Author: Editor

Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis

Editor , ArticlesLRIOG 2022-1 , , , , , .
Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis

Alessandra Graziottin 1,2 – Orcid, Elena Boero 1 – Orcid

1 – Alessandra Graziottin Foundation for the cure and care of pain in women NPO

2 – Center of Gynecology and Medical Sexology, San Raffaele Resnati Hospital, Milan, Italy

Corresponding Author: Alessandra Graziottin

direzione@studiograziottin.it

DOI: 10.53146/lriog1202161

Abstract

Sexual pain at intercourse, or dyspareunia, is a common symptom affecting up to 1 in 5 women. Despite its high prevalence, sexual pain is still underdiagnosed. When recognized it is poorly characterized in its etiology and consequently undertreated by clinicians, especially when they are not trained in sexual medicine. Sexual pain always has precise biological causes and is often comorbid with other gynecological, pelvic, muscular, urinary, and/ or intestinal pathologies. Correct diagnosis and treatment of sexual pain require collecting a detailed clinical history aimed at identifying the most relevant predisposing, precipitating, and maintenance factors. The goal of the work is to provide the clinician with a questionnaire to make the anamnesis of sexual pain “physician-friendly”, and facilitate the in-depth diagnosis of sexual pain. The clinical reasoning is carefully discussed as well, to guide the reading of the symptoms and signs of the pathologies potentially responsible for sexual pain to identify a tailored multimodal therapy.

Keywords: sexual pain; superficial dyspareunia; deep dyspareunia; clinical history; vulvar pain; endometriosis.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Primary amenorrheas: normogonadotropic, hypogonadotropic, hypergonadotropic

Editor , ArticlesLRIOG 2022-1 , , , , .
Primary amenorrheas: normogonadotropic, hypogonadotropic, hypergonadotropic

Vincenzina Bruni 1 – Orcid, Metella Dei 2 – Orcid

1 – University of Florence

2 – Endocrinologist gynecologist. Freelancer

Corresponding Author: Vincenzina Bruni

vbruni@unifi.it

DOI: 10.53146/lriog1202160

Abstract

Menarche is a critical cue of female sexual and reproductive health. Therefore, the absence of menses at appropriate age needs a competent evaluation. The article outlines the various pathogenesis behind the symptom of primary amenorrhea, starting from situations not related to endocrine disorders such as outflow tract obstruction or uterine underdevelopment. The diagnostic assessment in situations of hypogonadism is often a challenge for the clinician and may require successive rounds of investigation, especially in the differential diagnosis between pubertal delay and hypogonadotropic hypogonadism. An impaired development of the gonads is, for females, one of the leading causes of primary amenorrhea: understanding the genetics behind gonadal dysgenesis improves the ongoing care of the girl and the prediction of associated medical problems. Therapeutic options for these different situations will be the topic of a following review.

Keywords: primary amenorrhoea; constitutional pubertal delay, hypogonadotropic hypogonadism; functional hypogonadism; premature ovarian deficiency.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Anxiety disorders in pregnancy

Editor , ArticlesLRIOG 2022-1 , , , , .
Anxiety disorders in pregnancy

Roberta Anniverno1 – Orcid, Roberta de Filippis1 – Orcid

1 – Local Healthcare Company Fatebenefratelli Sacco, Macedonio Melloni hospital, Center for Women Psyche

Corresponding Author: Roberta Anniverno

roberta.anniverno@asst-fbf-sacco.it

DOI: 10.53146/lriog1202158

Abstract

Women are particularly at risk of developing Anxiety Disorders. Both the biological component linked to gender and the pregnancy have been recognized as potential risk factors for the development of anxiety disorders. In fact, it is appropriate to distinguish pregnancy related anxiety, which includes specific concerns related to pregnancy, from anxiety disorders in pregnancy. Recently the literature has focused on the construct of pregnancy related anxiety trying to recognize its key characteristics and identifying them on an emotional, cognitive and physical level. In approaching Anxiety Disorders, it is appropriate to follow a Bio-Psycho-Social model that examines in addition to the biological component also the characteristics of the person and the environment in order to identify risk and protective factors. In order to assess the presence of anxiety disorders in the perinatal period, in addition to the administration of clinical scales, the clinical interview is important through the investigation of the key characteristics of anxiety disorders found during pregnancy. Finally, the treatment foresees a possible pharmacological treatment integrated with a psychotherapy course, following the evaluation of the potential risks and benefits.

Keywords: perinatal anxiety disorders; pregnancy related anxiety; bio-psycho-social model; interdisciplinary approach; psychotherapy.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Weight excess and inflammation in menopause: pathophysyology of a dangerous liaison and role of lifestyles

Editor , , ArticlesLRIOG 2022-1 , , , , , .
Weight excess and inflammation in menopause: pathophysiology of dangerous liaison and role of lifestyles

Gabriella Pugliese1 – Orcid, Annamaria Colao1,2 – Orcid, Alessandra Graziottin3 – Orcid

1 – Department of Clinical Medicine and Surgery, Section of Endocrinology, University “Federico II” of Naples, Via Sergio Pansini, 5, Naples, Italy

2 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples, Italy

3 – Center for Gynecology and Medical Sexology – San Raffaele Resnati Hospital Milan, Italy; Graziottin Foundation for the treatment of pain in women, ONLUS, Italy

Corresponding Author: Gabriella Pugliese

robiniapugliese@gmail.com

DOI: 10.53146/lriog1202159

Abstract

Weight gain is a common condition in menopause. It recognizes both modifiable and non-modifiable multifactorial etiological mechanisms. They include age, climacteric hormonal changes, alteration of hunger and satiety circuits, sleep disorders, reduction of energy expenditure, sedentary lifestyle and nutrition, including the eating time (chrononutrition and chronotype). The redistribution of adipose tissue, mainly from the subcutaneous site to the visceral site, acts as a real endocrine organ capable of secreting adipokines and proinflammatory cytokines such as TNF-α, IL-1, IL-6 and leptin. This contributes to the menopausal chronic low-grade inflammation, that increases the risk of metabolic disorders, cardiovascular events and neurovegetative disorders. Lifestyles interventions are the first line approach to cope with this condition. To date there are no specific dietary and exercise recommendations to be prescribed in overweight/obese women at menopause. The purpose of this review is, first, to analyse the mechanisms that favour weight gain, with focus on the role of sleep disorders and of proinflammatory mediators produced by the adipose tissue; second, to provide practical recommendations focused on lifestyles, useful in the general clinical management of postmenopausal women. The potential role of bowel microbiota and chronotype will be finally briefly discussed.

Keywords: menopause; obesity; inflammation; sleep disorders; adipose tissue; adipokines.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Metabolic syndrome and birth risks

Editor , , ArticlesLRIOG 2022-1 , , , , , .
Metabolic syndrome and birth risks

Nicoletta Di Simone1 – Orcid, Gloria Lalli2 – Orcid, Greta Barbaro3 – Orcid

1 – MD, PhD at Humanitas University, Milan

2 – MD at Humanitas University, Milan

3 – MD at Università Cattolica del Sacro Cuore, Rome

Corresponding Author: Nicoletta Di Simone

nicoletta.disimone@hunimed.eu

DOI: 10.53146/lriog1202156

Abstract

Metabolic syndrome is a condition characterized by the simultaneous presence of a cluster of risk factors leading to an increased cardiovascular risk. During pregnancy this syndrome has important repercussions on the maternal and fetal well-being and can cause important risks at the time of delivery. Pregestational hypertension increases the risk of preeclampsia, intrauterine fetal growth restriction and abruptio placentae. Also type II diabetes is a risk factor for preeclampsia and hypodevelopment but may also involve the appearance of fetal macrosomia and polyamnios. Fetal macrosomia is responsible for an increased risk of shoulder dystonia and polyamnios can determine the umbilical cord prolapse at the time of rupture of the membranes. Obesity is another element of metabolic syndrome. The obese pregnant patient has an increased risk of premature childbirth, she has a lower probability of response to the medical induction of labor and requires higher doses of oxytocin. In addition, the management of these patients is also complicated from an anesthesiological point of view: the placement of the peridural catheter is more difficult and they have a higher risk that it will displace, therefore getting a good epidural analgesia in these patients is not always easy. In obese patients, the risk of performing an urgent cesarian section is higher and leads to increased anaesthetic complications (tough intubation and difficult mechanical ventilation), intraoperative complications (increased bleeding and difficult fetal extraction) and post-operative (increased risk of surgical site infection). Still unclear are the effects of a dyslipidic state on pregnancy, although the change in lipidic profile is, within certain limits, physiological. Metabolic syndrome is therefore a condition that must be intercepted before pregnancy arises, as all the factors that compose it are modifiable.

Keywords: metabolic syndrome; pregnancy; obesity; hypertension; diabetes; delivery.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Weight excess and inflammation in menopause: pathophysiology of a dangerous liaison and role of lifestyles

Editor , , ArticlesLRIOG 2021-4 , , , , , .
Weight excess and inflammation in menopause: pathophysiology of a dangerous liaison and role of lifestyles

Gabriella Pugliese1 – Orcid, Annamaria Colao1,2 – Orcid, Alessandra Graziottin3 – Orcid

1 – Department of Clinical Medicine and Surgery, Endocrinology Section, “Federico II” University of Naples, Naples, Italy

2 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples, Italy

3 – Center for Gynecology and Medical Sexology H. San Raffaele Resnati Milan, Italy; Graziottin Foundation for the treatment of pain in women, ONLUS, Italy

Corresponding Author: Gabriella Pugliese

robiniapugliese@gmail.com

DOI: 10.53146/lriog1202151

Abstract

Weight gain is a common condition in menopause. It recognizes both non- modifiable and modifiable multifactorial etiological mechanisms. The first include: age, climacteric hormonal changes, alteration of hunger and satiety circuits, reduction of energy expenditure and sleep disorders; while among non-modifiable factors: sedentary lifestyle and nutrition, including the ea- ting time (chrononutrition and chronotype). The redistribution of adipo- se tissue, mainly from the subcutaneous site to the visceral site, acts as a real endocrine organ capable of secreting adipokines and proinflammatory cytokines such as TNF-a, IL-1, IL-6 and leptin. This contributes to the meno- pausal chronic low-grade inflammation, that increases the risk of metabolic disorders, cardiovascular events and neurovegetative disorders. Lifestyles interventions are the first line approach to cope with this condition. To date there are no specific dietary and exercise recommendations to be prescribed in overweight/obese women at menopause. The purpose of this review is, first, to analyse the mechanisms that favour weight gain, with focus on the role of sleep disorders and of proinflammatory mediators produced by the adipose tissue; second, to provide practical recommendations focused on li- festyles, useful in the general clinical management of postmenopausal wo- men. The potential role of bowel microbiota and chronotype will be finally briefly discussed.

Keywords: menopause; obesity; inflammation; sleep disorders; adipose tissue; adipokines.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

Download the pdf  download_pdf