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Tubal and peritoneal infertility
4 degrees of uterine tubes occlusion are distinguished.
Infertility caused by uterine and cervical factors
Treatment of infertility
In case of uterine tubes impassability
In treatment of tube infertility
In case of infertility because of synechias presence
Immunological factors of infertility
Psychological aspects of infertility
Additional reproductive technologies
Female indications for using of this method are
Bases of female sexology
Marriage is considered to be sterile, if during 1 year of regular sexual life without using of contraceptives, pregnancy does not occur. Infertility happens in 10-12% of all marriages. It is subdivided into male, female and mixed. About 45% of sterile marriages are connected with male infertility, 55% of them with female infertility.
Absolute infertility, when there are such changes in organism, at which pregnancy is absolutely impossible (absence of uterus, ovaries), and relative, infertility when sterility is caused by some factors, that can be removed are distinguished. Primary infertility (when a woman has never had pregnancy) and secondary infertility (if there was pregnancy in the past) are distinguished also.
For finding out infertility cause, couple examination is necessary. Usually examination begins with husbands because of considerable simplicity.
Physiology of male reproductive system
A hypothalamic-pituitary-testicles system in men is a permanently functioning closed loop system providing biological reliability of reproductive function, producing few millions of spermatozoa daily. Mature male sexual cells consist of head, neck and tail portion. A head has an ovoid shape 4,5 micrometers long, 2,5 micrometers in width, that contains a big nucleus. A tale provides active cell mobility in woman's genital tract. Spermatozoa receive energy, necessary for motion by endogenous and exogenous substrates' metabolism. Mechanism of motive spermatozoa function is extraordinarily complicated, each oscillation is an enzyme-ionic-motive complex. The sperm flagellar axonema is structurally and chemically complicated organelle, which is capable to generate undate waves from ATP hydrolysis energy.
Spermatozoa motility changing takes place in-parallel with acquiring of fertilizing properties — capacitation. This process begins still in epidydymus, where immature spermatozoa acquire qualitatively new characteristics and turn into mature, mobile forms, and accomplishes in woman's genital ways, where sperm gets after ejaculation.
^ . The sperm samples agglomerate after 2-3-day up keep from sexual life. For spermogram it is rvecessary to analyze sperm not later than in 1 -1,5 hours after ejaculation. It is received either by means of masturbation, or during the interrupted sexual act. Men agglomerate it into clean dry vessel and supply into laboratory.
Volume of ejaculate in healthy men is from 2 to 5 ml. General amount of spermatozoa must compose not less than 50 mm. The lowest norm border is 20x106. The sperm which contains not less then 50% of spermatozoa and has a good movabitity is considered to be normal. Spermatozoa motion must be forward, in one direction. Spermatozoa with oscillatory or circle motions refer to infertile or low-fertile ones.
Pathological changes can be manifested in irregular form and dimensions of head or tail.
Azoospermy (absence of spermatozoa), necrospermy (dead spermatozoa), oligospermy (decreasing of spermatozoa amount), theratozoospermy (dominance of pathologically altered spermatozoa forms), can be found at sperm research.
Causes of male infertility are violation of spermatogenesis as an outcome of carried inflammatory process, traumas, infectious diseases in childhood (especially epidemic parotitis), urinary-genital infections in manifestation of orchitis and epidydymitis (gonorrhea), cryptorchism, varicocele, and also intoxicationwith alcohol and chemical agents. Frequently infertility is a result of ionizing radiation action, electromagnetic radiation, high temperature. Herpes simplex virus and Chlamydia infection are of a great importance in development of infertility. At these infections sperm can carry infection into female genital organs. Infertility happens also at exhausting liver, kidneys, lungs diseases, endocrine pathology (diabetes mellitus, Kushing illness).
Sometimes infertility appears as a result woman's sensibilization to the men's sperm. In case, when there are changes in spermogram, a man is directed to se-xopathologist or andrologist. If all spermogram indexes are normal, examination of the woman should be started.
Basic causes of infertility in women are:
Diagnosis of female infertility is based into careful history taking (age, profession, influence of harmful factors of production, carried diseases, harmful habits). Tactfully learning of the psycho-sexual life conditions, genital function, meaning that primary infertility is frequently a result of infantilism, and secondary one is a result of carried inflammatory processes.
In objective examination attention is paid to body building, expressiveness of secondary sexual signs, presence or absence of infantilism. Carefully examination of internal organs, and in necessity — function of incretion glands should be performed.
During gynecological examination an attention is paid to hairiness on pubis, external genital organs' abnormalities, state of Bartholin's glands. Examination of vagina (its width, vaults depth), form and size of uterine cervix, presence of erosive ectropion is indicated. Uterine size, position, consistence, form, movability and correlation between cervix and uterus dimensions is examined also.
Most frequently the causes of female infertility are endocrine diseases, which are associated with ovogenesis and ovulation disorders. Patients with different forms of hyperprolactinaemia, hyperandrogeny, with polycystic ovarian syndrome, postpuberty form of adrenogenital syndrome and with other forms of endocrine disorders suffer from infertility.
Considerable number of infertility cases is a result of endocrine ovarian dysfunction, and these violations can be both primary and secondary with carried inflammation. Anovulation or retardation of follicle maturing with defective luteal phase appear as a result of dysfunction of cyclic processes in ovaries.
Endocrine infertility happens also at dysfunction of hypothalamic-pituitary system. The irregular menstrual cycle in the form of amenorrhea, hypomenstrual syndrome and uterine bleeding is attached to infertility of endocrine origin
Examination of patients should include:
Treatment is in regulation of menstrual cycle, correction of basic disease manifestations, that caused endocrine infertility, and in stimulating of ovulation. Ovulation can be stimulated by prescription of Clomiphene citrate in the dose 50 mg from 5th till 9th cycle day, by Pergonal in combination with Chorionic Gonadotropin.
The adhesions process in small pelvis causes the bend of the tube with preserving of their patency. This is the reason of peritoneal infertility. Tube infertility is conditioned by anatomic and functional disorders in uterine tubes.
Occlusion of uterine tubes happens as a rule after gonorrheal salpingitis, however it can be a result of nonspecific inflammatory process. Inflammatory processes can be a cause of not only uterine tubes' impassability, but also by dystrophic changes in their walls, violation of peristalsis. Abortions also play a great role in etiology of infertility, because they bring on inflammatory processes in uterine mucous membrane with the following dystrophic changes that interfere with implantation.
Finally, salpingoovophoritis can cause ovulation disturbance, and if it takes place, then the adhesions process doesn't give a possibility for ovum to get into tube. Ordinary ovarian endocrine dysfunction can usually happen.
Diagnosis of tube infertility is held by means of hysterosalpingography, hydrotubation or pertubation. It is better to make hysterosalpingography with water soluble roentgen-contrast solutions (Kardiotrust, Urographyn, Verographyn, Trioblast). This method gives a possibility to estimate the capacity of uterine tubes.
The state of uterine tubes can also be estimated during the contrasting sonography, that is made by introduction of a contrasting substance Echovist into uterine cavity under ultrasonic control.
^ They are:
Sometimes dye-stuffs are used. For example, Speck's test with 0,06% solution of Phenolsulfophtalein is common. At permeability of uterine tubes this dye-stuff appears in urine in 40-60 minutes. After addition to it several drops of 10% NaOH solution it is coloured into red colour. Aburell's test is performed by analogy (with 0,3 % solution of Indigocarmine, which tinctures urine into green).
As a rule, diagnosis of permeability is made in the stationary during the first phase of menstrual cycle, on condition that there are no inflammation signs and the first degree of vagina purity is present.
Laparoscopy with the use of chromosalpingography with Methyl blue is also of a great importance. This method allows to estimate the tubal permeability and to find the occlusion place.
Infertility can be caused by the state of uterine mucous membrane, when endometrium undergoes dystrophic changes that interfere with implantation process and cause uterine form of amenorrhea in the result of carried inflammatory processes, repeated curretages of uterine cavity and action of cauterizing chemical substances.
Diagnosis is ought to be made in such directions:
Infertility can happen as a result of uterine cervix inflammation — endocervicitis. This is an outcome of cervical canal epithelial structural changes, viscidity and acidity of cervical mucus, that causes the violation of capacitation processes, interferes with penetration of spermatozoa into uterine cavity.
In order to exclude influence of vaginal and uterine cervix secrets on sperm Shuvarsky-Khurner's test is made. This test is made during the day of expec-tative ovulation. Before this test one should refrain from sexual intercourse for 3-4 days. In examination day after sexual intercourse the contents of posterior vault is put on object plate and examined under the microscope; the mobile spermatozoa within eyeshot are quantifying. The test is considered to be positive at the presence of 5 active spermatozoa within eyeshot. The test should be repeated 1-2 times more in case negative reaction.
A choice of treatment method depends on infertility cause. Inflammatory process as the infertility cause must be treated. Physiotherapy methods (diathermy, ozokerite therapy, mud cure, magnet therapy, laser therapy), biostimulators, contrainflammatory remedies are widely used.
^ treatment is made by method ofhydro-tubation — introduction into uterus and tubes medical mixtures, that include antibiotics, enzymes, korticosteroids.
It is recommended to take three courses of treatment (6 hydrotubations every other day), interruption between courses is 1 month. After the third course of hydrotubations a control of uterine tubes' permeability is recommended. If tubes are passable, it is recommend to prevent from pregnancy for 5-6 months, making during this time additional course of hydrotubation and mud care.
^ in case of poor efficiency from conservative therapy surgical methods are used: salpingolysis — release of tubes from adhesions and renewing of their abdominal parts' passability; salpingostomatoplasty — formation of the hole at abdominal part of a tube; salpingoanastomosis — suturing the tube together "end in end", ovarian implantation into the tube or uterus, tubal implantation into uterus.
^ in uterus their destruction is made under hysteroscopy control with the following prescribing of contra-inflammatory resorption therapy and hormonal preparations during 2-3 menstrual cycles for renewing of menstrual function.
In case, when infertility is associated with underdevelopment of genital organs replacement therapy, physiotherapy procedures (mainly thermal ones — ozokerite, mud cure), gynecological massage in combination with hoimonal therapy is prescribed. Hormonal therapy is obligatory administrated according to the phase of menstrual cycle. Estrogen-gestagen preparations, ovulation stimulators — Clomiphen citrate, Puregol, Pregnil are used.
Prophylaxis of infertility is the prevention of diseases, that lead to it: infectious diseases in childhood and in the period of pubescence, inflammatory processes in adult women.
An important role in infertility prophylaxis belongs to the doctors of female dyspencery, which are to propagandize the contemporary methods of contraception, that will give a possibility to prevent abortions.
While making sanitary-educational work one should pay a special attention to the question of hygiene of sexual life, to the harm of abortion, especially during the first pregnancy.
The immunological form of infertility, which is caused by formation of antispermal antibodies (LsLb) in the man's or woman's organism happens relatively rarely. Its frequency is 2 % among all infertility forms. In 20-25% of couples with uncertain infertility ethiology the antibodies to sperm are found at further examination.
Antispermal antibodies are generated in men, than in women more frequently. Mainly this is a result of barrier break between male reproductive tract and immune system. The cause of this can be vasectomy, damage of testicles at orchitis, traumas, infections of reproductive tract.
Antispermal antibodies influence on such reproduction links as: spermatogenesis, transport of sperm, gamete interaction. Antibodies (IgG) that are connected with spermatozoon head, disturb the fertilization process. Antibodies (IgA) attached to the flagellar axonema in the tail part of spermatozoon, influence on cells' mobility.
In women the formation of gumoral tissue antibodies and spermatozoa phagocytosis are the basic reactions of antisperm immunity. Immunity-competent cells phagocyte sperm and then use taken information for recognition of antigens. The formation of antibodies takes place in uterine cervix most actively, more rarely — in endometrium and tubes. Uterine cervix is the main link of local immunity in female reproductive system. IgA are generated in uterine cervix. Their concentration change during menstrual cycle and decrease in the period of ovulation.
Antibodies to antisperm antigens have precipitating, agglutinating, immobilizing properties. There is a sperm contact test with cervical mucous as a screening-test.
The intrauterine insemination is the most effective method in case of this form of infertility. A mechanical method of contraception during 6 months using condoms for removal of sperm contact with female genitals is recommended. It is necessary to examine a couple for latent infection, because infectious agents contribute to formation of antisperm antibodies.
In majority of women with infertility various violations of psychoemotional sphere such as: feeling of inferiority, loneliness, strained waiting of next menses and hysterical states connected with its beginning appear. A complex of these symptoms composes the so-called «pregnancy expecting syndrome».
Indexes of psychological tests, that characterize a degree of personal qualities instability, fear, confidence in oneself, expressence of psychological reactions on environment, in families, that do not have children are considerably raised. In sterile women a high degree of neurotizing is observed. In men there is the tendency to oppression, violation of behavior reactions. Frequently there happens deviation from normal scheme of sexual conduct, violations of erection and ejaculation.
A great stress for a couple is examination necessity and later on the execution of doctor's recommendations concerning the rhythm of sexual life, specifically determination of ovulation period of wife according to the tests of functional diagnosis and advice to use for conception exactly a certain time. Sometimes insistent demand of a wife to have sexual intercourse namely in the certain period can cause functional impotency in husband and appearing of fear before sexual act and other potency disorders. Diagnosis of azoospermy or other pathology of sperm can influences unfavorably on man's potency state. Such news cause impotence in more than in half of men, and frequency of its beginning depends on wife's reaction. Likely, such disorders when absence of organic changes are temporal and afterwards potency renews spontaneously or under the psychotherapy influence.
For women the necessity of sexual life according to results of functional diagnostics tests is also a stress situation, upon which not only psyche, but organs of sexual tract, specifically uterine tubes react. Their spasm (antiperistalsis) can occur. It disturbs gametes transport even on condition that the tubes are passable. That's why sometimes woman's fervent desire to become pregnant becomes her enemy. There are described many cases, in which long-waited pregnancy came after woman has decided to stop cure, to cancel measuring of basal temperature and waiting attentively for the time of expectative ovulation.The same thing has happened, when a pair, loosing a hope for own descendants, adopts a child.
Causes and types of psychological disturbances of persons in sterile marriage are various, that's why doctor's experience, patience, tact during taking history are necessary to define personality character, peculiarities of matrimonial relations and psychosexual reactions. Interpretation of analyses results and also choosing of examination and treatment methods demand a special caution, specifically, for the newest reproductive technologies — extracorporal fertilization, insemination with donor sperm etc.
Question about application of additional reproductive technologies is decided by skilled competent specialist on request of couple after corresponding inspection. It includes determination of blood type, rhesus-factor, HIV, Wassermann reaction, HBs antigen, bacterioscopy of vaginal smear, diagnostics of gonorrhea, toxoplasmosis, trichomoniasis, ureaplasmosis, gardnerelosis, micoplas-mosis, making tests of functional diagnostics for characteristics of menstrual cycle, ultrasonic examination of uterus and ovaries, hysterosalpingography, for indications — laparoscopy, double study of men's (donor) sperm and other necessary examinations. At presence of some anomalies in reproductive function of couple and at presence of indications for using additional reproducti /e technology a correspondent treatment is indicated.
Generally, all the contemporary methods of additional reproductive technologies are based in vitro fertilization biotechnology. Insemination with man's (donor) sperm—instrumental sperm introduction into internal woman's genitals is widespread.
Presence of inflammatory, neoplastic and hyperplastic processes in uterus and its adnexa, somatic and mental diseases, impassability of uterine tubes, women's age after 40 years are contra-indications for using insemination by donor's sperm.
Insemination is made during one menstrual cycle in periovulatory period. For women with normal menstrual function and full value ovulation one insemination is sufficient. However, 2-3 procedures in case when there are some problems connected with establishment of exact time of ovulation are made. In this case due to the long functional spermatozoa ability (72 hours) fertilization probability is increased.
Vaginal, cervical, uterine and peritoneal methods of insemination are distinguished depending on sperm introduction way. Intrauterine insemination is considered to have the highest effectiveness. It provides introduction of specially processed sperm by catheter into uterine cavity. Pressing on syringe piston the sperm gradually is introduced during 2-3 min. An extremely fast sperm hit on uterine mucous membrane can cause its reflectory contraction, that is followed by pain or expulsion of contents from uterus into vagina.
Attached to intraperitoneal insemination specially processed sperm is introduced by means of the posterior vault punction into cul-de-sac. A test on peritoneal spermatozoa migration is made as a rule, before insemination. This test is considered to be positive at preserving of spermatozoa motility in peritoneal liquid in vitro.
For sperm indexes improving, before insemination ejaculate is fractionated, motile forms are separated by filtration, several ejaculates by cryoconserving are accumulated and some medications (Callicreine, Dextrose, Arginin, Caffeine or prostaglandins) are added.
Method of insemination requires the functionally full value uterine tubes and ovulation in woman. So* before the procedure there must be provided a qualitative diagnostics of reproductive sphere state, normalization of menstrual cycle, medicinal stimulation of ovulation and preparation of endometrium for perception of impregnated ovum. For this reason hormonal, clinical and ultrasonic monitoring are used. The concentration of gonadotropic hormones, progesterone, estradiol in blood is determined. Accessible and sufficiently informative are the tests of functional diagnostics and menocyclogram charts.
Using of ultrasonic diagnostics allows to speak not only about passability of uterine tubes, growth and development of follicles, but also about quality and full value of the ovum. Transvaginal sonography enables to get clear image of ovaries and to realize a follicle growth monitoring even in those patients, which have had operations on organs of small pelvis, and also in those, which have exessive body weight.
The program of extracorporal fertilization with transferring of embryo into uterus (in vitro fertilization — IVF) is recommended in those cases, when conservative methods have failed. Absolute indication to application of this method is tube infertility due to severe dysfunction or absence of uterine tubes. Relative indications are previous plastic operations on tubes (woman's age is less than 30 years, time interval after operation is not more than one year), ineffectual salpingolysis (ovarylysis) in women aged 35 years, some forms of endometriosis and polycystic ovarian syndrome, infertility of unknown genesis, immunological infertility in women with constant high titre of antisperm antibodies during one year, some forms of male infertility.
The method of extracorporal fertilization with transfer of embryo into mother's uterus includes few stages:
In practice a superovulation stimulating is employed. This is caused by the fact, that in natural menstrual cycle the chance of simultaneous maturing of several ovums composes 5-10%, while in stimulated cycles chance of two and more follicles development can reach 35-60 %. With aim of superovulation stimulating Clomifene citrate or its analogues in combination with Chorionic gonadotropin is used. Chorionic gonadotropin-is used in all schemes of superovulation stimulation. It is introduced in case of enlarging of dominant follicle diameter up to 18-20 mm. In 35-36 hours after introduction ovocytes are aspirated from the follicle together with follicle liquid. For this purpose laparoscopy is indicated, during which a mature follicle is punctured with the needle, creating negative pressure of 120-200 mm Hg. Recently the method of transvaginal access to follicles during ultrasonic scanning becomes wide-spread.
Received follicular liquid is studied under the microscope for exposure of follicular-ovocyte complexes in it. At their presence the material is washed by special environment, that removes a larger half of follicular liquid. Considerable attention is paid to sperm preparation stage. Its main aim is in spermatozoa capacitating, because this moment during extracorporal fertilization is absent.
For fertilization a spermatozoa suspension is put into the environment, which contains 1-3 ovocytes in 1 ml. Incubation duration is 16-20 hours. Received embryos are cultivated at temperature 37°C in atmosphere containing 5% C02, 5% 02 and 90% N2 in environment with pH = 7,3.
A fertilization fact is determined to the presence of pronucleus in ovocyte's ovoplasm and a second polar body in periviteline space.
Transfer of embryo into uterus is made on the 3-4th day from fertilization moment, that should correspond to the stage of 8 or 16 cells. For this reason a special catheter is used, with the help of which an embryo with some cultural environment is conducted to uterine fundus through cervical canal.
For guaranteeing of long adequate function of yellow body in the day of embryo transfer and in 4 days after this the woman additionally gets 5000 units of Chorionic gonadotropin. For women with severe pathology of ovaries (for example, early or physiological menopause), donation of ovocytes is recommended. In that case embryo, which is developed in the result of fertilization of woman-donor's ovum by husband-recipient sperm, is put into uterine cavity of his wife, who carries a child.
In recent years a method of gametes' implantation into cavity of uterine tube is successfully used, which is a variant of additional reproductive technologies. Ovocytes are received, a suspension of enriched sperm is added to them and inserted during laparoscopy with special probe into one or two uterine tubes from mature follicles on background of ovulation stimulating.
In this case both fertilization of ovum taken from the follicle and elementary stages of embryo dividing take place in uterine tube, that is in natural conditions, not in incubation ones.
The newest achievement of contemporary reproductology is intracytoplas-matic injection of one spermatozoon (intracytoplasmatic injection sperm ISO). This program allows to become pregnant in those cases of male infertility, which were considered to be hopeless before. A spermatozoon is inserted into the selected ovum. Embryo, being got by such method is transfered into uterine cavity.
Program of surrogate maternity include the women, which because of pathology of reproductive sphere can not be pregnant with a child (uterus is absent because of operative intervention or can't function). Genetically native embryo is transfered into uterine cavity of a woman, who has given a consent to carry a child.
Ordinarily sexual disorders, with which women apply to gynaecologists or, for their direction, to sexopathologist are present.
Sexual function includes: sexual drive (libido), sexual excitement and orgasm.
Sexual drive (libido) is caused by sexual instinct and is manifested by two components — a desire for mutual intimacy with persons of contrary sex and a desire for sexual intercourse. One of the most early manifestations of sexual drive is an interest to the contrary sex having merely platonic character.
Anxiety for close intimacy appears in the process of sexual life and ordinarily only after development of orgasmic function.
In women libido has an orientation on a specific person, appears in majority of cases after previous preparation (petting). This drive has physiological cyclicity, associated with changes in woman's organism during menstrual cycle. That is considered, that a woman has maximum sexual appetenece just before ovulation, the least — before menses. There are women, in which the maximum sexual appetence appears during menses. Mental and emotional overstrain negatively influence on sexual drive. Concerning the age libido reaches its maximum to 30 years, holds on up to 55, and then gradually decreases.
^ appears under the influence of sexual irritants and is followed by general changes in organism—speed-up palpitation, blood pressure rise, swelling of breasts and nipples. In genitals during the sexual excitement some changes also take place. They are swelling and enlarging of the clitoris, minor and major labia. Vaginal mucous membrane is also lubricated. Expressed local blood stagnation appears. Due to it vagina contracts. All these changes contribute to enfolding of the penis by vagina, enforcing erotic stimulation of both man and woman.
Orgasm as a composing part of sexual function is its basic criterion. Physiological manifestation of female orgasm are rhythmic contractions of vaginal and uterine muscles, during which a woman gets physical pleasure. In majority of women from 5 to 12 contractions with 1 second intervals are observed. The organs of orgasmic feelings mainly are the vagina and clitoris, in some women orgasm type is mixed. Some authors indicate on presence of urethral, perineal, cervical orgasm.
Such disorders of sexual function are distinguished:
Anorgasmy — absence of orgasm. This form of sexual disorders is most frequently found. Its cause is disharmony in matrimonial relations.
Absolute and relative anorgasmy is distinguished.
Absolute — when orgasm does not come for none circumstances.
Relative — when orgasm happens in some circumstances.
Also there exists symptomatic anorgasmy as a manifestation of various diseases — inflammatory processes of female sexual sphere, that are followed by pain during intimacy, constriction of vagina, underdevelopment of sexual labia, various endocrine violations. If a patient applies to a doctor by the reason of anorgasmy, first of all it is necessary to exclude presence of these diseases.
Treatment of anorgasmy is caused by its form. It is necessary to find in patient the most expressed erogenous zones and to give the suitable recommendations. One should explain the necessity of emotional background creation and additional stimulation of erogenous zones. Positions which the partners use during the intimacy are of a great importance. In case of advantage of vaginal orgasm, traditional European position is suitable for the pair, at clitoris one — a pose of a "rider" or sideways position. It is necessary to persuade the pair, that a over pudency in poses choice, neglect of erotic petting can be a cause of anorgasmy appearing. At symptomatic anorgasmy one should treat the pathological states, that cause it in time.
Frigidity — full absence or abrupt decreasing of sexual drive. It can be primary and secondary. Primary frigidity is more frequent in young «unaroused» girls and lasts till the first orgasmic feels. At non-proper (negatively directed) sexual upbringing in childhood the primary frigidity can remain for the rest of life. It can happen also after rough or forcible first sexual act.
Secondaty frigidity appears by reason of various causes, however most frequently it is a result of anorgasmy as an effect of unskillful man's conduct during the sexual act. Emotions following this phenomenon deepen anorgasmy and bring the libido down. The basic symptom of frigidity is absence of sexual drive even after previous partner's petting.
At consulting a woman with the problems of frigidity, first of all it is necessary to find its possible cause and to give advice for its removal. Psychoerotic training of a couple gives good result. At first one should find woman's erogenous zones, explain desirability of their stimulating by a partner, and then in delicate form have a conversation with a husband, better without his wife.
Hypersexuality (nymphomania) is a raised sexual drive. It is found rather rarely. There are two its forms — in young women and a climacteric one. Young women rarely apply for help — only when the need in sexual contacts forces a woman to amoral conduct. A climacteric nymphomania passes heavily and brings extraordinary sufferings to women. In majority of cases a nymphomania is a symptom of the CNS disease, specifically of hypothalamic region, and also of some psychic diseases (autism, oligophrenia, maniacal states). Treatment of hypersexuality is in radical cure of basic diseases that cause this pathology.
Onanism (masturbation) is the receipt of sexual enjoyment by means of sexual organs irritating. Masturbation refers to pathological only then, when it is made frequently, specially in the background of normal sexual life. In majority of cases women resort to masturbation on background of long absence of orgasm at presence of sexual excitement. It is not considered to be a pathology, when sometimes a healthy woman masturbates because of temporal absence of intimacy. Prolonged surplus masturbation causes woman's astenization. Excessive masturbation is treated by means of hypnotherapy, going in for sport, increasing of physical loading is recommended.
Proper psychosexual education in childhood is necessary for prophylaxis of sexual violations in women. The task consists in giving of necessary information about hygiene of sexual life, about childbirth. Simultaneously one should remember about delicacy of such information. One should not wake up girl's sexual appetence early, but one should not intimidate the girls.
Elucidation should have individual, not public character. Doctors should make the conversations about sexual education with parents of a growing-up girl, so they could properly orient their children in this question. Antenuptial consultations on the questions of sexual life hygiene are very important.
Partners should know, that they have to respect individual peculiarities and the needs of each other. Sexual intercourse must be realized in civilized conditions, in conditions of complete secluding. After the first sexual act one should recommend to avoid coitus for a while, so that the pain could not cause negative reaction on sexual intercourse. Intimacy is not recommended during inflammatory processes and menses.
In prophylaxis of frigidity and anorgasmy these factors are of a great importance. Also one should remember that except the body there are other erogenous zones such as eyesight, hearing, scent.
Very often young people feel a need in everyday intimacy and don't feel tired after the sexual acts. Such frequency of sexual intercourse is considered to be normal. Sexual acts are harmful in case when they are repeated in short time intervals. They cause both general exhaustion and traumatizing of genitals. Coitus interruptus also damages the health and sexual life of the matrimonial pair. It causes not only blood stagnation in organs of small pelvis, but influences unfavorable on psychoemotional sphere, that can lead to sexual violations. One of the important moments of anorgasmy prevention is reliable contraception. Moral trauma and painful feelings carried by woman during artificial termination of pregnancy also can cause the appearing of steady anorgasmy. That's why before making abortions one should prepare the woman psychologically, and also use a careful anaesthetizing.
|Topic: Infertility marriage. Family planning||Abstract. Puliaeva K. Differences in management: do male and female have different leadership style|
|Пуляевой Е. С|
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