the mucous membrane of the external genitalia are poorly developed, it is thin, easily vulnerable and easily susceptible to allergic and bacterial inflammation. It is connected with low level estrogens (female sex hormones) and the alkaline environment of the vagina due to the absence of the Dodeleyn stick in it, which releases lactic acid and promotes self-cleaning of the vagina.
INTRODUCTION
Chapter 1. MODERN VIEWS ON THE REPRODUCTIVE HEALTH OF WOMEN (REVIEW OF THE LITERATURE).
1.1. The reproductive system of women and its role in depopulation processes.
1.2. Methods for assessing reproductive health.
1.3. Hormonal relationships in reproductive health disorders.
1.4. Factors affecting disorders in the reproductive system.
1.5. Increased body weight and its role in the regulation of the reproductive system.
1.6. Interaction of immunological, biochemical and hormonal factors in reproductive health disorders.
Chapter 2. PROGRAM, MATERIALS AND RESEARCH METHODS.
2.1. Hormonal background residents of the Krasnodar Territory.
2.2. Characteristics of the control group and comparison groups.
2.3. Laboratory research methods.
2.4. Study of psychological status.
2.5. Determining the impact of agroecological factors on reproductive health.
2.6. Ultrasonic method.
2.7. statistical method.
Chapter 3. REPRODUCTIVE SYSTEM OF RESIDENTS
KRASNODAR REGION AND ITS CHANGES.
3.1. Analysis of the demographic situation in the region and its components.
3.2. Reproductive health of women in the region at different age periods of life.
3.3 Impact of agro-ecological and climatic-geographical factors on the reproductive system.
3.4 Psychological factors affecting reproductive health.
Chapter 4. MEDICAL FACTORS AFFECTING
REPRODUCTION.
4.1 Causal relationships in survey groups.
4.2 The impact of reproductive health on the course of the perimenopausal period.
Chapter 5. STATE OF THE REPRODUCTIVE SYSTEM IN DIFFERENT
AGE IN THE BACKGROUND OF CHANGES IN THE HUMORAL
HOMEOSTASIS.
5.1. General clinical characteristics of the survey groups.
5.2. Changes in hormone levels and carbohydrate metabolism.
5.3. Features of the immune status in women of different age groups with menstrual disorders.255.
5.3.1. Influence of menstrual irregularities on the leukogram indices of women of different age groups.
5.3.2 Age-related changes in cellular immunity in women with menstrual dysfunction.
5.3.3 Comparative analysis indicators of cellular immunity in women with menstrual dysfunction relative to the corresponding! age control.
5.3.5 Comparative analysis of the content of leptin and cytokines in women with menstrual dysfunction in relation to the corresponding age control.
CHAPTER 6. TREATMENT PROGRAMS FOR DISORDERS
REPRODUCTIVE HEALTH IN DIFFERENT AGE PERIODS.
6.1 Correction of menstrual dysfunction through complex metabolic therapy and its effect on the course of pregnancy.
6.2 The use of COCs based on the developed system for determining hormonal status disorders.
6.3 Complex therapy in the perimenopausal period.
6.4 Changes in clinical and laboratory parameters during therapy in women with menstrual dysfunction and overweight.
Recommended list of dissertations
Regional features of reproductive health of adolescent girls in Primorsky Krai 2005, Doctor of Medical Sciences Khamoshina, Marina Borisovna
The state of the reproductive system in girls and women with menstrual dysfunction (MF) against the background of chronic tonsillitis (CT) 2004, Doctor of Medical Sciences Antipina, Nelli Nikolaevna
The influence of somatic and gynecological pathology on the reproductive health of adolescent girls in the Chechen Republic 2012, Candidate of Medical Sciences Yankhotova, Eliza Madaevna
The main factors and determinants of the loss of the reproductive potential of the female population of Eastern Siberia 2011, Doctor of Medical Sciences Leshchenko, Olga Yaroslavna
REPRODUCTIVE HEALTH OF ADOLESCENT GIRLS IN THE MOSCOW MEGAPOLIS IN MODERN SOCIO-ECONOMIC AND ENVIRONMENTAL CONDITIONS 2009, Doctor of Medical Sciences Semyatov, Said Muhammyatovich
Introduction to the thesis (part of the abstract) on the topic "The reproductive system of women in different age periods of life"
The health of a nation is determined by the health of people of childbearing age, their ability to reproduce offspring. Having signs of a crisis, the difficult demographic situation in modern Russia is an acute problem (Message Federal Assembly President of the Russian Federation, 2006), which requires the development of effective programs to support motherhood, childhood, and families. Socio-political transformations in Russia, which began in the last quarter of the last century, caused the deformation of many cultural and spiritual values, which also affected reproduction: a decrease in reproductive health indicators, a transformation of family lifestyle, negative trends in the health status of different age groups, in different ways. manifested in various regions of the country (Khamoshina M.B., 2006; Grigorieva E.E., 2007). The implementation of the national project "Health" and the Concept of Reproductive Health of the Russian Federation will significantly change the situation, achieving not only a quantitative increase in children born, but also optimizing the health of living and future populations.
The study of the features of the functioning of the reproductive system at different age periods of women's lives, the influence of climatic, geographical, agroecological factors on them, as well as the study of changes in the functioning of the reproductive system occurring under their influence, is a very urgent task, which involves considering in aggregate all age periods of a woman's life - from the antenatal period before menopause.
WHO in 2004 adopted global strategy reproductive health, focusing on professional activity and occupational health (Izmerov N.F., 2005; Starodubov V.I., 2005; Sivochalova O.V., 2005), declaring, in addition to the state of the environment and lifestyle, a significant adverse effect of harmful production factors on the reproductive function of women.
In connection with the peculiarities of the implementation of the reproductive function, the protection of the reproductive health of a woman in the Russian Federation, suffering from the adverse effects of environmental and production factors, is of particular importance (Sharapova O.V., 2003; 2006). The proportion of adolescents who have a number of combined disorders of somatic and reproductive health is increasing (Kulakov V.I., Uvarova E.V., 2005; Prilepskaya V.N., 2003; Podzolkova N.M., Glazkova O.L., 2004 ; Radzinsky V.E., 2004, 2006).
In the last 10 years, the gynecological morbidity of girls and adolescent girls has significantly increased and the age of patients has decreased, this is especially noticeable in the increase in the frequency of menstrual disorders and neuroendocrine syndromes (Serov V.N., 1978, 2004; Uvarova E.V., Kulakov V.I. ., 2005; Radzinsky V.E., 2006): by 2007, the number of "menstrual disorders" in girls increased by 31.5% and in adolescents by 56.4%. The predicted deterioration in the reproductive health of women of childbearing age in this regard determines not only the medical, but also the socio-economic urgency of the problem of optimizing the reproductive health of women.
The lack of a strategy for managing a woman from her intrauterine development to old age leads to an incorrect interpretation of the existing age-related problems of reproduction; the cause-and-effect relationships of the formation of somatic, reproductive health and quality of life in the puberty, reproductive and menopausal periods have not been determined.
Correction of the revealed violations, based on the determination of the relationship between the body systems responsible for its reproductive function, made it possible to reimagine the pathogenesis of diseases and disorders of the reproductive system, improve its condition in different age periods, and reduce reproductive losses.
The purpose of the study: to develop and implement a set of milestone medical and recreational activities to improve and maintain reproductive health in different age periods of a woman's life in the current environmental and socio-economic conditions of southern Russia.
Research objectives:
1. to study the indicators of reproduction, reproductive and somatic health of the population of the Krasnodar Territory, depending on the agro-ecological and climate-geographic impact, psychological factors in the family and at work, and the quality of medical care.
2. to establish the features of hormonal and immune homeostasis in different age periods depending on environmental influences before puberty and, in combination with production ones, in the reproductive and menopausal periods of life.
3. define age features occurrence and development of gynecological diseases and disorders, their relationship with extragenital diseases.
4. to substantiate the concept of reproductive health formation in the specific environmental and socio-economic conditions of the Krasnodar Territory, taking into account the different agro-ecological load, the state of somatic and psychological health.
5. to develop an algorithm for improving the health of patients with reproductive health disorders based on the studies and evaluate its effectiveness.
6. develop and implement a system of organizational, treatment and diagnostic measures aimed at improving the state of the reproductive system of girls, adolescent girls, women of the reproductive and menopausal periods, taking into account antenatal development, childhood and pubertal periods, born and living in adverse conditions agro-ecological impact and climatic and geographical influence of the habitat of the south of the Russian Federation.
Scientific novelty of the research.
A multivariate mathematical analysis of the influence of climatic, geographical and agroecological factors on the formation and functioning of the reproductive system, gynecological morbidity was carried out, which contributed to the clarification of the reasons for the low reproduction of the population of the Krasnodar Territory. The ideas about the pathogenesis of disorders in the reproductive system and the characteristics of gynecological diseases in different age periods of a woman's life have been expanded.
The concept of formation of reproductive health in different age periods of women's life is substantiated, taking into account the agro-ecological load, psychological health, immunological and hormonal characteristics of the body.
For the first time, a reliable relationship was revealed between the state of the reproductive system and immunological, hormonal features of homeostasis, depending on the presence of extragenital diseases, including metabolic disorders.
A comprehensive program for the rehabilitation of patients with disorders in the reproductive system has been developed and implemented by testing medical and diagnostic measures based on new approaches to the pathogenesis of the formation of reproductive disorders.
Practical significance work.
On the basis of the analysis, a scientifically based system of measures was developed and implemented in the Krasnodar Territory to improve the reproductive health and reproductive potential of adolescents, women of the reproductive period in order to realize their reproductive function in the present and future, improve the state of somatic and gynecological health, and the quality of life of women in the menopausal period. .
Developed, tested and implemented on the territory of the region and the city of Krasnodar "Method for determining hormonal status disorders in women" (invention No. 2225009 dated February 27, 2004) and "Method of hormonal contraception" (invention No. 2222331 dated January 27, 2004), allowed to increase the use of COCs in the region by 69.7% and reduce the number of abortions by 63.4%, which is ahead of the rate of decline in the number of abortions in the Russian Federation by 34.8%.
An algorithm for clinical and laboratory examination of women at various ages has been developed and put into practice, including a survey methodology using specially designed questionnaires, the determination of hormonal, cytochemical and immunological parameters, which has made it possible to develop and implement a comprehensive method for the treatment of reproductive health disorders, which is based on the proposed by us complex of metabolic therapy (decision on granting a patent for the invention 2006 113715/14(014907) dated 04/21/2006).
A center for pediatric and adolescent gynecology, schools for women of the late reproductive and perimenopausal age have been created, which, along with a gynecologist, provide for the positions of a psychologist, andrologist, geneticist, dermatovenereologist, urologist and infectious disease specialist.
Implementation preventive measures and treatment and diagnostic algorithms for improving the health of women in different age periods, outside and during pregnancy, led to a decrease in perinatal mortality by
5.3%, the stillbirth rate - by 10.6%, the maternal mortality rate has stabilized (13.1/100 thousand births).
Basic provisions for defense.
1. Reproduction of the population of the Krasnodar Territory at the end of XX - early XXI century is characterized by a decrease in the birth rate and an increase in mortality, negative indicators of natural population growth, exceeding those in most territories of the Russian Federation, an earlier onset of depopulation processes than in the country (“Russian cross” - since 1990).
2. In addition to the deterioration of socio-economic living conditions, demographic indicators may be affected by reproductive health indicators that have deteriorated by the end of the 20th century (1999-2000): an increase in gynecological morbidity by 12.7% compared to 1990, menstruation disorders by 75.5%, an increase in the number of infertility in marriage by 16.9%, the incidence of absolute male infertility by 15%, diseases of the kidneys and urinary tract by 13.7%, neoplasms by 35.8%, malignant diseases of women by 17.6 %, including the mammary gland by 31.5%, the cervix and body of the uterus by 12.7%, and the ovaries by 15.2%. The frequency of diseases of the circulatory system increased by 50.7%, and diseases of the blood and blood-forming organs - by 63%, including anemia - by 80.5%, diseases of the digestive system - by 45.2%, diseases of the endocrine system - by 64, 3%, including diabetes by 15.3%, which may be the result of the ongoing agro-ecological load on the habitat, which is 4.5-5.0 times higher than the national average, while the level of oil products content is 1.5-2.5 times higher in 15 districts and cities of the region .
3. Gynecological morbidity, which has undergone significant changes in all age groups, is characterized by: the growth of childhood gynecological diseases due to the increase in inflammatory diseases evenly in all age groups (0-14 years old by 8.7%, 15-17 years old by 27.9%, 18-45 years old by 48.5%); increase benign tumors ovaries in age. 0-9 years only in those born to mothers with a long-term threat of miscarriage, who received various, including hormonal, drugs; Premature adrenarche in girls aged 6-8 years is highly correlated with the treatment of mothers with glucocorticoids during pregnancy. In general, girls and adolescent girls of the region are characterized by an increase in the age of menarche from 13.6 ± 1.2 years to 14.8 ± 1.5 years with a significant increase in the number of menstrual irregularities not only in the puberty, but also in the reproductive periods: 15-17 years -36% (ZPR - 15%, LPR - 21%); 18-35 years - 40%: amenorrhea - 5.7%, oligomenorrhea - 30-35%, dysmenorrhea - 23%, premenstrual tension syndrome - 17%, luteal phase insufficiency - 14%. A significant increase in diseases of inflammatory origin, uterine fibroids, adenomyosis and their combination in the late reproductive period (36-45 years) with a decrease in menstrual irregularities may be the result of improper reproductive behavior.
4. Differences in the frequency of gynecological morbidity are due to living in areas with different intensity of use of agrochemical fertilizers. Gynecological morbidity with a significant predominance of inflammatory and endocrine-determined diseases is higher in areas where the pesticide load is higher (2.0-2.5 MPC).
5. Psychological aspects of reproductive health, differentiated at different age periods of a woman's life, highly correlate with the presence of gynecological diseases and disorders: in prepuberty and puberty, low self-esteem and guilt prevailed due to delayed sexual development, late formation of secondary sexual characteristics, cosmetic defects, earlier pubarche, then in the reproductive period there is more often a feeling of guilt due to infertility in marriage, miscarriage, including the habitual one, not self-accusation prevails, but the search for reasons from the outside. After the birth of a child, these phenomena disappear, replaced by a sense of superiority over the remaining infertile "peers. A sharp deterioration in the psychological status in the menopausal period is associated with both an increase in extragenital diseases and menopausal disorders. Women who had psychological problems in the pubertal and reproductive periods, almost 100% susceptible to depression in menopause.
6. Hormonal homeostasis is characterized by different from the normative secretion of prolactin in all age groups: in the prepubertal and pubertal periods, prolactin exceeds the national average by 5.7±0.3%; at the same time, in obese girls and girls it is significantly higher than with normal body weight, and in reproductive age its content is higher than the norm by 9.3 ± 0.1%, with obesity - by 13.2 ± 0.1%. In the menopausal period, prolactin levels decrease more rapidly than in the Russian Federation, at 49.2±0.3 years its level is lower by 42%, and at 55.1±0.7 years - by 61%.
7. Indicators of immune homeostasis are highly correlated with menstrual irregularities and body weight. With an increase in body weight in all age groups, a significant increase in leptin was found, most pronounced up to 18 years (3.7 times). When the menstrual cycle is disturbed, leptin decreases: its level significantly decreases in the reproductive age by 1.7 times, in the menopausal age - by 2.4 times, which correlates with the quantitative depression of the cellular link of immunity increasing with age. With increased weight in reproductive age significantly (p<0,05) повышается число МС-клеток, а в возрасте старше 46 лет происходит отмена количественных дефектов клеточного иммунитета. При нарушениях менструального цикла с возрастом снижается содержание интерлейкина-4 и увеличивается концентрация интерлейкина-1(3, а при повышении массы тела - увеличение концентрации интерлейкина-4 и тенденция к снижению интерлейкина-1Р
8. Gynecological diseases and disorders occur the earlier, the less weight girls are born. The low birth weight of daughters of mothers treated for a long time during pregnancies is noted in 72% of cases, in 78.8% it is combined with chronic and/or acute hypoxia. Immune status disorders, frequent and prolonged diseases in childhood are associated with inflammatory diseases of the genitals (12%), menstrual cycle disorders (17%), oligo- and dysmenorrhea (27%), premenstrual syndrome (19%), uterine bleeding during puberty (3%). In reproductive age, the onset of inflammatory diseases occurred at 20-24 years (70%), mainly as a result of induced abortion, IPPGT associated with frequent changes of sexual partners. In the late reproductive and menopausal periods, abnormal uterine bleeding (40-44 years), endometrial hyperplasia (47 years), uterine fibroids (40 years), endometriosis (38-42 years) and their combination (41-44 years) predominate. The combination of genital and extragenital diseases in all age groups was 1:22.5: on average, there were 2.9 diseases per woman in the reproductive period, 3.1 in the late reproductive period, and 3.9 diseases in the menopausal period.
9. The concept of RH formation in specific climatic, geographical, ecological and socio-economic conditions of the Kuban provides for the interdependence of ante- and intranatal factors, low birth weight as an integral indicator of intrauterine distress, high infectious index, aggravated heredity, high allergization, extragenital and gynecological morbidity in all age periods of life women and the possibility of correcting predicted and detected disorders using the developed algorithm of diagnostic and treatment measures.
10. The algorithm for improving the reproductive system is based on the optimization of the required medical examination of girls and women of childbearing age with the necessary volume of laboratory diagnostic methods in high-risk groups of reproductive health disorders and the traditional treatment of identified and prevention of predicted diseases. This makes it possible to reduce gynecological morbidity at the age of up to 18 years by 29%, at the age of early reproduction by 49.9%, in the late reproductive period by 35% and in the menopausal period by 27.6%.
11. The developed and implemented system of organizational and treatment and diagnostic measures makes it possible to generally improve reproductive health in various age groups: in 2004-2006, maternal mortality was consistently 2 times lower than the national average, perinatal mortality was reduced by 1.3 times, the stillbirth rate was reduced by 10 .6%, infant mortality from congenital anomalies decreased by 1.1 times, the number of infertile marriages decreased by 19.6%, the birth rate increased by 3.7%, the number of abortions decreased by 9.9%, the number of women using effective methods increased contraception by 69.7%.
Approbation of research results and publication.
The main provisions of the dissertation were reported at the Russian Scientific Forum "Maternal and Child Health Protection" (Moscow, 2005), the Republican Scientific Forums "Mother and Child" (2005, 2006), the Kuban Congresses of Obstetricians and Gynecologists (2002, 2003, 2004), the international conference "Immunology of reproduction: theoretical and clinical aspects" (2007), International conference "Therapeutic aspects of modern hormonal contraception" (2002), congresses of obstetricians and gynecologists of the North Caucasus (1994, 1998) and European congresses on contraception (Prague, 1998; Ljubljana, 2000 ; Istanbul, 2006),
The results of the study are presented in 41 publications, including 11 publications in journals recommended by the Higher Attestation Commission of the Russian Federation; methodological manual for doctors "Algorithm for prescribing hormonal contraceptives" (Regional Department of Health), monograph "Reproductive health of residents of the Krasnodar Territory: ways to improve it" (2007).
Implementation of the research results.
The results are implemented in the work of: the Department of Health of the Krasnodar Territory (department of assistance to mothers and children), Regional Clinical Hospital No. 1; Regional Perinatal Center, Regional Family Planning Center, City Multidisciplinary Hospital No. 2 of Krasnodar, as well as in antenatal clinics, obstetric and gynecological hospitals in Krasnodar and the Krasnodar Territory. The developed complex is used in the work of endocrinologists, neurologists dealing with reproductive health problems. The obtained data are used in the educational process at the Department of FPC and teaching staff of KSMU for training obstetrician-gynecologists, general practitioners, clinical interns and residents, as well as at the Department of Obstetrics, Gynecology and Perinatology of KSMU.
A short-term training program on topical issues of reproductive medicine was developed, tested and introduced into the educational process of the departments of obstetrics and gynecology of KSMU, including issues of a systematic approach, management of patients with disorders in different age periods, as well as infertility and miscarriage.
The structure and scope of the dissertation.
The dissertation consists of an introduction, an analytical review of the literature, a description of the program, research materials and methods, four chapters of the materials of our own research, justification and evaluation of the effectiveness of the measures taken, a discussion of the results,
Similar theses in the specialty "Obstetrics and Gynecology", 14.00.01 VAK code
Reserves for optimizing the reproductive health of women in the Republic of Sakha (Yakutia) 2011, Doctor of Medical Sciences Douglas, Natalya Ivanovna
Reproductive health of women with hypothalamic syndrome. The system of prevention and rehabilitation of its violations 2003, Doctor of Medical Sciences Artymuk, Natalya Vladimirovna
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Dissertation conclusion on the topic "Obstetrics and gynecology", Karakhalis, Lyudmila Yurievna
1. Reproduction of the population of the Krasnodar Territory at the end of the 20th and beginning of the 21st century has unidirectional trends with the country as a whole, significantly differing in the earlier onset of depopulation processes (the “Russian cross” is implemented in 1990) and significantly higher rates of natural population decline, which is determined by climatic and geographical features region, exorbitant agrochemical load in most of the territory of the region, the consumption of food and water containing toxicants.
2. The deterioration of RD is due to the constantly increasing gynecological morbidity in all age periods of life: the total figures are 12.4% up to 18 years, 45.8% are at the age of 18-45 years, over 45 years - 41.8%.
3. The "peak" of gynecological morbidity at the age of 0-18 years falls on the age of 15.4±1.2 years, 18-45 years - 35.2±1.1 years, over 45 years - 49.7±0.8 years.
4. The somatic health of the female population is characterized by a significant excess of statistical indicators for the Russian Federation: diseases of the cardiovascular system - by 4.7%;, respiratory diseases - by 11.3%, diseases of the gastrointestinal tract - by 17.6%, endocrine pathology - by 5.9%, diseases of the mammary glands by 3.7%.
5. Infertile marriage, the frequency of which increases from 13.7% in 2000 to 17.9% in 2006, is an integral indicator of reproductive distress in the region, due not only to socio-economic, agroecological, climatic and geographical impact on the habitat, but also psychological changes in personality, family, society, most pronounced in girls with gynecological diseases and disorders and in women in barren marriages.
6. Gynecological morbidity in girls and adolescent girls is highly directly correlated with frequent and prolonged treatment of the threat of miscarriage in their mothers, mainly with preparations of corpus luteum hormones (low weight - 3.9%, macrosomia - 12.9%, adrenarche 24.2% ). The influence of chronic hypoxia during pregnancy and/or acute hypoxia during childbirth on the development of MS, in particular ZPR, should be considered proven. The same contingents are characterized by a decrease in the immune status, an increase in infectious (ARVI, chicken pox, scarlet fever) and somatic morbidity of allergic and endocrine origin.
7. Endocrine-determined diseases, tending to increase, in women of reproductive age reached values comparable to inflammatory diseases: 29.4% and 32.1%. Dominant in the structure of gynecological morbidity are fibroids, adenomyosis, their combination, MC disorders, abnormal uterine bleeding with corresponding age peaks. The predominance of inflammatory diseases in the age group of 20-24 years is associated with the abortion of the first pregnancy, frequent change of sexual partners and high prevalence of SIS.
8. The peculiarities of the menopausal period in Kuban women should be considered its earlier onset (47.6±1.5 years), manifested by psychological (37.8±2.6 years), vegetative-vascular (38.5±3.4 years) and urogenital (41 .7 ± 2.4 years) disorders. Significantly more frequent somatic morbidity (2-2.5 per 1 woman), on average, 1 woman accounts for 3.1 diseases in the reproductive and 3.9 in the menopausal periods.
9. Features of hormonal homeostasis of all women with endocrine-related diseases of the genital organs are changes in prolactin excretion: increased up to 45 years (pubertal and reproductive) and reduced in the menopausal period. In all age periods, the level of prolactin excretion correlates with the excretion of cortisol, testosterone, 17-OP. Significant differences in the interaction of these hormones in women with and without obesity (p<0,05).
10. Hormonal effects are metabolically realized through leptin and cytokines, especially altered in obesity in the reproductive and perimenopausal periods: leptin increases 3.7 times, interleukins - 1.7-2.1 times.
11. Disturbed relationships of endocrine-metabolic regulation of homeostasis are transformed into severe immune deficiency (the level of interleukins decreases by 7.9%, lymphocytes - by 5.1%, leukocytes - by 1.2%, the content of immunocompetent lymphocytes changes in almost all gynecological diseases, which, perhaps, explains the high incidence of chickenpox in women with MC disorders in the reproductive period of life.
12. The concept of RH formation in the specific environmental, climatic and geographical conditions of the Kuban is based on the idea of the interdependence of the causal determinants of heredity identified by this study, the drug load on the body of the mother of the future girl, leading to an increase in gynecological morbidity in childhood and adolescence, combined with it somatic and infectious diseases of immunocompromised children and adolescents, an almost twofold excess of the total incidence in reproductive age and one and a half times in menopausal. In combination with the agrochemical load, increased insolation, the harmful effects of industrial production, a decrease in material well-being in families and psychological changes in attitudes towards reproduction in society, the problem of the reproductive health of women in the Krasnodar Territory can be considered as an interdisciplinary multifactorial problem that requires urgent measures by government authorities, changes in organizational fundamentals of medical care for women of all age groups, social interaction of educational, humanitarian and religious organizations.
13. The system of organizational and treatment and diagnostic measures developed on the basis of this concept, based on the priority use of methods for optimizing medical care to improve the condition of the reproductive system of girls, adolescent girls, women of fertile and menopausal ages, using modern technologies for diagnosing and treating reproductive disorders, creating new structural and functional institutions (adolescent health center) with simultaneous treatment of gynecological, andrological, somatic, urological diseases and psychological rehabilitation, identification of risk groups and extended laboratory studies of homeostasis in risk groups of reproductive disorders, including a rational contraceptive policy, made it possible to reduce the rate of maternal mortality, improve perinatal indicators, reduce the incidence of children under 18 years old by 6.8%, 18-45 years old - by 10.2%), 46 years and older - by 4.9%. I I
1. Clinical examination of girls in a children's clinic should be carried out with the participation of a pediatric gynecologist, especially in risk groups for violations of the formation of the reproductive system: children from mothers treated for a long time during pregnancy, with an increased drug load.
2. A prognostic and early diagnostic criterion for the state of the reproductive system is the combined determination of the excretion of prolactin, 17-OP, testosterone. Their abnormal values should provide for an in-depth study of the excretion of leptin, interleukins and the determination of the immune status. First of all, girls who already have metabolic changes in areas with unfavorable agro-ecological conditions and the harmful influence of other production factors are subject to in-depth examination. It is advisable to conduct a continuous staged clinical examination of girls, adolescent girls, women of childbearing age for timely prediction, detection and treatment of disorders of RH and gynecological morbidity.
3. A further reduction in the number of abortions, especially during the first pregnancy, is possible only with the joint participation in the education of adolescents of education workers (secondary schools, vocational schools), health care (territorial antenatal clinics, youth centers), public and religious organizations.
4. Staged clinical examination of women of childbearing age can be effective only with a full comprehensive examination of girls at the age of 18 when she moves from the stage of a children's polyclinic (pediatric gynecologist) to an adult network - a territorial polyclinic and antenatal clinic. Further medical examination, the scope of examination and treatment should be determined by the state of somatic and reproductive health, the presence of harmful environmental factors and the psychological status of patients.
5. Treatment of gynecological diseases, timely carried out by traditional methods, allows to achieve a cure for uterine fibroids - absolute with surgery and up to 60% with conservative methods of treatment, inflammatory diseases of the genitals in 31.4%, MC disorders in groups under 18 years of age in 49.9% , in the reproductive period - in 39.8%>, in the perimenopausal period - in 27.6%.
6. Infertile marriage, diagnosed in a timely manner with proper examination and the use of assisted reproductive technologies, makes it possible to achieve the birth of the desired child in almost 85% of cases, including tubal pregnancy - 32.7%, ovarian - 16.8%, male infertility - 21, 7%, with insemination - in 9.6% and IVF - in 19.2%.
7. An increase in the number and severity of diseases of the reproductive system of menopausal age provides for the timely recovery of women in late reproductive age, in relation to the conditions of the Kuban at 39-43 years old - “peak gynecological morbidity”: tumors of the uterus and ovaries - 39.7 years, endometriosis - 40, 3 years, cervical erosion - 42.3 years.
8. HRT for menopausal disorders, based on the conscious choice of the method by the patient herself, lasting 3-5 years, including in somatically burdened women with individual selection of the drug, taking into account the route of administration, allows leveling the psychological problems of menopause in 70%, urogenital - in 87% , vegetative-vascular - in 80%, metabolic-endocrine - in 17%, there is no significant increase in DMZH and diseases of the circulatory system and gastrointestinal tract. The increase in prolactin that occurred before menopause is leveled by the appointment of dopaminergic phytopreparations.
Staged clinical examination of girls, adolescent girls, women of fertile and menopausal age, taking into account socio-economic, environmental, psychological factors of life, carried out by the joint activities of doctors of various specialties, can reduce the incidence: up to 18 years in general by 49.9%, 18- 35 years old - by 39.9%, 36-45 years old - by 31.6%, 46 years and older - by 27.7%.
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Functions sexual or reproductive system aimed primarily at the continuation of the existence of man as a biological species. All life-supporting systems function from the moment of birth to death, the reproductive system "works" only in a certain age period, corresponding to the optimal rise in physiological capabilities. This temporal conditionality is associated with biological expediency - the bearing and rearing of offspring requires significant resources of the body. Genetically, this period is programmed for the age of 18–45 years.
Reproductive function is a complex of processes that covers the differentiation and maturation of germ cells, the process of fertilization, pregnancy, childbirth, lactation and subsequent care of offspring. Interaction and regulation of these processes are provided by the system, the center of which is the neuroendocrine complex: hypothalamus - pituitary gland - gonads. The central role in the implementation of the reproductive function is played by the reproductive, or genital, organs. The reproductive organs are divided into internal and external.
The structure and age features of the male reproductive system.
In men, the internal genital organs include the gonads (testicles with appendages), the vas deferens, the vas deferens, the seminal vesicles, the prostate, and the bulbourethral (Cooper) glands; to the external genital organs - the scrotum and penis ... more ⇒
Testicle- a paired male sex gland that performs exo- and endocrine functions in the body. The testicles produce spermatozoa (external secretion) and sex hormones that influence the development of primary and secondary sexual characteristics (internal secretion). In shape, the testicle (testis) is an oval, slightly compressed laterally body, lying in the scrotum. The right testicle is larger, heavier and located higher than the left.
The testicles are formed in the abdominal cavity of the fetus and before birth (at the end of pregnancy) descend into the scrotum. The movement of the testicles occurs along the so-called inguinal canal - an anatomical formation that serves to conduct the testicles to the scrotum, and after the completion of the lowering process - to locate the vas deferens. The testicles, having passed the inguinal canal, descend to the bottom of the scrotum and are fixed there by the time the child is born. Undescended testicle (cryptorchidism) leads to a violation of its thermal regime, blood supply, trauma, which contributes to the development of dystrophic processes in it and requires medical intervention.
In a newborn, the length of the testicle is 10 mm, the weight is 0.4 g. Before puberty, the testicle grows slowly, and then its development accelerates. By the age of 14, it has a length of 20-25 mm and a weight of 2 g. At 18-20 years old, its length is 38-40 mm, weight - 20 g. Later, the size and weight of the testicle increase slightly, and after 60 years, slightly decrease.
The testicle is covered with a dense connective tissue membrane, which forms a thickening at the posterior edge, called the mediastinum. From the mediastinum inside the testicle, radially located connective tissue septa extend, which divide the testis into many lobules (100–300). Each lobule includes 3–4 closed convoluted seminiferous tubules, connective tissue, and interstitial Leydig cells. Leydig cells produce male sex hormones, and the spermatogenic epithelium of the seminiferous tubules produce spermatozoa, consisting of a head, neck and tail. The convoluted seminiferous tubules pass into the direct seminiferous tubules, which open into the ducts of the testicular network located in the mediastinum. In a newborn, the convoluted and straight seminiferous tubules do not have a lumen - it appears by puberty. In adolescence, the diameter of the seminiferous tubules doubles, and in adult men it triples.
The efferent tubules (15–20) emerge from the network of the testis, which, strongly wriggling, form cone-shaped structures. The combination of these structures is an appendage of the testicle, adjacent to the upper pole and the posterolateral edge of the testicle, in which the head, body, and tail are distinguished. The epididymis of a newborn is large, its length is 20 mm, its weight is 0.12 g. During the first 10 years, the epididymis grows slowly, and then its growth accelerates.
In the region of the body of the epididymis, the efferent tubules merge into the duct of the appendage, which passes in the region of the tail into the vas deferens, which contains mature but immobile spermatozoa, has a diameter of about 3 mm and reaches a length of 50 cm. Its wall consists of mucous, muscular and connective tissue membranes. At the level of the lower pole of the testicle, the vas deferens turns upward and, as part of the spermatic cord, which also includes vessels, nerves, membranes and the muscle that lifts the testicle, follows the inguinal canal into the abdominal cavity. There it separates from the spermatic cord and, without passing through the peritoneum, descends into the small pelvis. Near the bottom of the bladder, the duct expands, forming an ampulla, and, having received the excretory ducts of the seminal vesicles, continues as the ejaculatory duct. The latter passes through the prostate gland and opens into the prostatic part of the urethra.
In a child, the vas deferens is thin, its longitudinal muscle layer appears only by the age of 5. The muscle that lifts the testicle is poorly developed. The diameter of the spermatic cord in a newborn is 4.5 mm, at 15 years old - 6 mm. The spermatic cord and vas deferens grow slowly until the age of 14–15, and then their growth accelerates. Spermatozoa, mixing with the secretion of the seminal vesicles and the prostate gland, acquire the ability to move and form seminal fluid (sperm).
The seminal vesicles are a paired oblong organ about 4-5 cm long, located between the bottom of the bladder and the rectum. They produce a secret that is part of the seminal fluid. The seminal vesicles of a newborn are poorly developed, with a small cavity, only 1 mm long. Up to 12–14 years old, they grow slowly, at 13–16 years old, growth accelerates, the size and cavity increase. At the same time, their position also changes. In a newborn, the seminal vesicles are located high (due to the high position of the bladder) and are covered on all sides by the peritoneum. By the age of two, they descend and lie retroperitoneally.
Prostate gland (prostate) located in the pelvic area under the bottom of the bladder. Its length in an adult man is 3 cm, weight - 18-22 g. The prostate consists of glandular and smooth muscle tissues. The glandular tissue forms lobules of the gland, the ducts of which open into the prostate part of the urethra. Prostate mass in a newborn
0.82 g, at 3 years old - 1.5 g, after 10 years there is an accelerated growth of the gland and by the age of 16 its mass reaches 8–10 g. The shape of the gland in a newborn is spherical, since the lobules are not yet expressed, it is located high, has a soft texture, glandular tissue is absent in it. By the end of the pubertal period, the internal opening of the urethra shifts to its anterior superior edge, the glandular parenchyma and prostate ducts are formed, the gland acquires a dense texture.
Bulbourethral (Cooper's) gland - a paired organ the size of a pea - located in the urogenital diaphragm. Its function is to secrete a mucous secretion that promotes the movement of sperm through the urethra. Its excretory duct is very thin, 3-4 cm long, opens into the lumen of the urethra.
Scrotum is a receptacle for testicles and appendages. In a healthy man, it is reduced due to the presence in its walls of muscle cells - myocytes. The scrotum is like a "physiological thermostat" that maintains the temperature of the testicles at a lower level than the body temperature. This is a necessary condition for the normal development of spermatozoa. In a newborn, the scrotum is small in size, its intensive growth is observed during puberty.
Penis has a head, neck, body and root. The head is the thickened end of the penis, on which the external opening of the urethra opens. Between the head and the body of the penis there is a narrowed part - the neck. The root of the penis is attached to the pubic bones. The penis consists of three cavernous bodies, two of which are called the cavernous bodies of the penis, the third - the spongy body of the urethra (the urethra passes through it). The anterior part of the spongy body is thickened and forms the head of the penis. Each cavernous body is covered on the outside with a dense connective tissue membrane, and inside it has a spongy structure: thanks to numerous partitions, small cavities (“caves”) are formed, which fill with blood during intercourse, the penis swells and comes into a state of erection. The length of the penis in a newborn is 2-2.5 cm, the foreskin is long and completely covers its head (phimosis). In children of the first years of life, the state of phimosis is physiological, however, with a pronounced narrowing, swelling of the foreskin can be noted, leading to difficulty urinating. A whitish sebaceous substance (smegma) accumulates under the foreskin, produced by glands located on the glans penis. If personal hygiene is not followed and infection is added, smegma decomposes, causing inflammation of the head and foreskin.
Before puberty, the penis grows slowly, and then its growth accelerates.
spermatogenesis - the process of development of male germ cells, ending with the formation of spermatozoa. Spermatogenesis begins under the influence of sex hormones during the puberty of a teenager and then proceeds continuously, and in most men - almost until the end of life.
The process of sperm maturation occurs inside the convoluted seminiferous tubules and lasts an average of 74 days. On the inner wall of the tubules are spermatogonia (the earliest, first cells of spermatogenesis), containing a double set of chromosomes. After a series of successive divisions, in which the number of chromosomes in each cell is halved, and after a long phase of differentiation, spermatogonia turn into spermatozoa. This happens by gradual elongation of the cell, changing and elongating its shape, as a result of which the cell nucleus forms the head of the spermatozoon, and the membrane and cytoplasm form the neck and tail. Each spermatozoon carries a half set of chromosomes, which, when combined with a female germ cell, will give a complete set necessary for the development of the embryo. After that, mature spermatozoa enter the lumen of the testicular tubule and further into the epididymis, where they are accumulated and excreted from the body during ejaculation. 1 ml of semen contains up to 100 million spermatozoa.
A mature, normal human spermatozoon consists of a head, neck, body, and tail, or flagellum, which ends in a thin terminal filament (Fig. 9.3). The total length of the spermatozoon is about 50–60 µm (head 5–6 µm, neck and body 6–7 µm, and tail 40–50 µm). In the head is the nucleus, which carries the paternal hereditary material. At its anterior end is the acrosome, which ensures the penetration of the sperm through the membranes of the female egg. Mitochondria and spiral filaments are located in the neck and body, which are the source of the motor activity of the spermatozoon. An axial filament (axoneme) departs from the neck through the body and tail, surrounded by a sheath, under which 8–10 smaller filaments are located around the axial filament - fibrils that perform motor or skeletal functions in the cell. Motility is the most characteristic property of the spermatozoon and is carried out with the help of uniform blows of the tail by rotating around its own axis in a clockwise direction. The duration of the existence of the sperm in the vagina reaches 2.5 hours, in the cervix - 48 hours or more. Normally, the spermatozoon always moves against the flow of fluid, which allows it to move up at a speed of 3 mm / min along the female genital tract until it meets the egg.
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