Gynecology

The vaginal microbiota of a healthy woman is a unique microecosystem comprising more than 300 bacterial species. The main vaginal bacteria of a healthy woman are Lactobacillus spp. (90–95%), with the most common being L. crispatus, L. iners, L. jensenii, and L. gasseri. Based on the dominant Lactobacillus species, five types of communities are distinguished: CST I, II, III, IV, and V. Lactobacilli ensure a normal vaginal pH (3.8–4.4) and inhibit the growth of other microorganisms, particularly Escherichia coli, Trichomonas vaginalis, Gardnerella vaginalis, Prevotella bivia, etc. Different lactobacilli species produce different levels of reactive oxygen species. Many studies demonstrated a close relationship between vaginal microbiota disturbance and the development of malignancies, particularly cervical, vagina, and vulvar cancer. This review analyzes published studies, which showed a positive correlation between a low content of lactobacilli, an increase in the abundance of pathogenic bacteria, and cancer of the anogenital region; the association between some bacteria, the persistence of the human papillomavirus, and the development of dysplasia of the lower reproductive system was demonstrated. Timely diagnosis and treatment of vulvovaginal infections and vaginal dysbiosis would reduce the risk of human papillomavirus persistence and, consequently, the development of dysplasia and cancers of the lower genital tract.

Endometriosis is now recognized as a significant issue in the global health system. According to the available data, endometriosis affects women not only of reproductive age, but also other age cohorts. Recent studies demonstrate that the clinical manifestation of the disease is present in absolute prevalence long before adulthood. Dysmenorrhea and pelvic pain often begin in adolescence, negatively affecting learning, daily activities, and interpersonal relationships. In addition, adolescent patients have several not only medical, but also social characteristics, which require adjustments to the clinical management of endometriosis. Underestimation of the severity of disease symptoms in adolescents leads to a significant progression of severe forms with a negative impact on fertility. The article discusses the characteristics of the clinical course of adolescent endometriosis and outlines the management of patients in accordance with current Russian and international guidelines. Given the diverse symptoms of endometriosis and the high prevalence of other pain syndromes in adolescents, it is recommended to use a multidisciplinary approach to treatment whenever possible; in particular, it should involve a pediatrician, algologists, and medical psychologists, in order to reduce pain sensitivity and eliminate concomitant mood disorders. In the pharmacological arsenal, there is an option for effective treatment of adolescent endometriosis − a combined oral contraceptive based on ethinyl estradiol and dienogest, which effectively suppresses the pathogenetic cascade of endometriosis, relieves clinical symptoms, and improves the quality of life for patients in this cohort.

Changing the features of the menstrual cycle to certain limits up to a short anovulation can be considered as a normal and transient response to adverse living conditions, including stress factors. The line separating such a normal reaction from a disease is very fluid and can be crossed in the setting of a predisposition. Stressful exposures include objectively adverse and subjectively significant factors of different duration and intensity. The predisposition to menstrual irregularities can have genetic prerequisites and be triggered by epigenetic factors. This literature review provides up-to-date data on the issue of stress-dependent menstrual disorders. Due to the significant role of prolactin metabolism disorders in the etiology of such disorders, the prospects of using plant-origin dopaminomimetics, including in young patients, have been considered.

Currently, the problem of connective tissue dysplasia (CTD) remains a significant concern. Its manifestations are highly variable, including in obstetric and gynecological practice. Therefore, it is necessary to address complications of pregnancy associated with CTD. We reviewed key papers, primarily published between 2018 and 2024, on CTD in obstetric and gynecological practice by authors from Russia and the CIS countries, given the virtual absence of scientific publications on this topic in the foreign literature. These data confirm the presence of such a pathology as CTD in women of reproductive age, which can become a trigger for a complicated course of pregnancy. The issues of diagnosis, prevention, and treatment of this disorder remain relevant; therefore, further research is necessary in this area to develop algorithms for the prevention and management of patients with CTD.

Background. Pelvic organ prolapse (POP) is a significant medical and social problem with a high prevalence and an upward trend in the incidence. It significantly impacts the quality of life and tends to relapse after surgical treatment of the supporting structures of the pelvic floor. Despite the proven association of POPs with obstetric traumas, their role remains poorly understood.

Aim. To assess the frequency of obstetric traumas in patients with POP and determine the directions for their prevention.

Materials and methods. A prospective case-controlled study was conducted involving 210 women (150 patients with POP and 60 control patients) who underwent surgical treatment in 2023–2024. Obstetric history was reviewed, including perineal trauma, episio-/perineotomy, large foetus, type of delivery.

Results. The absolute number of births did not affect the risk of POP (p>0.05); however, the complicated course of labor was a key predictor; in patients with obstetric traumas, the risk was 4.2 times higher (relative risk – RR 4.20, 95% confidence interval – CI 1.68–8.78), with episio-/perineotomy – 8.8 times higher (RR 8.80, 95% CI 1.9–18.6), with fetal macrosomy – 5.4 times higher (RR 5.40, 95% CI 3.35–13.43). Cesarean section did not show a protective effect on POP prevention (p>0.05).

Conclusion. Obstetric traumas are a significant but partially modifiable risk factor for POP. Prevention of macrosomia, avoidance of routine episiotomy, and minimization of obstetric traumas are key areas for reducing the POP incidence.

Background. In recent decades, the frequency of various intrauterine pathologies (IUPs) has increased, which is diagnosed in 38–72% of women of reproductive age. An imbalance in cell proliferation, differentiation, and death plays a crucial role in the pathogenesis of IUPs.

Aim. To determine the content of proteins regulating the internal pathway of apoptosis in endometrial cells and circulating lymphocytes in patients of reproductive age with various IUPs.

Materials and methods. A comprehensive clinical, instrumental, and biochemical assessment was conducted in 47 women of reproductive age (mean age was 39.5±2.74 years) with various IUPs. Clinical, ultrasound, hysteroscopic, morphological, and biochemical methods were used in all patients.

Results. In patients with an endometrial polyp, the most pronounced imbalance of apoptotic factors was detected. In such patients, a statistically significant increase in the Bcl-2 anti-apoptotic protein was observed in the endometrium, as well as a considerable increase in pro-apoptotic factors, including p53 protein, cytochrome C, and cleaved PARP, compared to female subjects without IUPs. The simultaneous elevation in Bcl-2 was determined in circulating lymphocytes.

Conclusion. The combination of clinical, instrumental, and biochemical methods of examination enhances the accuracy of diagnosing various IUPs. Interpretation of clinical data should be carried out taking into account the results of instrumental and biochemical research, which will optimize treatment tactics and prevent the likelihood of disease recurrence.

Background. Surgical interventions for early forms of pelvic organ prolapse and urinary incontinence may be associated with a risk of complications. Correction using hyaluronic acid (HA)-based implants is a modern, minimally invasive technique. Its outcomes depend on the properties of the drugs used and require clarification.

Aim. To evaluate the efficacy and safety of soft tissue implants for intimate contouring and urinary incontinence repair using HA modified with polyethylene glycol diglycidyl ether (PEGDE), REPART G.

Materials and methods. The study included 30 females with a mean age of 45±5.5 years. The patients were divided into two groups: Group 1 (n=15) with mild and moderate stress urinary incontinence (SUI) and Group 2 (n=15) with involutive genital changes. Routine perineological examination methods were used to assess the condition before treatment: gynecological examination, Valsalva test, cough test, assessment of the degree of pelvic organ prolapse according to the POP-Q classification, and pelvic floor muscle strength according to the Oxford scale. Before the treatment and 3 months after the treatment, the frequency of incontinence and sexual dysfunction was compared using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, PISQ-12. To confirm the diagnosis of SUI, Group 1 patients underwent a comprehensive urodynamic examination (according to ICS guidelines), as well as an ultrasound of the urethrovesical segment and perineum before the treatment and 2 weeks, 6, and 9 months after the treatment. In Group 1, patients received paraurethral injections of the 24 mg/mL REPART G Deep implant at 4 points (0, 3, 6, 9 o’clock positions), 1.0 mL at each point. In Group 2, contouring was performed by injecting 1–4 mL (depending on the amount required for the correction of the existing defect) of the REPART G Normal implant.

Results. Questionnaires showed significant improvements in certain aspects of sexual function and a decrease in the frequency of urinary incontinence episodes after treatment. Patients with urinary incontinence demonstrated a significant improvement in the ultrasound parameters of the urethrovesical segment in the early stages, with a partial return to baseline by Month 9 after treatment. Adverse reactions were rare, transient, and had no impact on the overall aesthetic and functional effect.

Conclusion. Soft tissue implants based on HA modified with polyethylene glycol diglycidyl ether (PEGDE), REPART G, demonstrated a good tolerance and significant improvement in tissue structure, urological symptoms, and sexual function in the correction of mild SUI and involuntary changes in the genital area. They enable delicate and safe restoration of the tissue structure, reducing the severity of symptoms in case of age-related tissue changes.

Adenomyosis is a common form of endometriosis that affects fertility and is one of the leading causes of dysmenorrhea. It is typical for women aged 35–50. The most common form is diffuse adenomyosis, while focal adenomyosis, a cystic variant, is very rare, especially in patients younger than 30. The main diagnostic methods are ultrasonic examination and magnetic resonance imaging. The article presents a rare clinical case of cystic juvenile adenomyosis in a 17-year-old adolescent girl with severe primary dysmenorrhea who underwent organ-sparing surgical treatment to preserve fertility and eliminate pain. Pathohistological examination confirmed the cystic form of adenomyosis. Forty days after the surgery, painless menstruation occurred; thus, complete pain relief without hormone therapy was achieved.