Atrofie poševní sliznice

10.10.2012 kategorie: Klimakterium

Naše společnost sice není tak falešně úzkoprsá, jak to zaznívá v slavné hře "Vagina - monology" americké autorky Evy Ensler, ale přesto i české ženy mají problémy hovořit o své pochvě a sexualitě a to dokonce i s lékařem.

 

Pochva jako výsostně pohlavní orgán je významně ovlivňována hladinou ženského pohlavního hormonu estrogenu v krvi respektive ve sliznici a podslizniční vrstvě poševní stěny. Nepřekvapí tedy, že u žen po přechodu dochází v individuálně rozdílné době k rozvoji atrofie poševní. Atrofie - tedy nedostatečný růst - je spojena se zeslabením sliznice, ta ztrácí svoji elasticitu i  lubrikační schopnosti. Současně ubývá i glykogen, složitý cukr nezbytný pro život přirozeného ochránce poševního prostředí lactobacila.

Stav relativního nedostatku estrogenů s rozvojem poševní atrofie se může objevit i v reprodukčním věku - u kojících žen, uživatelek čistě gestagenní antikoncepce nebo při některé léčbě.

 

Atrofie poševní se projevuje souborem potíží a je označována jako atrofická vaginitida. Projevuje se poševním dyskomfortem zejména pálením, které může být i v klidu, ale zhoršuje se po styku , který sám je pak nepříjemně bolestivý až nemožný. Dominantně se vyskytuje u žen po přechodu a to až v 61% u žen bez léčby a překvapivě i u 27% žen s hormonální terapií. Dalším projevem mohou být opakované žlutavé výtoky. Současně s poruchou růstu sliznice močové trubice a močového měchýře, které jsou rovněž závislé na estrogenu, se může zhoršit i kvalita udržení moči.

 

 

Přes vysoký výskyt těchto potíží, které jsou nejen obtěžující, ale současně i zhoršují psychosociální vztahy, se jen 3% pacientek aktivně svěřuje s tímto problémem svému lékaři a 16% není schopno o tomto problému vůbec hovořit.  

Hlavní možností jak takové potíže řešit je lokální podávání estrogenů. Je možné jej kombinovat s jakoukoli systémovo léčbou tedy i s hormonální substituční terapií.

Na rozdíl od této systémové léčby, nemá lokální podávání estrogenů žádná rizika a neexistuje tedy ani žádný stav, při kterém by nemohli být podány. To platí zejména pro polední generaci lokální estrogenní léčby. Globule a krémy s relativně vysokými dávkami estriolu nebo ve světě equinních estrogenů či promestrienu byly nahrazeny malými vaginálními tabletkami s dávkou 25 mikrogramů estradiolu. Studie jednoznačně prokázaly bezpečnost této léčby pro organismus ženy i orgány malé pánve včetně sliznice dělohy.

Při rozvinutých příznacích je léčba zahajována 10 - 14 dní trvajícím každodenním podáváním jedné tablety a následně přecházíme do dlouhodobé udržovací fáze s aplikací dvakrát týdně. Podávání dvakrát týdně lze u méně vyvinutých příznaků postavit i do role léčby první volby.  Terapie se podává bez omezení, dokud potíže neustoupí či v jejich prevenci.

Aplikace je výhradně vaginální a je usnadněna jednorázovými aplikátory připomínajícími malou propisovací tužku.

Projevy atrofické vaginitidy nejsou přirozeným příznakem stáří velícím k opuštění koitálních aktivit a sexuality jako takové. Je chybou omezovat tuto významnou část lidské psychosociální komunikace kvůli snadno řešitelným problémům.  Prolomte mlčení a pojďte si s tentokráte v parafrázi amerického profesore Alfreda Kinseye „povídat o sexu".

 

 

Neváhejte se obrátit o pomoc na svého lékaře, pokud máte jakýkoli s následujících projevů atrofické vaginitidy:

-         suchost pochvy

-         svědění v pochvě

-         pálení v pochvě

-         bolesti v pochvě

-         bolestivý styk

-         špinění či krvácení po styku.

Mohou být ostatně i projevy jiných chorob, které je nezbytné včas léčit.   

 

MUDr. Tomáš Fait, Ph.D.


Komentáře

02.08.2010 - kamilla
Na oslabenou imunitu, sníženou obranyschopnost organismu, fyzické a duševní vyčerpání navrhuji preventan. Je kvalitní.
03.03.2011 - StazkaC@seznam.cz
Dobrý den.Jsem šest let po hysterektomii.Asi 4 roky mám ordinovány Difluenu gel a Ovestin krém.Po dvou letech po začátku užívání se mi začal ztrácet epitel na sliznici na vnitřní straně malých styd.pysků( med.byla zvýšena)a asi půl roku mám silné svědění poštěváčku.Když jsem to sdělila své gynekoložce,řekla mi,že to patří k úbytku hormnonů a každá žena reaguje jinak,budu se s tím muset smířit.Velmi to však ovlivňuje můj sexuální život.Jsem v této oblasti vzrušivá,s manželem jsme měli sex 4 x týdně a nyní to prostě nejde.Po styku mě tato oblast bolí i několik dnů.Zmírní se po natření Fenistilem a požití Zodac tabl.Pokud to jde,snažím se neoblékat spodní prádlo,aby se mi tam nic netřelo.Je mi 58 let.Děkuji za radu.Jana
30.08.2011 -
29.02.2012 - jarmila
Dobry den.Pred 5-timi rokmi mi skoncila menstruacia.Mojim problemom je atroficka vaginitida,na ktoru som zacala uzivat gynoflor.Chcela by som vediet priblizne po akej dobe by sa mal moj stav zacat zlepsovat k spokojnosti mojej aj partnera.Dakujem za odpoved
09.03.2012 - romianka
Dobrý den,hledám info,jak alternativní cestou snížit hladinu ženských hormonů v těle..Děkuji za radu Romana
19.07.2012 - jana
Mám 7 let po hysterektomii, užívala jsem HST estrofem.nyní jsem rok po operaci rakoviny prsa,nádor byl z čáati závislý na estrogenu.Po operaci užívám arimidex.Mám problém, suchost pochvy a bolest při styku.estrogenní léčbu už nemohu ,lubrikační gel nepomáha.Dá se to řešit? Je mi 52 let.Děkuji
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