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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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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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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

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Thyroid diseases and female infertility

Editor , , , , , ArticlesLRIOG 2021-4 , , , , , .
Thyroid diseases and female infertility

Chiara Graziadio1,2 – Orcid, Emanuele Filice1 – Orcid, Rosa Pirchio1 – Orcid, Renata Simona Auriemma1 – Orcid, Alessandra Graziottin3 – Orcid,

Annamaria Colao1,2,4– Orcid

1 – Department of Clinical Medicine and Surgery, Federico II University, Naples

2 – Italian Center for the care and well-being of the obese patient (C.I.B.O.), Federico II University, Naples

3 – H. San Raffaele Resnati Center of Gynecology, Milan

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

Corresponding Author: Chiara Graziadio

chiaragraziadio@live.it

DOI: 10.53146/lriog1202152

Abstract

BACKGROUND: Thyroid diseases (hypothyroidism, hyperthyroidism and thyroid autoimmunity) have been independently associated with fertility di- sorders and pregnancy failure, both in case of spontaneous conception and/ or after assisted reproduction technology (ART). Several studies have looked at the association between thyroid dysfunctions, thyroid autoimmunity (TAI) and reproduction. The aim of this paper is to identify the impact of thyroid diseases, starting from birth, on female infertility, by means of review of the recent pertinent literature.
METHODS: We reviewed the pertinent literature regarding the association between thyroid diseases and female infertility off the main international database (MEDLINE, PubMed).
RESULTS: Thyroid dysfunctions, associated or not with thyroid autoimmunity, can alter ovulation and the associated immunoendocrine processes with con- sequent menstrual irregularities. These complexes endocrine disruptions can result in mild to severe fertility disorders and increased spontaneous abor- tions. Thyroid autoimmunity is associated with an increased risk of miscar- riage and preterm delivery, both in spontaneous pregnancies as well as in pregnancies after ART.
CONCLUSIONS: Thyroid dysfunctions may lead to menstrual disorders and infertility via direct and indirect interactions with the hypothalamo-pituitary- ovarian axis and the reproductive organs.
In the management of the infertile woman, the complete screening of thyroid hormones and autoimmunity is recommended in order to promptly treat any hormonal dysfunctions that may be a cofactor or the cause of infertility. Fur- ther studies are needed to improve diagnostic and therapeutic fertility issues associated with or due to thyroid disorders.

Keywords: hashimoto’s thyroiditis; Basedow-Graves’disease; hyperthyroidism; hypothyroidism; female infertility; thyroid autoimmunity.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

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Love cells: the affective role of the fetal cells migration into the maternal limbic system

Editor , ArticlesLRIOG 2021-4 , , , , .
Love cells: the affective role of the fetal cells migration into the maternal limbic system

Mario Valerio Tartagni1 – Orcid, Alessandra Graziottin2,3 – Orcid

1 – “Fontana” Department of Gynecology and Obstetrics, Kantonsspital Graubünden, Chur, Switzerland.

2 – Graziottin Foundation for the treatment of pain in women, Onlus

3 – Center of Gynecology and Medical Sexology, H. San Raffaele Resnati Milan

Corresponding Author: Mario Valerio Tartagni

DOI: 10.53146/lriog1202142

Abstract

Why do foetal cells migrate in mother’s limbic system? During pregnancy the mother’s brain undergoes both microscopic and macroscopic changes. The foetus, throughout the whole pregnancy, sends its own cells (Pregnancy Associated Progenitor Cells, PAPCs) to colonize many maternal organs, inclu- ding the brain and the limbic system. This phenomenon is known as “micro- chimerism”. The migration of PAPCs has both an evolutionary and affective meaning because the limbic system is the department of the brain dedicated to the regulation of emotions and memory. Here, the PAPCs will differen- tiate into neurons and glial cells, forming new synapses and therefore new connections with and among maternal neurons. This process is accompanied by structural alterations (documented by magnetic resonance imaging and orchestrated by the hormonal changes characteristic of gestation) invol- ving the limbic system and the other brain structures closely connected to it, which are the very same areas colonized by the migration of the foetal cells. Instrumental diagnostics and specific tests showed that greater volumetric losses of grey matter during pregnancy were strongly related to the quality of mother-child attachment and absence of hostility towards the newborn in the postpartum period. Greater brain alterations during gestation were asso- ciated to a higher degree of maternal attachment to her child after birth. For the first time in literature. In this review we have integrated the studies on the migration of PAPCs in the maternal brain with those, very recent, on the morphological and functional alterations that the maternal brain undergoes during pregnancy, indicating a possible synergistic effect of these two com- ponents. Part of the biologic base of the maternal-child attachment takes place during this migration suggesting that the foetus could play a surprising active role in modulating the mother’s ability to love him, right from its life in uterus.

Keywords: limbic system; pregnancy associated progenitor cells (PAPCs); pregnancy; microchimerism; stem-cell migration.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

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Metabolic syndrome in menopause

Editor , , , ArticlesLRIOG 2021-4 , , , , .
Metabolic syndrome in menopause

Roberta Scairati1 – Orcid, Renata Simona Auriemma1 – Orcid, Annamaria Colao1,2 – Orcid, Alessandra Graziottin3,4 – Orcid

1 – Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy

2 – United Nations Educational, Scientific and Cultural Organization (UNESCO), Chair for Health Education and Sustainable Development, University Federico II, Naples, Italy

3 – Director of the Center for Gynecology and Medical Sexology, H. San Raffaele Resnati, Milan

4 – President of the Graziottin Foundation for the treatment of pain in women – Non profit organization

Corresponding Author: Roberta Scairati

robertascairati@gmail.com

DOI: 10.53146/lriog1202149

Abstract

Background: Menopause is associated with a high risk for cardiometabolic diseases, including metabolic syndrome (MetS), cardiovascular disease (CVD) and type 2 diabetes (DMT2).
Insulin resistance, abdominal obesity, dyslipidemia and hypertension are in- terdependent factors associated with menopause. The increase in the syste- mic inflammation is the common denominator of MetS. The purposes of this review are i) to clarify how the natural cessation of ovarian function, which is characterized by the decline of female sexual hormones and the relative in- crease of androgens, could explain the relationship between MetS, increase of the inflammatory indexes and menopause; ii) to understand how surgical menopause could influence the onset of MetS; iii) to highlight the role of hormone replacement therapy.
Methods: We revised the published literature in english language on PubMed database, from year 1992 to year 2021, by searching the following keywords, including 1) a refined definition of metabolic syndrome 2) relationship betwe- en metabolic syndrome and systemic inflammation 3) relationship between metabolic syndrome and obesity, insulin resistance, hypertension, osteoporo- sis and hypothyroidism, 4) surgical menopause and metabolic syndrome, 5) effects of HRT on the components of the MetS in post-menopausal women. Results: Derived evidences suggest an increased incidence of metabolic syn- drome in menopause, probably due to woman aging and hormonal chan- ges in menopause, worsened by hypothyroidism, inappropriate lifestyles and lack of timely initiated HRT.
Conclusions: Menopause plays a crucial role in the development of MetS and surgical menopause; sudden cessation of ovarian function can lead to a hi- gher incidence of MetS and systemic inflammation than physiological me- nopause. Hormone replacement therapy (HRT) and a healthy lifestyle may positively influence some aspects of Mets. Our observations can help in the clinical management of menopause-related MetS.

Keywords: menopause; surgical menopause; metabolic syndrome; inflammation; hormone replacement therapy.

Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283

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