What is reproductive health?
Human Reproductive Health- this is a combination of psychological and physiological conditions in which he is able to produce and provide offspring. This means that reproductive health includes not only sexual health and the normal functioning of the reproductive and reproductive systems, but also a whole range of socio-economic indicators that affect human psyche and norms of behavior. By the way, reproductive health may not be in the best condition if a person has psychological deviations, including sexual deviations, behavioral deviations or other serious deviant deviations. On the other hand, in the presence of some deviations, but a comfortable state when they appear, the state of normal reproductive health is more than achievable.
The world around us exposes the body to constant stress, psychological and physical loads - this negatively affects the general state of human health. In an unstable state of the body, as well as post-stress situations, reproductive health cannot be considered normal. This suggests that a lot of people on the planet are constantly in a state of impaired reproductive health.
The main factors are still social and sexual components: the health of the reproductive system, normal relationships in the family, the absence of psychosomatic disorders of the reproductive organs. With a harmonious and favorable balance of these factors, human reproductive health can be considered normal and implying trouble-free reproduction of offspring. Unfortunately, the realities of modernity do not allow society to create the most prosperous environment for a person, and therefore his reproductive health is constantly under threat.
Prevention of human reproductive health
In connection with the emerging threat, as well as the creation of the most theoretical basis for determining and describing the state of reproductive health, many scientists began to develop methods for its prevention and, if necessary, restoration. The currently accepted complex includes:
- development of preventive measures and direct treatment of diseases of the human reproductive system;
- development of preventive measures and direct treatment of diseases of the reproductive system;
- study and treatment of diseases of mental disorders of human sexuality;
- prevention, prevention and treatment of sexually transmitted diseases;
- family planning, ongoing public education on sexuality, family planning and healthy relationships;
- prevention and development of means to prevent infant and maternal mortality;
- assistance to young families, material and psychological.
It is worth noting that in Russian Federation a number of measures are being taken to improve the reproductive health of the population as part of a program to improve the demographic situation in the country. More attention so far has been women's reproductive health- The state is actively developing gynecology, expanding the sponsorship of maternity hospitals to improve preventive and other medical equipment, and also allocates serious funds to single mothers and mothers of 2 and subsequent children. Unfortunately, male reproductive health is a purely commercial topic. At the moment, there is no high-quality free urology in many regions, men undergo diagnostics and treatment of the reproductive system, often very far from home.
The future of reproductive health in Russia
Nevertheless, Russia is well aware that the future of the country depends not only on the figures of demographic studies, but also on the health of the nation. The introduction of measures to prevent and improve the reproductive health of Russians is one of the government's activities in relation to general medicine. Apparently, the social part of reproductive health will improve systematically, in waves, along with the introduction of social reforms and additional sponsorship of social institutions. The medical part requires more attention, and it is not yet known whether the country should expect a serious leap in the development of urology, venereology and gynecology in the foreseeable future.
Unlike traditional preventive technologies for educational institutions aimed at preventing visual impairment, posture, neuropsychic health and other "school diseases" in schoolchildren, the proposal of this program is dictated mainly by the unfavorable socio-demographic situation in society, which can be characterized as follows .
For almost 10 years, there has been no natural population growth in the country, which is due to a significant decline in the birth rate, an increase in the number of deaths, including in infancy. The demographic crisis is exacerbated by the growth of obstetric and gynecological diseases among pregnant women and women in childbirth, as well as the high prevalence of chronic diseases among modern schoolgirls (up to 75%), which threatens the reproductive opportunities of the younger generation of women.
Medical and sociological studies testify to the rejuvenation of the age of onset of sexual activity and to the insufficient physiological and hygienic literacy of young people in this area. So, according to the data of the Research Institute of Hygiene and Health Protection of Children and Adolescents in 1997-1998. A survey of about 5,000 city schoolgirls and students of vocational schools (vocational schools) aged 15-17 found that 90% of the respondents had never visited a gynecologist, despite the fact that 35% of vocational school students and 25% of schoolgirls considered it possible for them to join sexual life before 16 years.
Screening examinations of the state of menstrual function in schoolgirls of modern educational institutions reveal that a third of them have an unformed menstrual cycle with a "experience" of menstruation of 3 or more years. In new types of educational institutions (gymnasiums, lyceums, specialized schools), an even greater prevalence of this disorder was revealed.
It is known that the gynecological service in the country is focused mainly on adult women, and those who actively seek the necessary gynecological care. Adolescent girls do not have such activity both due to age-related psychological characteristics (shame, fear of exposing the loss of virginity, etc.), and because their lack of physiological literacy makes it difficult to objectively assess the changes in the body that occur during puberty and have prognostic value for the formation of reproductive opportunities. In particular, the inability of the majority of older schoolgirls to correctly assess the state of their menstrual function, the fundamental basis of their reproductive health, has been established. The most common mistakes in this case were the incorrect calculation of the duration of the menstrual cycle (from the end of the previous to the beginning of the next menstruation, instead of counting from the beginning of the previous to the beginning of the next menstruation), the recognition of short (less than 3 days) periods as normal, a skeptical attitude towards calendar management menstruation, etc.
According to the latest data, menstrual dysfunction in adolescent girls is calling card they have a complex of somatic disorders and diseases. For girls with menstrual dysfunction, the combination of several diseases at once is typical, often a latent course of anemia, diathesis, pulmonary diseases, liver and kidney dysfunctions, etc.
From this it follows that the state of menstrual function in schoolgirls is an indicator of their general ill health. This requires timely detection, comprehensive examination and subsequent treatment of such girls by specialists of various profiles. So, in the period of a pronounced demographic decline experienced by Russia, the health of girls acquires special value as the demographic potential of society. And not only for this reason. For most women, motherhood is the meaning of their biological destiny, the basis of psychological comfort and self-affirmation in the family and society.
Since violations of sexual development and menstrual function are formed at puberty at the stage of schooling, the protection of the reproductive health of schoolgirls is becoming relevant among the preventive tasks of the modern school (see Appendix). The solution of this problem is especially important for schools with an in-depth content of education, since scientific research has established the dependence of the state of menstrual function in schoolgirls on the amount of educational and educational influences on their body in the process of schooling.
The proposed program was developed by the Research Institute of Hygiene and Health Protection of Children and Adolescents on the basis of observations, on the one hand, of the formation of menstrual function in modern schoolgirls, on the other hand, of the course of pregnancy, childbirth, the condition of newborns in nulliparous women (results of the analysis of medical records of maternity hospitals) . The unifying factor for these studies was the conduct of a questionnaire survey of schoolgirls and women in childbirth according to a single program that characterizes the characteristics of the school period of life for both. This made it possible to establish risk factors for the formation and subsequent implementation of the reproductive function in female girls. The content of the developed preventive program provides for two options for its practical use in schools.
The first version of the program includes simultaneous (from 1 to 4 points) and sequential implementation of the following activities.
1. A conversation with schoolgirls of IX-XI grades about the features of the formation of the menstrual function, risk factors for its timely formation, about the importance of the menstrual function for the childbearing capabilities of a woman, etc. (The full content of the conversation is set out below).
2. Screening testing of the state of menstrual function in schoolgirls present at the conversation using a special questionnaire (attached).
3. Express analysis of the conducted testing and selection of schoolgirls of the “risk group” according to the state of the evaluated function.
5. Control over the further actions of schoolgirls of the “risk group” (are parents informed about this, did they seek advice from specialists, was treatment prescribed, does the girl follow it, what is the result after the course of treatment?).
When conducting a conversation with schoolgirls, a valeologist should proceed from the fact that the audience of his listeners are girls 15-17 years old, whose menstrual cycle should be fully formed. In the population of modern girls, the vast majority of them have their first menstruation at the age of 13 (i.e., at 12 years with months). After the appearance of the first menstruation, a year is taken to establish the normal biological cycle of this function. Therefore, if the first menstruation came at the age of 13 and the year is allotted for the establishment of a normal biological cycle, then by the age of 15 the girl's menstrual cycle should be formed. Based on this, the main content of the conversation should include issues of monitoring the state of the menstrual function as the fundamental basis of the reproductive capabilities of each girl.
The concept of the formation of the menocycle includes the regular repetition of menstruation after a certain period of time, and individual for different girls, for example, after 21-24--28--30 days. Any of these terms is normal, it is only important that it be constant. Because of this monthly repetition of menstruation in everyday communication, they are called "monthly".
An important question is how to measure the duration of the menstrual cycle? It is measured from the beginning of one menstruation to the beginning of the next.
Girls should keep track of their periods. First, in order to establish when the biological cycle of menstruation was formed, and then in order to control your gynecological health. It is known that most women's diseases begin with menstrual irregularities, and girls of "menstrual" age should know for sure that menstruation stops when pregnancy occurs. The valeologist addresses the question to the audience: “Who among you knows in what simple way you can accurately track the state of your menstrual cycle?” Maintaining a menstruation calendar has proven itself well, where the day the “menstruation” begins is shaded in red, and the day when they ended is shaded in blue or black. When maintaining such a calendar, a girl receives information about several main characteristics of her menstrual function at once: about the period of the cycle (from the beginning of one to the beginning of the next menstruation), about the regularity of its repetition (from month to month), about the duration of each menstruation.
Now let's talk about the "risk factors" for the formation of menstrual function. “The study of the causes of the unformed menstrual cycle in schoolgirls with an “experience” of menstruation of three or more years revealed the leading role in this large total, as doctors say, the socio-biological load on the girl’s body. The components of such a load were the presence of 1) a chronic disease; 2) a large amount of educational and educational impacts on the body of girls (for example, parallel education in two schools: a language gymnasium and music school); 3) insufficient formation of sex hormones during puberty. Individual analysis showed that most of the girls in the group under evaluation had a history of a complex of these unfavorable factors.
If the presented data is presented in the form of a diagram (Fig. 1), then it shows that only 25% of girls with an unformed menstrual cycle had one of the listed unfavorable factors, and 75% had a combination of two or three unfavorable factors in their anamnesis.
Rice. one.
Rice. 2.
1 - delay in the formation of menstrual function (more than 1.5 years); 2 - irregular menstrual cycle; 3 - heavy menstruation; 4 - menstruation with pain syndrome.
Thus, 46% most often combined the presence of a chronic disease with a large amount of educational and educational workload, and 29% had a combination of all three of these factors (chronic disease, large educational and educational workload and hormonal insufficiency).
What does it say? The fact that at the stage of puberty of children, large social loads inhibit the biological processes of the body, which include the formation of the menstrual cycle in girls. Therefore, in the interests of protecting the reproductive health of schoolgirls, their social (educational and educational) burdens during puberty should be reduced.
The following figure (Fig. 2) illustrates the impact of bad habits on the state of menstrual function: smoking (dashed columns), drinking alcohol along with smoking (black columns). The control for comparison was girls who did not have bad habits (white columns). The columns indicate the prevalence of complaints about menstrual dysfunction in the compared groups of girls. As the figure shows, as the burden of girls' lifestyles with bad habits increases, the number of complaints about various menstrual dysfunctions increases, and the number of complaints increases especially.
the prevalence of complaints about irregular (2) and heavy (3) menstruation (almost twice as compared to the number of such complaints among those who do not have bad habits). From this follows the conclusion: is it worth keeping and even more so abusing bad habits, putting at risk your hopes to become a mother, to have a happy family?
How the state of menstrual function is connected with the course of childbirth in women is shown in Fig. 3.
In order to answer this question, scientists divided primiparous women into two groups depending on the nature of their birth (physiological or abnormal). After that, with the help of electronic computers for each group, a mathematical analysis of the relationships between the complex of indicators of obstetric-gynecological and school anamnesis was carried out. The work done by doctors is called the determination of the structure of the functional system of the body, which is formed in a person to achieve the final result of any purposeful activity. Childbirth was just considered as the end result of the activity of the reproductive system of a woman. To build this functional system, only statistically significant relationships between indicators were selected from mathematical analysis.
As the top part of Fig. 3, the immediate conditions for physiological childbirth in nulliparous women are the presence of health in the school years (its criterion in the questionnaires was information about the absence of a chronic disease in a woman during her school years, frequent acute and childhood infections), as well as the formation of the menocycle by the time of pregnancy. The independent and closest relationship in women of this group was noted between the age of onset of "menstruation" and the nature of the course of menstrual age (the period from the first menstruation to the establishment of its regular cycle). Both of these indicators in this case corresponded to physiological norms. The pathological course of childbirth was directly related only to the nature of the course of pregnancy, which in the observed women in 78% of cases had signs of pathology. The main and independent block in abnormal childbirth consisted of significant relationships between indicators of menstrual function both in school years (the age of the onset of "menstruation", the course of menstrual age, the period of establishment of the menocycle), and by the time of pregnancy. All indicators characterizing the state of menstrual function, in this case, deviated from the physiological norm.
Rice. 13.
The chain of these links included a significant link with a large amount of teaching and educational workload of women in school years. In other words, a woman's childbearing prognosis is laid down in her school years and will be determined by the state of health, menstrual function, and the volume of the girl's educational load during her school years.
The above information serves as a basis for concluding that the state of menstrual function is the fundamental basis of a woman's reproductive health. This requires constant self-monitoring and periodic medical monitoring of her condition.
And as a first step in this direction, the valeologist invites the schoolgirls present at the conversation to assess the state of their menstrual function, using for this a special questionnaire test developed by the Research Institute of Motherhood and Childhood in Ivanovo (Table 1). The test questionnaire is based on a thorough collection of girls' gynecological history data and is a screening test that is used to identify individuals suspected of having a particular pathology. Conducting screening tests does not require mandatory medical qualifications, and therefore it is recommended that valeologists conduct it. At the end of the test, a standard of the norm and deviations from it is given, which allows the girl herself to assess the state of her menstrual function and respond in time to the presence of violations.
Prevention of diseases of the cardiovascular system. The most common diseases of the cardiovascular system:
Arterial hypertension. The incidence of arterial hypertension is up to 25% of the total adult population of our country.
Ischemic heart disease (CHD). Represents a wide range of cardiovascular diseases (myocardial infarction, etc.), the death rate from which amounted to 30% of the total number of deaths over the past year.
Stroke. The second leading cause of death among all cases of cardiovascular disease after coronary heart disease.
Risk factors can be divided into two types according to the effectiveness of their elimination: fatal and removable.
Fatal Risk Factors- this is a given, something that must be reckoned with, something that cannot be changed:
Age. After the age of 65, the risk of developing cardiovascular disease increases significantly, but not equally for everyone. In the presence of other risk factors, the probability of the disease increases by 65%, in the absence of such factors - only by 4%.
Floor. Male gender is a risk factor for cardiovascular disease. It is statistically proven that arteries not damaged by atherosclerosis occur in only 8% of men (compared to 52% of women) aged 40 to 70 years.
Heredity. If parents or close blood relatives were ill with arterial hypertension, atherosclerosis or cardiosclerosis, then the risk of falling ill with the corresponding diseases increases by 25%.
Avoidable Risk Factors- this is something that can be changed by taking appropriate measures or making adjustments to the lifestyle.
Smoking. Crying people die from coronary heart disease 2 times more often than those who have never smoked.
Alcohol abuse. Minimal alcohol consumption (20 ml of ethanol per day for women and 30 ml of ethanol for men) reduces the risk of all types of cardiovascular diseases. The risk of death is increased in those who abuse alcohol.
Arterial hypertension. A state of chronically elevated blood pressure increases the risk of developing coronary heart disease by 3 times.
Overweight. It not only increases the risk of cardiovascular disease, but also has an extremely negative effect on the development of an existing disease.
Diabetes. It increases the risk of developing coronary heart disease and peripheral vascular disease by several times, and also complicates the course of the disease.
Low physical activity. It negatively affects the tone of the body, the endurance of the body, resistance to external influences. Increases the risk of cardiovascular disease by 2-3 times. Increases the risk of sudden heart attacks.
Wrong nutrition. An excess of saturated animal fats in the diet, which are high in cholesterol, leads to atherosclerosis and, therefore, catalyzes the development of a wide range of cardiovascular diseases.
abdominal obesity. If the normal waist circumference is exceeded (more than 94 cm in men and more than 80 cm in women), the risk of developing diseases of the cardiovascular system is increased.
Stress. In a state of stress, the body functions incompletely, especially with regard to blood vessels, metabolism and all other systems associated with the nervous system. Chronic stress contributes to the development of cardiovascular disease, and acute stress can be a catalyst and impetus for the onset of a life-threatening attack.
Prevention:
Smoking cessation and protection from passive smoking.
Restriction of alcohol consumption.
Weight control.
Balanced diet: eating meat (especially red), a sufficient amount of fish (at least 300 g per week), eating vegetables and fruits, refusing or limiting fatty, fried, smoked. Controlling blood cholesterol levels and normalizing it with the right healthy diet.
Physical activity. The optimal and necessary level of physical activity is 150 minutes of any physical activity per week - this is a prerequisite for successful prevention of cardiovascular diseases.
Stress control. Healthy sleep and a philosophical attitude to life, on the contrary, significantly increase your chances of both avoiding cardiovascular diseases and successfully recovering from existing ones.
Diabetes control. Control of blood sugar levels, control of changes in health status, observation by an endocrinologist.
Blood pressure control. Blood pressure control and correction according to the doctor's recommendations.
medical control. The need for regular medical examinations:
Examination by a general practitioner once a year.
At each visit to the doctor - determination of blood pressure (BP) (at least once every two years, if blood pressure is less than 120/80 mm Hg), body mass index (BMI).
Determination of cholesterol levels 1 time in 5 years (or more often at the discretion of the doctor).
Prevention of reproductive health disorders. According to the WHO, reproductive health is a state of complete physical, mental and social well-being of the reproductive system, its functions and processes, including the reproduction of offspring and the harmony of psychosexual relationships in the family.
Reproductive health protection - a system of measures that ensures the emergence of healthy offspring, prevention and treatment of reproductive organs, protection against sexually transmitted diseases, family planning, prevention of maternal and infant mortality. Reproductive health is influenced by many factors (socio-economic, environmental, industrial, etc.), some of which are currently assessed as unfavorable. The deterioration of reproductive health is reflected in medical and demographic indicators: fertility, infant mortality, morbidity in pregnant women, infertility in marriages, etc.
O The main directions in work with the population to preserve reproductive health:
1. Work with adolescents and youth (health schools, seminars, anonymous consultations on reproductive health issues, preventive medical examinations);
2. Prevention of abortion and its consequences (information about methods of contraception, free contraception available, medical and psychological assistance);
3. Individual selection of contraceptive methods;
4. Prevention of STIs;
5. Counseling couples on pregnancy planning.
The system of preventive measures for the protection of reproductive health
includes:
Carrying out annual medical examinations within the guaranteed volume of free medical care, clinical examination and rehabilitation
women and men reproductive age a;
Improving the methods of diagnosis and treatment of female and male infertility;
Measures for the prevention and early diagnosis of diseases of the reproductive organs, including cancer of the breast, cervix, prostate diseases;
Improving the forms and methods of providing medical care to childless couples;
Implementation of measures to prevent health problems for women and men during menopause and andropause;
Prevention of congenital malformations of the fetus and congenital anomalies (malformations), by further improving medical and genetic care for the population, introducing new perinatal technologies for early fetal diagnosis, developing a system of mandatory screening for pregnant women and newborns;
Informing citizens about the advisability of premarital medical genetic counseling for medical reasons;
Raising awareness of men and women about occupational risks to reproductive health;
Implementation of measures aimed at reducing the frequency of transmission of various types of infections, primarily HIV infection, from mother to child.
Protection of reproductive health of children and adolescents.
Women's health during pregnancy, childbirth and the postpartum period.
Prevention of mental health. Mental health is defined by the WHO as a state of well-being in which a person can realize their own potential, cope with the normal stresses of life, work productively and fruitfully, and contribute to their community.
WHO highlights the following mental health criteria:
● awareness and feeling of continuity, constancy and identity of one's physical and mental "I".
● feeling of constancy and identity of experiences in similar situations.
● critical to oneself and one's own mental production (activity) and its results.
● compliance of mental reactions (adequacy) with the strength and frequency of environmental influences, social circumstances and situations.
● the ability to self-management behavior in accordance with social norms, rules, laws.
● the ability to plan one's own life and implement these plans.
● the ability to change the way of behavior depending on the change in life situations and circumstances.
Mental health promotion is based on a variety of strategies, all of which aim to have a positive impact on mental health.
Mental health and mental disorders are determined by numerous and interacting social, psychological and biological factors:
Evidence clearly points to an association with indicators of poverty, including low levels of education and, in some studies, poor housing and low incomes. A recognized risk to mental health is worsening and persistent adverse socioeconomic conditions.
The increased susceptibility of disadvantaged people to mental disorders can be explained by factors such as feelings of insecurity and hopelessness, rapid social change, and the risk of violence and poor physical health.
An environment in which basic civil, political, socioeconomic and cultural rights are respected and protected is also fundamental to promoting mental health. Without the security and freedom afforded by these rights, it is extremely difficult to maintain a high level of mental health.
Mental health is about behavior. Mental, social and behavioral health problems can interact, thereby increasing their impact on behavior and well-being.
Substance abuse, violence and abuse of women and children, on the one hand, and health problems such as HIV/AIDS, depression and anxiety, on the other hand, are the most common and most difficult to deal with in conditions of high unemployment, low income, limited education, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyles and human rights violations.
A national mental health policy should not only address mental health disorders - it should also recognize and regulate the broader aspects of mental health promotion. This includes the socioeconomic and environmental factors described above, as well as behaviour. This requires incorporating mental health promotion into policies and programs of the public and private sectors, including education, labour, justice, transport, the environment, housing and improvement, and the health sector. Government decision-makers at the national and local levels play a particularly important role, whose actions have an impact on people's mental health that they may not be aware of.
To improve mental health, there are effective measures:
● Early childhood interventions (eg, home visits to pregnant women, preschool psychosocial interventions, a combination of nutritional and psychosocial interventions in disadvantaged populations);
● Child support (eg skills development programs, child and youth development programs);
● Providing socio-economic opportunities for women (eg improved access to education, micro-credit schemes);
● Social support for older populations (eg buddy support initiatives, day centers and community aged care centres);
● Programs targeting vulnerable groups, including minorities, indigenous peoples, migrants and people affected by conflict and natural Disasters(eg psycho-social activities after natural disasters);
● Mental health promotion activities in schools (eg, programs that support environmental change in schools, child-friendly schools);
● Mental health interventions at work (eg stress prevention programs);
● Policies to address housing problems (eg improving housing conditions);
● Violence prevention programs (eg riot policing initiatives)
May, 2007
DI. Tarusin, Professor of the Department of Polyclinic and Social Pediatrics of the State Educational Institution of Higher Professional Education of the Russian State Medical University of Roszdrav, Head of the Scientific and Practical Center for Pediatric Andrology in Moscow, Head of the Center for Pediatric and Adolescent Andrology, Dr. med. Sciences
Russia is currently going through an extremely difficult period of development - the so-called demographic transition, when there is an ever-increasing life expectancy, coupled with a decrease in the number of marriages, fertility and negative natural population growth.
More and more often, a newly formed family is faced with a situation where the natural desire to reproduce offspring ends in failure. The frequency of infertile marriages in Russia currently reaches 15% (for newly formed couples). The number of men who complain about the violation of potency is also increasing every year. Every third man after 30 years old faces regular difficulties in sexual life.
All of the above, of course, applies to patients who have left the limits of childhood and adolescence. But this is the “intrigue” of this publication: really, how can one talk about reproductive health in children? After all, the reproductive function is characteristic of people who have reached puberty. Thus, WHO defines reproductive health as “a state of complete physical, mental and social well-being that allows you to lead a safe and effective sexual life, combined with the ability to reproduce healthy offspring at the time and in the amount determined by the individual himself.” Where is the place of pediatrics in this definition?
Reproductive health of children and adolescents
Of course, it is not possible to fully talk about reproductive health in children. But having the thesis that it is from a child that an adult grows in the future, we get a noticeable and very important role of the pediatric community in shaping reproductive health. So, despite the fact that the reproductive function turns out to be characteristic of an adult, the roots of its formation, as well as the occurrence of reproductive health disorders, are located in the interval from the moment the zygote is formed to the point of realization of the biological function of the reproduction of offspring.
Thus, in childhood and adolescence, we can talk about predictors of reproductive disorders, that is, factors predisposing to the formation of certain abnormalities in the reproductive system.
Recent studies show that in childhood and adolescence, up to 64% of diseases occur that pose a direct or indirect threat to the reproductive function of the male body. Attitude to the organs of the reproductive system, as coming into action from the moment of the onset of puberty, today is nothing more than an outdated paradigm that before the onset of puberty "the testicles of the boy sleep." Meanwhile, morphological studies have shown that even in the neonatal period, and especially in the interval from 6 months to 2 years, the structure of germ cells undergoes serious changes in the qualitative and quantitative pool of gonocytes - primary spermatogonia. And all this happens under the integrative influence of the hormonal supply system of the hypothalamic-pituitary-gonadal axis. Moreover, doctors, prescribing certain medications to children aged 2–6 years, sometimes do not think about the fact that it is during this period that the maturation and preformation of the receptor apparatus of the sex glands occurs, and from the age of 6, the process of adrenarche, “preparing the ground” for an adequate response of hormonal receptor structures to the effects of tropic hormones.
It depends on how the prevention and treatment of diseases of the reproductive system in a child was carried out, how a man or woman will grow up in terms of individual reproductive viability. Therefore, as for any kind or type of health, the axiom about “problems comes from childhood” is true for reproductive health.
Reproductive disorders and their predictors in pediatrics
Before talking about predictors of reproductive disorders in childhood, attention should be paid to what is meant by reproductive disorder. Strictly speaking, the sexual function in men is represented by two components: the function of reproduction (adequate, non-deficient spermatogenesis and the emission of seminal fluid) and the function of copulation (unhindered sexual intercourse). The sum of these two functions is the reproductive health of the male individual, which is realized through the endocrine system and the preservation of traditional patterns of reproductive behavior. Thus, before talking about lesions of the organs of the reproductive system, it is necessary to define the reproductive system as such. Until now, the concept of "reproductive health" is mainly associated with the genital system. Meanwhile, the organs of the reproductive system should include not only the external genital organs, but also the organs of the endocrine system, which ensure the integration of the functional activity of the external genital organs and the body as a whole, as well as departments of the central nervous system responsible for the formation of human reproductive behavior. Only the perception of this complex multi-organ system as a single and indivisible one, working in functional interconnection and integration, allows us to develop the correct tactics for the treatment of reproductive disorders.
Classification
Predictors of reproductive disorders can be classified according to the following features:
- a sign of constancy in time: transitory or obligate;
- a sign of the depth of the lesion: genetically determined, causal (random), acquired (including iatrogenic);
- a sign of the nature of the lesion: anatomical, functional, combined;
- sign of curability: curable and incurable;
- a sign of sanogenicity: with or without a tendency to spontaneous sanogenesis.
Klinefelter's syndrome can be classified as obligate disorders, when a polysomy along the X chromosome is registered in the karyotype, initiating aplasia of the germinal epithelium in the patient's gonads. An example of transient disorders is delayed sexual development, which, with the right approach to treatment, does not leave significant consequences for reproductive health. Genetically determined lesions are hereditary syndromes, such as adrenogenital syndrome. An example of a causal lesion can be any pathology of obliteration of the vaginal process of the peritoneum, and an acquired disorder is, for example, the situation of the occurrence of a hydrocele after surgical treatment of a varicocele, which also bears the stamp of iatrogenic. It is necessary to recognize as an anatomical disorder of reproductive health such diseases as, for example, hypospadias, epispadias, inguinal hernia with its long-term effects on the state of the organs of the reproductive system and reproductive prognosis, and many other diseases that today fall within the competence of "children's surgery". A functional disorder can be recognized as a state of androgen deficiency in puberty, when instead of a hormonal boom, a deficiency of sex steroids occurs. A combined lesion may be varicose veins of the left spermatic cord (varicocele) in combination with delayed sexual development. The category of incurable conditions includes, for example, anorchism. To curable - diseases that, with the proper organization of treatment, can be fully compensated by the efforts of a specialist, child and parents. As an example, synechias of the foreskin can be attributed to conditions prone to spontaneous sanogenesis, which, with proper care for the external genital organs of a boy, disappear on their own by the age of 6. Conditions that are not prone to spontaneous sanogenesis include an inguinal hernia, which under no circumstances will “close on its own”, as it is a typical example of an anatomical anomaly.
Classification of diseases of the reproductive system according to the basic principle of treatment:
- violation of the anatomy of the organs of the reproductive system;
- violation of the interaction of the organs of the reproductive system;
- violation of relations between the organs of the reproductive system and the external environment;
- combined lesions.
Diseases of the reproductive system, accompanied by a violation of the anatomy:
- anomalies in the number and position of the testicles;
- anomalies in the development of the urethra and prostate;
- anomalies of the vaginal process of the peritoneum;
- cystic transformations of the organs of the reproductive system;
- diseases of the foreskin;
- tumors and neoplasms;
- genetically determined and / or causal intersex transformations (when there is a violation of the process of determining gender).
Lesions of the reproductive system, accompanied by a violation of hormonal homeostasis:
- violation of the pace of sexual development;
- violations of the quality of sexual development;
- intersex sexual development;
- deep genetically determined lesions, accompanied, in addition to violations of hormonal homeostasis, anatomical anomalies and defects.
Damage to the mental component of reproductive health:
- violation of the identification of one's own "I" with one's genetic and phenotypic sex;
- violations of sexual self-identification;
- violation of the natural sex determination of the choice of a sexual partner;
- complexes of "small", "fat", "lagging behind in sexual development", "small penis", etc.;
- consequences of experienced violence and deprivation;
- specific rare disorders.
It is important to remember that the above conditions, as a rule, are often combined, and the delegation of authority for the treatment of reproductive health disorders to various specialists (endocrinologist, surgeon, psychologist and psychiatrist) does not lead to sufficient patient rehabilitation. Only a specially trained specialist - a pediatric andrologist - is able to solve these problems with types of long-term reproductive prognosis, since he can take into account all the factors that affect its violations.
The role of the pediatrician
What is the role of the pediatrician in the prevention, early detection, treatment and rehabilitation of children and adolescents with signs that indicate the likely occurrence of reproductive health disorders? Oddly enough, the role of the primary care pediatrician in this matter today can be recognized as the main one. It is he who first sees the child after birth and, being armed with knowledge about reproductive health, is able to promptly refer the patient to a specialist.
In 2003, a new one appeared in the nomenclature of medical specialties - pediatric urology-andrology. It is this doctor who is called upon today to assist in solving such a complex problem. Today we can say that this is a significant breakthrough in the system of primary and specialized preventive medical care for children, since previously there was no doctor of this profile in the list of specialists at all. Over time, a completely delineated, separate medical area of \u200b\u200bknowledge will be allocated to the protection of the reproductive health of boys and adolescents.
So, the pediatrician first examines the external genitalia of the child. Therefore, it is he who can identify signs of their defect or developmental anomaly. The pediatrician sees the child in the family, sees the features of his upbringing, communication with parents, peers, and can identify deviations in the state of psychology of the growing man. A pediatrician, observing a child from year to year, is able to note certain signs of lagging or advancing in sexual development. In addition, it is the pediatrician who can evaluate the effectiveness of the efforts undertaken by the specialist. Because the specialist observes the child in refined conditions of a specialized appointment, and the pediatrician sees the patient in the school and family environment that is familiar to him.
What is needed today? To equip the pediatrician with modern knowledge about the prevention, diagnosis, treatment and rehabilitation of diseases that threaten the happiness of the future man, and teach them how to apply them in practice. There is not so much basic knowledge, they fit into the cycle of thematic improvement. In addition, it must be remembered that the protection of the child's reproductive health begins ... with the removal of a diaper or panties during a medical examination. And also with a small victory over oneself, since one can understand how difficult it is for a pediatrician at the reception to ask a teenager to take off his underpants. And also - with reproductive alertness, since only such a stereotype of professional thinking formed in a special way allows one to suspect a reproductive disorder, or at least see the discrepancy between the existing parameters and the standards.
If district pediatricians become allies of professional pediatric andrologists, in the short term, joint efforts can significantly improve the reproductive health of the younger generation.
