A message on the topic of women's reproductive health. What is human reproductive health - what factors influence, how to maintain and prevent violations. Ecology and working conditions

Demographic indicators today testify to depopulation and a decrease in the reproducing cohorts of the population, as a result, they intensify the aging of the population. Over the past decade, there have been 7 million fewer children, and their share has fallen from 24% in 1990 to 24% in 1990.

Up to 19% in 2000. According to forecasts, by 2015 this figure may decrease to 15%, and by 2050 to 12% in the structure of the Russian population [ 147J.

Demographic processes, which are based on the laws of population development, are distinguished by the inertial specificity of the change of generations and are difficult to respond to external influences. The crisis state of society forms problematic youth, which in turn determines the face of the future generation in various aspects.

A terrible consequence of these trends is the decline in the health potential of each subsequent generation in relation to the previous one. This means that children do not replace their parents either in terms of number or quality of health. It is estimated that over the past 75 years, the annual loss of health potential is 1%, i.e. for 1 / 4 century, the loss of health of the population reached a quarter of the available stock.

One of the most pressing problems modern society have become the problems of adolescent children, as the most susceptible to the socially negative influence of society and the environment. Moreover, a number of works testify to the special sensitivity of the adolescent reproductive system to their effects.

The formation, development and formation of the reproductive system begins from the moment of conception and continues until the age of puberty, i.e. up to 18 years old. The implementation of the function of the reproductive system (PC) of a woman is associated with the age of 18-44 years.

Thus, all stages of the formation of the PC function of a girl over the course of 18 years is a preparation for future motherhood, and in many respects determine not only the health of a woman, but also her offspring. In this sense, protecting the health of a girl and a teenager, as a future mother, acquires the importance of primary tasks. national policy states.

Human reproductive health is due to the complex impact of biological, social and economic factors, including ecology, quality medical care and lifestyle of the individual.

Yu.P. Lisitsin (1989) calculated that the most important indicators of human health, including reproductive health, are determined by 50% by conditions and lifestyle, by 20-25% by the state of the external environment, by 20% by genetic and hereditary factors, and only by 10-15% the quality of medical care. However, these data are valid only for an adult.

I.G. Dubovoy (2002) explains the dependence of adult health indicators by 50% linking them to the living environment, 33% - the state of the population, 10% - the level of health development and 4% - the standard of living of the population. At the same time, for children, the significance of the listed factors is somewhat different and is estimated at 31%; 43.2%; 12.2% and 13.6% respectively.

Each of the above factors has an age-specific significance and changes its rating throughout life.

person. So, for a child, biological factors are especially significant - hereditary, mother's health, the course of pregnancy and childbirth, as well as the quality and availability of medical care, especially during the first 2 years of life.

For adolescence in the period of MS formation, the most important indicators of health are the “burden” of accumulated somatic pathology and reproductive behavior associated with the problem of early sexual activity, STIs, unwanted pregnancies and abortions. Socially significant diseases, such as alcoholism, drug addiction, mental disorders, which largely determine the reproductive behavior of a teenager, become significant.

Quantitative indicators the state of RD is the frequency of complications during pregnancy, childbirth, and abortion, the prevalence of neoplasms of the genitals and gynecological pathology in the studied population. The most significant information about the state of RD in children and adolescents remains data on the frequency and structure of gynecological pathology.

Health indicators are recorded by attendance at medical institutions, and the results of preventive examinations or screening studies. State statistics is based on the indicators of gynecological morbidity in terms of access to medical institutions and fixes them for children under 14 years of age according to the integrated indicator "menstrual disorders", in adolescents, "salpingitis and oophoritis" are also taken into account. According to official published data, these figures from 1992 to 2002 have a steady upward trend in all age groups.

gynecological diseases in preschool children occur in 3.9% of girls preschool age, and according to M.S. Shushunova - 29.3%. V.A. Dynnik (1993) identified rural adolescents in 75% of the mental retardation, and Yu.A. Gurkin (1998) believes that all variants of sexual development disorders account for 16.4-21%.

In the work of P.N. Krotina (1998) showed an age-specific increase in the incidence of gynecological pathology by more than 2.5 times from 116.2%o at 14 years old to 297.0%o at 17 years old, which is explained by an increase in the frequency of gynecological morbidity in girls and its "accumulation" with age.

There are few data on the frequency and structure of gynecological pathology based on the results of screening studies abroad. This is probably due to the peculiarities of building specialized care for girls, and the lack of practice of preventive examinations. Most studies of the structure of gynecological pathology were carried out on the basis of negotiability.

Among children 5-18 years old, residents of Athens, who applied for help, vulvovaginitis in children is 77.7%, tumors of the pelvic organs - 11.1%., precocious puberty - 3.7%, and injuries - 5.4% . 59.7% of adolescents sought help for NMC, 12.5% ​​for pelvic tumours, 5.6% for vulvovaginitis, 2.5% for breast pathology, and 4.4% for sex life consultations.

According to the department of the gynecological clinic in Buenos Aires (Argentina), 10,120 patients were examined, 80% of whom were adolescents and 20% children. The reasons for adolescents seeking help were sexual infections in 30.2% of cases, NMC in 26.5%, contraception in 15.2%, breast pathology in 4.3%, tumors and tumors in 0.4% of cases. 0.5% for

Meanwhile, it is known that for assessing the health of a population or individual cohorts of the population, morbidity rates according to preventive examinations are especially significant, since they are not affected by the desire (or ability) of the patient to seek help, i.e. they reflect the true characteristics of health, determining the frequency of occurrence of gynecological pathology in the studied population and the ranking place of each class of diseases (or nosological forms) in its structure.

An analysis of scientific literature data allows us to state that the leading trend in the dynamics of RH indicators in children is an increase in the frequency of gynecological pathology in most regions of Russia. Back in 1983 M.N. Kuznetsova and E.A. Bogdanova revealed gynecological pathology in 8-12% of the population of girls and adolescents. Yu.A. Gurkin reports that in 1996 the incidence rate in Russia was 120%o with fluctuations by region: in Yakutsk - 115.6%o, in Novgorod - 147.6%o, St. Petersburg - 108.8%o, and in 2000 in St. Petersburg, the incidence of gynecological diseases in girls reaches 350%.

However, the prevalence of gynecological pathology among children and adolescents is estimated differently and varies significantly. So, according to published data, the frequency of gynecological pathology in the children's population in Ufa is 15%, in Bryansk up to 50%; V Tula region 89.2% of girls have gynecological pathology, and in Astana (Kazakhstan) this figure is 20%.

Even greater discrepancies relate to similar data presented by age groups. Yes, according to our data

obtaining information. The reasons for seeking help at the Department of Gynecology and Pediatrics (Finland) for girls under 16 years old were endocrine disorders (28%), "local gynecological symptoms" - 22%, problems associated with sexual activity (17%). In the older age group, 2.2% of patients were diagnosed with pregnancy, 24% had pain and 24% had "local gynecological symptoms".

The presented data allow us to state the absence of conditions for a comparative analysis of gynecological pathology, due to the large difference in the methodology for its determination.

A special place in the system of specialized gynecological care is played by the stationary link. "Hospitalized" morbidity reflects the condition of children with the most severe, difficult to diagnose or recurrent pathology. However, there is very little information about the disease in specialized hospitals in the literature.

The experience of the hospital CDC "Juventa" states that the main contingent of the hospital was 80% - adolescents hospitalized for abortion, 3-10% - girls with NMC, 8.3% with inflammatory diseases of the pelvic organs, 2% in need of minor operations and 6.3% patients with dermatovenerological profile. The leading pathology of "hospitalized" morbidity is NMC, and inflammatory diseases.

Such a few publications on the work of specialized hospitals can be explained primarily by their small number and low prevalence, which makes us think about the insufficiently developed stage of providing qualified gynecological care to children.

The given information about gynecological pathology makes it possible to approximately assess the state of reproductive health, which is primarily due to the fact that the methodology for collecting material - division into age groups, diagnostic standards and statistical processing of data differ significantly. As noted above, RH is influenced by a number of factors, which include somatic health, a person's lifestyle and reproductive behavior, stress, environmental, economic and social problems.

Somatic pathology and reproductive health

The connection of somatic pathology with reproductive health is noted in the works of many authors, which emphasize the "dependence" of the function of the reproductive system, as well as the timing and pace of sexual development, on the state of general health.

A generally recognized trend in children's health, most scientists consider a decrease in the quality of health and an increase in morbidity rates in all age groups. It should be noted that an increase in the frequency of somatic pathology in children and adolescents over the past 5 years has been noted by many leading pediatricians, confirming its increase, both in general and by groups and classes of diseases of the endocrine and nervous system, diseases of the gastrointestinal tract and genitourinary system.

N,G. Baklasnko (1999) states an increase in the overall incidence of children under 14 years old over the past 5 years by 9.1%, and in adolescents (15-17 years old) by 29.4% in almost all classes of diseases. Moreover, in girls, the incidence rate is 15 times higher than in boys. Over the past 10 years, the number of school graduates suffering from chronic diseases has increased from 43.9

up to 75-80%, 10% have a pathology of the reproductive system.

One of the negative trends today can be considered the deteriorating health potential of newborns. Thus, in the 90s, the proportion of children born already sick increased 2.4 times and reached 39.3% by 2000. A decrease in health potential is also observed in the process life cycle: the proportion of healthy children among those born is 60%, among primary school students - 8%, senior classes - 5%, the same patterns apply to reproductive health.

Functional and chronic pathologies begin to form at a very early age. Only in 5 years (1995-1999) the incidence rate increased by 15%, and half of adolescents suffer from chronic diseases. The prevalence of borderline mental disorders among children under 18 reaches 79%.

The relationship between the state of somatic and reproductive health has been traced in the works of domestic scientists in sufficient detail. Based on the extensive data on the results of preventive examinations of girls aged 14-18, P.N. Krotin (1999) showed that in girls belonging to the I group of health, there were practically no violations of the reproductive function, in the II group of health, 35% of the examined patients were diagnosed with the presence of gynecological pathology, and in the girls of the III group, this figure was almost 100%.

Similar data were obtained by N.A. Sokolova (1989) when examining 1458 girls aged 12-16 in Blagoveshchensk. In her opinion, gynecological morbidity in group I (the most

somatically burdened) is 16.92%, in group II - 19.72% and in group III of healthy girls - 10.4%.

Based on a survey of 2000 girls 7-14 years old residents of the city of Nalchik, A.Z. Beytuganova (2000) proved a 2-fold increase in sexual development deviations in girls of the III health group, compared with "absolutely healthy" peers.

I.A. Komaev et al. (2003) conducted a study of the health status of Nizhny Novgorod students aged 15-25, which showed that the overall morbidity rate is 1266.6%o, and the level chronic diseases and morphological and functional deviations - 168.6%o, the increase in this indicator compared to 1998 was 10.1%. The first ranking place in the structure of morbidity according to the data medical examinations in all age groups, are occupied by genitourinary diseases, and the increase over 3 years in the class of diseases was 32.9%, and in diseases of the reproductive system - by 35%.

Endocrine system and reproduction

The reproductive system is characterized by stable connections of all its links that ensure the process of self-regulation, as well as its interaction with the work of other systems, the relationship of reproduction with the endocrine and nervous systems is especially closely traced. The reproductive system, being self-regulating, functions in close connection with the organs of the endocrine system, which is largely due to the uniformity of their structure and the nature of their work and a single hypothalamic-pituitary regulatory center. In addition, PC is a specific endocrine element in a single functional system that provides adaptive mechanisms for the body's adaptive reactions. Therefore, the violation of the function of some elements

endocrine system can change the work of others, and cause pathological changes in them.

The influence of endocrine pathology on the reproductive system has been studied in the most detail. It has been established, for example, that dysfunction of the adrenal cortex is accompanied by disorders of sexual development, and the menstrual cycle up to amenorrhea. One of the main clinical symptoms This pathology is the premature sexual development of a girl according to the heterosexual type, due to the increased production of androgenic steroids, with a congenital blockade of cortisol synthesis. Clinically, depending on the level of androgenization, an increase in the clitoris and the formation of the urogenital sinus are possible, followed by the development of opso-, oligo- or amenorrhea. Hypercortisolism (Itsenko-Cushing's disease) occurs in children against the background of damage to the hypothalamic parts of the brain and increased production of ACTH, which leads to hyperfunction of the adrenal cortex and, as a result, androgenic hyperproduction, blocking the action of sex steroids.

Hypofunction of the adrenal cortex does not have such a strong effect on the function of the reproductive system, however, a violation of the menstrual cycle with hypocorticism is characteristic, although some patients maintain a regular menstrual cycle.

A common endocrine pathology is a dysfunction of the thyroid gland. Thyroid diseases in half of the cases are familial. With thyrotoxicosis, various menstrual irregularities are observed from irregular menstruation to persistent amenorrhea. Both primary and secondary hypothyroidism has a significant

influence on the development, formation and function of the reproductive system of the child. An early and even clinically unexpressed deficiency of thyroid hormones can cause premature sexual development of a girl according to the heterosexual type. Adolescents with hypothyroidism are characterized by delayed sexual development, menorrhagia, oligo- and amenorrhea. At the same time, there is a correlation between the severity of thyroid hormone deficiency and the severity of damage to the reproductive system.

Among the endocrine pathologies that have importance for the function of the reproductive system, a special place is occupied by the hypothalamic syndrome of puberty (HSPPS). It is interesting that environmental factors, as well as heredity, lifestyle and living conditions, can act in relation to HSPS as risk factors, etiology and trigger mechanisms for the formation of the disease. HSPS is a disease based on damage to the diencephalon with hypothalamic-pituitary-endocrine dysfunction.

According to R.P. Mirimanova (1992) among the endocrine pathology during puberty, the SSPPS is about 60%. According to our studies, 32% of girls suffering from various forms of menstrual irregularities have signs of HSPS, and studies in 1992 showed that over the past 20 years the prevalence of the disease has doubled.

The hypothalamus is an extremely complex structure of the brain, with numerous functions, including regulation of the activity of the endocrine glands, SEXUAL and eating behavior, emotional reactions, control of body temperature during vegetative-vascular reactions, and many others. Generally

hypothalamic structures of the brain are the main factor providing homeostasis Dysfunction of the hypothalamic structures of the brain, determines wide range peripheral symptoms, the leading of which are endocrine-exchange, neurological and emotional manifestations [I, 37, 169, 226].

The state of the reproductive system of patients with HSPPS is characterized by varying degrees of imbalance of sex hormones, developing into a picture of luteal phase insufficiency (LFP) or persistent anovulation, where absolute or relative hyperestrogenism remains the leading sign. The clinically described phenomenon is expressed by juvenile uterine bleeding, or rare and scanty menstruation up to amenorrhea. GSPPS therapy aimed at normalizing the function of the diencephalic structures of the brain includes a low-calorie diet, physiotherapy and balneotherapy, neuro- and psychotropic drugs, appetite suppressants and other drugs, depending on the symptoms of the disease. According to our data, adequate, individually selected non-hormonal therapy makes it possible to restore the menstrual cycle in almost 60% of patients with HSPPS in the absence of severe hyperandrogenism, which in turn emphasizes the secondary nature of the dysfunction of the reproductive system in HSPPS.

Thus, the influence of the endocrine system on sexual development and the function of the reproductive system as a whole is quite large. It should be emphasized that even latent forms of dysfunction of the endocrine organs can disrupt the activity of the organs of the reproductive system. Severity

decompensation for the underlying disease correlates with the severity of dysfunction of the reproductive system. And, finally, adequate therapy of the underlying disease makes it possible to eliminate dysfunctions of the reproductive system and even restore fertility, which proves the secondary nature of changes in the reproductive system in the presence of endocrine pathology. In this regard, the treatment of various forms of disorders of sexual development and menstrual function in girls with endocrine pathology should begin with the selection of adequate therapy for the underlying disease.

Lifestyle, stress and reproductive health With the concept of "adverse living conditions" usually

low economic status of the family, malnutrition or its deficiency, difficult living conditions are associated. Of course, these conditions determine the high morbidity of the child, the presence of chronic foci of infection, lack of weight, delayed sexual and physical development, and menstrual irregularities up to amenorrhea. However, overeating malnutrition, allergic reactions, reduced physical activity also increase the number of gynecological pathologies in childhood and puberty. sustainable current trend, especially the urban population, is a massive information load on children. This is especially pronounced in adolescents aged 14-18 who have an intense school load, additional classes for preparing for a university, parallel studies at a music school, language classes or computer technology, usually accompanied by a lack of night sleep. Meanwhile, of no small importance, especially during periods of intensive training, is the normalization of sleep.

an increase in the number of neurotic disorders in adolescence, which is associated by psychiatrists with the characteristics of the psychology of adolescents, and individual characteristics of personality development.

The impact of pathological stress on the reproductive system of a child is realized, on the one hand, through inhibition of the function of the subcortical structures of the brain and is manifested by a decrease or blockade of the secretion of gonadotropic releasing hormones, as well as the impact of a massive release of adrenal hormones, both cortisol and androgens, on various parts of the reproductive system. The observations of domestic psychiatrists reliably show that almost half of the girls with borderline

mental states, have certain menstrual irregularities.

Psychiatrists believe that 40-60% of adolescents have certain characterological features, or psychopathological conditions. Psychiatrists distinguish 12-14 types of accentuation of the character of a teenager, which have reduced adaptive capabilities to society. In turn, it is accentuated adolescents who are at risk for the formation of neuroses, neurotic personality development and various kinds of psychopathy. The conditions of modern life lead to a sharp increase in the teaching load, an increase in the intensity of interpersonal conflicts, and the negative influence of scientific and technological progress. A direct relationship has been established between prolonged psychological discomfort, the development of emotional overstrain, which ends in neurosis and (or) the formation of psychosomatic diseases - hypertension,

As far back as 1980, the works of E. Knobel showed that the formation of the circoral rhythm of the release of releasing hormones of gonadotropins begins at night, when the influence of external stimuli is minimized. Gradually, within 1-2 years, the nature of the RG-LH pulsation becomes regular both at night and during the daytime, but only by the age of 18-20 it becomes stable, corresponding to "adult" parameters. In this regard, the normalization of the duration and usefulness of sleep for a teenager is of a preventive and even therapeutic nature in relation to the function of the reproductive system.

Implementation of overloads associated with educational process is carried out through the neuroendocrine system and acquires the character of chronic stress. Dosed exercise stress, an active lifestyle and sports have a beneficial effect on the formation and development of the function of the girl's reproductive system. At the same time, super-powerful loads associated with professional sports slow down, and in some cases block the development of hypothalamic-pituitary-ovarian relationships; in highly qualified athletes, violations of sexual development and the menstrual cycle occur almost 2-3 times more often than in their peers.

The pubertal period is critical for the formation of personality and the formation of character during the transition from "childish" to "adult" psychology, and is characterized by a number of behavioral reactions and a bright personal coloring of the perception of events. The discrepancy between personal claims and objective possibilities, and, perhaps most importantly, its underestimation in the microsocial environment (family, friends, teachers) entails the development of neuroticism and depression. This is confirmed by

immunodeficiency, dysfunction of the reproductive system. .

At the same time, it has been proven that positive emotions play a rehabilitating role, through the normalization of the metabolism of brain neurons. This is especially effective in relation to neurotic states.

Prolonged psychotraumatic situation or a special acuteness of an event like a “strike of fate” creates a long-term excitation focus in IC4C, leads to depletion of the PRC capabilities and disorganization of peripheral organs.

Numerous studies by domestic physiologists have made it possible to prove the leading role of the limbic-reticular complex (LRC) in the genesis of emotional stress. A series of works has shown that the excitation of PRK is the primary response to conflict situations, on the basis of which changes in visceral functions are subsequently formed and consolidated. Interestingly, various biological motivations - fear, hunger, anger, etc. include the same adreno-cholinergic and serotonergic neurotransmitter mechanisms, but in different proportions of brain structures. The circulation of excitation within the LRC underlies the formation of congestive excitations during emotional stress, forms a situation of prolonged pathological stress, and changes neurochemical processes. Adrenal hormones released during stress (adrenaline, cortisol) have an inverse effect on PRK, maintaining and prolonging arousal. Even a slight short-term excitation of LRK in a conflict situation changes the sensitivity of neurons to neuropeptides - norepinephrine, acetylcholine and serotonin by 21-42%, which

due to a change in the conformation of the protein molecules that make up the membrane receptors of neurons and metabolic processes within the neuron itself.

Reactions to stress, from the point of view of neurophysiology, differ significantly and depend primarily on specific neurochemical integration, various cortical-subcortical structures of the brain involved in adaptation to stress. As experimental studies have shown, hallmark stress resistance turned out to be a genetically determined high level of norepinephrine and P-endorphins in brain structures.

The state of the reproductive system under conditions of prolonged exposure to stress is characterized by a decrease in gonadotropic activity and a corresponding decrease in the concentration of sex steroids. The level of secretion of hormones of the endocrine glands involved in this process depends on the individual predisposition of the organism, including the predominantly thyroid, somatotropic axis in the work, or reacts with an increase in the secretion of prolactin. The fact of activation of the ACTH system - the adrenal cortex, as the main mechanism of the body's neuroendocrine reaction, remains undeniable.

Thus, pathological stress, affecting the girl's body, leads to significant changes in the function of the LRC, disorders of autonomic regulation, as well as the organs of the endocrine and reproductive systems.

Clinical manifestations of long-term stress exposure include HSPS, amenorrhea against the background of weight loss, various types of menstrual irregularities. A classic example of acute stress is the absence of menstruation in girls during periods of difficult examination sessions (admission to the institute) or important sports competitions.

Reproductive behavior and reproductive health of girls

The term "reproductive behavior" is understood as a system of actions and relationships mediating the birth or refusal to have a child in marriage or outside of it.

In refraction to adolescence, this definition should be supplemented by the characteristics of the sexual behavior of young people, when not the creation of a family, or the birth of offspring are the driving force of relationships, and natural hypersexuality does not find a rational mature self-esteem and does not allow foreseeing possible consequences. Hypersexuality of adolescents is a physiologically determined pattern associated with the basic survival instincts and the preservation of the species. Later, with psychological maturation and further personal development, in women by the age of 18-25, the instinct of motherhood appears. In young men, this process is delayed up to 25-30 years and, as a rule, is less pronounced than in women.

Modern reality reflects a decrease in the influence of the family and attitudes that are socially significant for a teenager. Religious, moral and ethical foundations are being eroded. However, these processes occur not only (perhaps not

so many) in the adolescent environment, but also in the "adult" world of social relations.

The high sexual activity of girls, the decrease in the age of onset of sexual activity create natural health problems and a threat to the subsequent implementation of reproduction. According to various studies in Russia for last years? 50% of adolescents aged 15-18 years old have experience of sexual contacts, and sometimes much earlier. According to V.R. Kuchmaemoy (1996), 31.1% of Pskov adolescents have experience of intimate relationships, in Moscow and St. Petersburg, 36% of schoolchildren and vocational school students begin sexual activity before the age of 17.

P.N. Krotin (2000) claims that among 14 year old girls there were 93.7% virgins, by the age of 15 - 92.5%, and at 16 - 13.9%.

Among those who are sexually active, 21.9% have entered into sexual relations at 13 years old, 40% at 14 years old, 21% at 15 years old and 17.1% over 15 years old. Similar data is presented by T.I. Yuzvyuk (2001) the age of first sexual contact in adolescents at 15 years old is 36.9%, 16 years old - 27.6%, 12 years old - 1.5%.

In the work of L.V. Gavrilova (1997), with an analysis of extensive material in Russia, showed that the average age of onset of sexual activity in adolescents is 16.0 ± 0.2 years. The number of sexually active female adolescents is 27%, boys 32%, with 43.8% having regular sexual contacts, and 36.6% sporadic. Among the methods of contraception, the most popular are ineffective ones - condoms, coitus interruptus, the calendar method, which is primarily associated with the awareness of adolescents about existing methods of contraception. The main source of such information for adolescents is their peers and

mass media (63-84%) and only 2% each educational and medical institutions. The unanimous opinion (85-98%) of students aged 13-17 is the need to conduct classes on the basics of physiology and hygiene of the reproductive system in all regions of Russia. Similar data were obtained during a survey of residents of St. Petersburg, residents of the Volgograd-Volga region, Kemerovo and Altai Territory and other territories.

It should be noted that according to the results of the series similar works abroad, the reproductive behavior of young women coincides with the patterns of behavior of adolescents in Russia, and an increase in sexual activity and a decrease in the age of onset of sexual activity occurs both in highly developed countries and in countries of the 3rd world. Interestingly, a rather low frequency of contraception use or the use of its ineffective methods is also characteristic of Russian women reproductive age.

A natural consequence of early sexual activity is an increase in STIs and sexually transmitted infections among adolescents. So, according to the research institute. ON THE. Semashko, in 1997 the number of adolescents with newly diagnosed syphilis increased by 70 times compared to 1930 "and the prevalence of syphilis among girls aged 15-17 is twice as high as in general among all women. In 1996, more than 1.8 million people were registered in the country for the first time with STDs. The incidence rate was 1282.7 per 100,000 population, and the proportion of congenital syphilis in the Astrakhan region is 72.7% of the number of sick children.

34.5% of children were infected sexually, and 78.9% of them were girls. The relationship between early sexual activity and the incidence of STIs is emphasized in a number of publications, where special attention is drawn to adolescents with deviant behavior.

special social group are girl prostitutes, the number of which Lately tends to increase, however, studies on the state of RD in girls prone to promiscuity and early sexual debut are clearly not enough. According to N.B. Morozova (1988), 25% of prostitutes are girls aged 13-15, of which 86-90% began their sexual life after sexual violence, where the frequency of STIs exceeds the average population values ​​by 2-8 times. According to foreign studies, in children who have been sexually abused, the prevalence of gonorrhea reaches 26%; chlamydia up to 17%, trichomoniasis up to 19%, syphilis 5.6%.

Incidence rates vary widely in different regions and even population groups within the same region. I.Yu.Voronova et al. found that 38% of raped girls have IP1II. Meanwhile, a series of papers shows the importance of PID infections, not only for the present health of the girl, but, to a large extent, for her future. Today it has been proven that, for example, chlamydial infection leads to scarring of the mucous membrane of the fallopian tubes and their sharp narrowing, the appearance of antisperm antibodies and causes obliteration of the spermatic cord, which generally causes the development of persistent infertility.

It is characteristic that the asymptomatic course of the disease determines the presence of severe forms of the disease, chronicity and growth

the number of relapses, as well as the frequent combination of various STIs among themselves

A logical consequence of the increased sexual activity of adolescents is unwanted pregnancy and abortion. An analysis of foreign publications allows us to state large variations in the frequency of pregnancy and abortion in adolescents. The analysis of state statistics of 46 countries, carried out in 2000, made it possible to divide the studied countries into 3 groups:

Group I - with a very low abortion rate - 12 per 1000 per year (Netherlands and Japan);

Group II - low level - 40-69 per 1000 per year (Canada, New Zealand, Australia and part of European countries);

Group III - a high level of teenage abortions - 70 or more per 1000 per year (Belarus, Bulgaria, Romania, Russian Federation, USA).

The patterns of the dynamics of the frequency of abortions on the example of the United States coincide with the data for Russia and are most likely due to common causes, but they diverge in time. Thus, in the United States, there was an increase in the number of pregnancies among adolescents in 80-85 years. by 9%, and births by 18%. Subsequent stabilization by the end of the 80s and a slight decrease in the indicator to 36-59 per 1000 by the beginning of the 90s. Subsequently (90s), the frequency of abortions decreased, but the number of pregnancies did not decrease, as a result, over 10 years, an increase of 26% in the birth rate was noted, both in 15-19-year-olds and in girls under 15 years old.

There is also a wave-like change in the frequency of abortions and childbirth among adolescents in our country, however, the peak of abortions occurred at the beginning of the 90s (1992-1994) - 100 or more per 1000, with a subsequent decrease in the frequency of abortions, but an increase
births to young mothers. Both in the United States and in Russia, the process of changing indicators for different regions (states) occurs unevenly and gradually. Thus, in the United States, the rate of abortions among adolescents in different states ranges from 37 to 64, in Russia from 32 to 94 per 1,000 women.

Such close attention to the prevention of unplanned pregnancy in adolescents is primarily due to the high incidence of complications and adverse outcomes in the form of subsequent infertility. Thus, complications after termination of pregnancy are observed in adolescents 17.4-34%. An unfavorable, complicated course of pregnancy has been proven in 92% of women aged 16-20 who have had an abortion.

The unanimous opinion of the majority of researchers is the ability to prevent a significant part of abortions, with which adolescents themselves agree, who also believe that 60-70% of abortions are preventable, and the main way to reduce the number of abortions is a reasonably and adequately formed state system of family planning, which includes all components of this services.

At the same time, even the active application of the system of measures to prevent pregnancy in adolescents does not give tangible results if it does not take into account the peculiarities of behavioral reactions, traditions or the "mentality" of the population. Experience foreign countries faced with the problem of an increase in the number of pregnancies among adolescents a little earlier, dictates the need to create educational programs and their active implementation in curricula. A prime example is Sweden, the country with the lowest abortion rate in the world. Valuable experience has been accumulated in this direction in our country as well.

Ecology and reproductive health

According to the totality of the impacts of environmental and socio-economic factors in recent decades an alarming situation has developed, which has led to a significant deterioration in the state of health of the population, a decrease in the birth rate and

life expectancy, increased mortality and deterioration in the quality of offspring.

Scientific and technological progress (STP) gives mankind many conveniences and a radical improvement in living conditions. At the same time, Hill carries not only creative potential, but also causes a number of negative consequences. The acceleration of the pace of life, urbanization, information overload, weakness, noticeably change the structure of human life. An inevitable consequence of scientific and technological progress is a change in the environmental situation due to man-made pollution. environment.

The ecological picture is even more aggravated by the lack of due attention to the use and modernization of protective and treatment measures in the planning and operation of production facilities. Many experimental and epidemiological studies confirm the undoubted influence toxic substances and unfavorable environmental situation on the health of the population.

The impact of chemical compounds on the human body can manifest itself at the molecular, cellular and systemic levels. In turn, the breakdown of the system of regulation of biochemical processes, reaching a certain level, contributes to the development of the disease.

The dependence between the maximum permissible concentrations (MPC) of harmful substances in the atmosphere and

morbidity. So, an increase in the total MPC by 2-3 times, increases the incidence? by 10%, and at pollution levels exceeding the MPC by 10-15 times, we can expect a twofold increase. However, the impact of 2 or more factors is not always equal to the simple sum of the effects. The danger of potentiation of long-term effects, realized at the genetic level, remains for subsequent generations.

Among technogenic endemics, industrial, neighboring and transgressive variants are distinguished. Of greatest interest are "neighborly", microelementoses, in which

intoxication is detected in persons living next to the production. Transgressive technogenic diseases are recorded at a considerable distance from enterprises, and the transfer of production emissions (including radiation) is carried out due to atmospheric and water circulation. .

Currently, anthropogenic influence, among the factors that shape health, in particular, human reproductive health, has taken one of the first places in terms of their importance. Children, adolescents and pregnant women were especially sensitive to their effects.

In Russia, 15% of the territories are zones of ecological disaster, 30% of the population lives in ecologically unfavorable conditions.

A number of chemical compounds (organophosphorus, copper-containing, pesticides, oxidizing agents, lead, zinc, nickel, etc.) clearly affect metabolic processes with a violation of porphyrin and other types of metabolism, which leads to anemia

The toxic load with salts of heavy metals is realized through the blockade of sulfhydryl groups and leads to deformation of the lipoprotein body of the membranes and a decrease in the reception of membraiotropic hormones and a violation of hormonal regulation. No less important for the child are the increase in concentration and the toxic effect of salts of heavy metals and trace elements (mercury, lead, arsenic, beryllium, cadmium, ammominosis, etc.). An imbalance of macro- and microelements in the external environment is associated with the development of thyroid pathology, damage to parenchymal organs, and an increase in the frequency of oncological pathology.

Chlorine-containing pesticides have an extremely adverse effect on the child's body. In children, a high frequency of thyroid pathology, leukopenia, and an increase in neutrophil activity are found. The long-term effect can be considered the effect of pesticides on germ cells.

Almost all toxic compounds, even at low concentrations with prolonged exposure, have a pronounced effect on the immune status, which is manifested by the suppression of cellular and humoral immunity and the formation of autoimmune diseases, which is confirmed by M.Ya. Studenikin (1991), stating an increase in allergies associated with sensitization of the fetus and newborn by various external

agents.

The vast majority of works on environmental issues reproduction, was carried out at enterprises of various profiles, where the effect on workers of enterprises of vibration, noise, radiation, various chemical agents, microwave fields, radiation and infectious diseases was studied in detail.

pathogens. It has been proven that the presence of occupational hazards in women contributes to the growth of allergic diseases, chronic somatic pathology, neurotic disorders against the background of neurocirculatory dystonia, violations of the formation of the function of the reproductive system and early menopause. The works of a number of authors have shown that under conditions of contact of women with industrial hazards, there is a change in the functional activity of the hypothalamic-pituitary system of women, an increase in gynecological morbidity and complications during pregnancy and childbirth.

E.K. Ailamazyan suggested that the process of formation of the pathology of the reproductive system depends on the duration of the woman's stay in these conditions and has a certain staging of development: 1) the phase of acute disadaptation in the first 3 years is clinically manifested by ovarian dysfunction, infertility, miscarriage; 2) the phase of chronic subcompensation lasts about 10 years, when the development of pathology depends on the adaptive capabilities of the individual, and, finally, 3) the phase of chronic decompensation, occurs as a result of the depletion of the adaptive capabilities of the organism, causes irreversible changes in the reproductive system.

Radiation and reproductive health. The first studies on the effect of ionizing radiation on the body were carried out at the beginning of the 20th century. However, modern radiation medicine is based on a relatively small number of observations of people who received various doses of radiation exposure in connection with X-ray diagnostic and therapeutic procedures, as well as on the experience of Japanese and American researchers accumulated after the atomic bombings.

Hiroshima and Nagasaki. Numerous experimental works on animals make a significant contribution to the understanding of the regularities and reactions of the body to radiation exposure, however* most often the data obtained on laboratory animals cannot be extrapolated to humans. Penetrating into tissues, b, c, g particles interact with them on molecular level, resulting in the formation of new molecules, including extremely aggressive free radicals. Changes in tissues can occur within seconds or decades, leading to immediate cell death and/or disruption of their function, provoking genetic and carcinogenic diseases. Conventionally, “low doses” of radiation include exposure, ? component 0.04-0.05 Gray, i.e. 2 orders of magnitude less lethal.

An active study of the effect of long-term exposure to low doses of radiation on human health took place in the 80-90s of the last century, primarily due to the Chernobyl accident in 1986, but this issue still remains unresolved.

The complexity of assessing the effect of the phenomenon is associated with a number of reasons, the main of which is the lack of restored radiation doses received by individuals, which in turn is determined not only by external and internal exposure, but also by the processes of accumulation of effects of radiation exposure in tissues by the reactivity of the organism, and the summation of environmental factors. .

Based on the generalized epidemiological studies NRB-76/87 (1988), the team of authors came to the conclusion that one of the most important effects of radiation exposure on humans is damage to the reproductive organs, while the general

radiation dose and duration of exposure are determinants of the radiobiological effect. The latency of manifestations of the action of low doses of radiation on tissues, organs and the functioning of systems is a dose-dependent process and is determined by the total dose, duration of exposure, stage of cell development and age of the organism at the time of exposure.

The question of the direct damaging effect of radiation on the gonads is actively discussed in the literature. According to the survey Japanese women, residents of Hiroshima and its environs, the frequency of menstrual irregularities in them is directly dependent on the distance to the epicenter, and clinical manifestations ranged from amenorrhea to bleeding.

The accident at the Chernobyl nuclear power plant was not the first precedent in Russia, and had a number of features compared to the previous ones. The release of radionuclides occurred in several stages within 3 months. The main dose-forming components were: short-lived radionuclide iodine-131, and long-lived CS-134, 137, strontium (St-90) and plutonium (Pu-239 and Pu-240). The total activity of the ejected iodine was 10 6 curies, cesium 2 6 curies.

The consequences of the Chernobyl disaster cannot be reduced only to radiation damage, the 1986 accident entailed a complex burden on human health associated with severe stress, a change in lifestyle, and limitation of life. long stressful situation in the affected areas led to an increase mental illness and exacerbation of latent ones.

The study of the state of health of children in the post-accident years unequivocally proves the deterioration of physical and neurological

mental development, increased morbidity, reduced adaptive capacity and immunity.

At the same time, a number of studies undertaken in 1988-89 found no differences in health indicators, the state of organs and systems in children. International experts in 1991, studying the state of the thyroid gland in children according to ultrasound data and the secretion of TSH, Ts, T 4 , TSH, did not find significant differences with the norm.

At the same time, a number of studies have reliably shown an increase in the frequency of thyroid pathology in children, an increase in malignant neoplasms due to thyroid cancer, tumors of the central nervous system, and skin cancer.

A lot of work undertaken by domestic researchers proves the negative impact of radiation exposure on the respiratory, digestive, endocrine and reproductive systems of children and adolescents.

Research by V.F. Kirillov (2001), conducted in the Ilovsky district of the Tula region in 1985-1998, showed that the frequency of general morbidity in children aged 12-16 years since 1986 has changed unevenly, but with an upward trend. In terms of prevalence, the pathology of the ENT organs (chronic tonsillitis, pharyngitis) takes the first place - 110.9 per 1000 examined, and the second place is occupied by disorders of the nervous system, mainly due to vegetative-vascular dystonia. Practically healthy children accounted for only 3.6-6.3%. Indicators of sexual development and the age of menarche corresponded to the normative parameters. At the same time, the frequency of gynecological pathology, thyroid dysfunction was observed in 36-40% of girls.

According to S.N. Buyanova and I.S. Savelyeva (1995), in girls, residents of the controlled territory Bryansk region,

menstrual disorders were found in 59.0% and a decrease in the level of FSH, LH and estradiol was recorded. The work of E.I. Plekhova (1993) found that menstrual disorders are diagnosed in 60% of menstruating girls in the city of Pripyat, 15% of them showed signs of hyperandrogenism. An increase in thyroid diseases in the post-accident period by 6-8% was noted, and violations of the type of hypofunction amounted to 82.4%. In contrast to this opinion, V.F. Kokolina (1993) reports an increase in the gonadotropic activity of the pituitary gland, as well as activation of steroidogenesis in the ovaries.

N.V. Lichak (2000) and O.I. Manakova (2000) believe that endocrine pathology occupies the first place in the structure of morbidity in adolescents, residents of the Bryansk region, and an increase in the number of girls suffering from inflammatory diseases of the reproductive system is associated with the inhibitory effect of radiation on the child's immune system.

The most difficult, both in theoretical and practical terms, remains the problem of correctly assessing the impact of harmful effects environment on the state of the reproductive system.

Today, in the literature, there is a clear opinion about the insufficiency of monitoring the state of the external environment according to MPC, since in the refraction natural conditions territories and living conditions of people, they are not very informative, although the rationing of MPC is certainly necessary. In addition, MPC does not take into account the strength of the biological effect of the sum of several factors and does not evaluate their mutagenic, carcinogenic, embryotoxic and other effects, which requires special attention to the development of these problems.

The traditional indicator of the influence of environmental factors on reproduction is the assessment of the dynamics of standard indicators of maternal mortality, fertility, infant and perinatal mortality. Another indicator is the frequency of anomalies, since in the population this indicator is quite stable and does not exceed 2-3%. However, cohort studies with a representative elective cohort of the main group and an adequately selected control cohort with a sufficiently long 3-5 years of observation are optimal for studying the state of the reproductive system in an unfavorable environmental situation.

In general, the literature data presented testify to the vast accumulated experience in conducting research on the study of the influence of environmental factors, including radiation, on a woman's reproductive health.

At the same time, some issues of pathogenesis and the direct influence of radionuclides on various parts of the reproductive system, especially taking into account other anthropogenic influences, are not completely clear, and in some cases contradictory. In this regard, the study of the state of reproductive health of girls and girls in the period of formation of the function of the reproductive system may be the most promising and justified.

Deviant behavior and reproductive health

A special group, both for health reasons in general and for the peculiarities of gynecological pathology, is made up of an extreme contingent of adolescents with deviant behavior serving sentences in correctional colonies.

The system includes 184 detention centers and 13 prisons. In total, as of September 1, 2001, 991,156 people were being held in institutions of all types.

The contingent of persons in places of deprivation of liberty differs significantly from the population and includes adolescents with delinquent behavior, with a large proportion of drug addicts, alcoholics, HIV-infected and STIs. Despite the reorganization of the penitentiary system in 1998, due to the specifics of the living conditions of the contingent of prisoners, a system of medical care has developed in prisons and educational colonies, which differs significantly from that available in Russia.

The study of the health status of the inhabitants of prisons, focused on the concentration of infectious diseases.

In the United States (1990), syphilis was detected among female prisoners in 35%, chlamydia in 27%, gonorrhea in 8% (193J. A tense situation is described in the prisons of Brazil, Africa and Australia. Thus, in Brazilian prisons, syphilis is detected in 7, 4%, hepatitis B in 17.5%, hepatitis C in 6.3%, and HIV infection in 3.2%. the number of HIV-infected in the establishments of the Penitentiary Institutions of Russia increased by an average of 1.2 times.Similar data are available for Ukraine.The number of HIV-infected, the inhabitants of pre-trial detention centers in 1987 amounted to 11, in 1995 455, in 1996 - 2937 people.

Features of behavior, worldview and psychology distinguish the contingent of prisoners from the general population of the country, which largely determines the high prevalence of I111111, tuberculosis and HIV infection. The contingent of prisoners is characterized by frequent unprotected sex, prostitution,

For many years there have been isolated works devoted to the study of the state of health of individuals, as well as the possibilities of prevention, treatment and organization of assistance in prisons. These works were carried out under the heading "DSP" and are based on the results of a survey of people who are in reception centers, specialized hospitals or released on parole. Moreover, the vast majority of studies were conducted by psychiatrists, and were reduced, first of all, to the conduct of a forensic medical examination and the determination of the degree of sanity of the defendant. Cardinal changes took place in 1992, when the Decree of the President Russian Federation dated October 8, 1997, Jfe 100 institutions of the penitentiary system came under the jurisdiction of the Ministry of Justice of the Russian Federation, and there was a real opportunity for cooperation between departmental and public health systems. The importance of this event is determined both by the number of people in prison and by their level of health, in particular, by infection and, as a result, by the risk of its dissemination in the general population.

In terms of the number of prisoners, Russia occupies a leading place in Europe. According to official data, these figures in Russia are 10 times higher than those in the Scandinavian countries and in; 65 in the UK and in 1999 amount to 685 per 100,000 population.

According to the website of the public center for the promotion of criminal justice reform, in 2001 the penitentiary institutions of the GUIN MIL of the Justice of the Russian Federation included 739 correctional colonies (37 for women), 64 educational colonies for minors, including 3 for girls, where 18910 teenagers were kept , including about 1000 girls up to 19 years of age. Besides, in

drug and alcohol use, homosexual contacts in prison conditions, tattooing, low levels of education and self-esteem.

Due to the special selection in educational colonies, adolescents contained in them are distinguished by an increased frequency of mental disorders and features of personality development. In particular, the spectrum of psychopathology includes various types of psychasthenias, psychopathy, neuroses and neurosis-like states that develop against the background of neglect, deprivations (social, sensory and emotional), which include prison.

Specialized gynecological care for girls

Proposed and introduced in the 50s of the XX century, the gynecological service in Russia for girls was formed

in the form of a three-stage system, which made it possible to most adequately provide the young population with medical care.

The purpose of the 1st stage of service is preventive work in organized children's groups, carried out by medical or specially trained paramedical personnel.

Along with conducting primary preventive examinations and identifying patients who need examination and consultation with a gynecologist, the duty of a 1st stage specialist is sanitary educational work with girls, parents, teachers and doctors of related specialties.

The tasks of the N-th stage are the diagnosis and treatment of gynecological diseases in outpatient settings (office of a gynecologist of childhood and adolescence). The duties of the doctors of these offices include timely hospitalization of patients in a hospital and monitoring them after discharge from the hospital, as well as monitoring children at high risk for impaired reproductive system function, organizing and conducting individual and group classes with adolescents, including on problems family planning.

At the third stage of the specialized service, inpatient medical and diagnostic assistance is provided to the most difficult and urgeitic patients.

The tasks of the third stage of the service are examination and clarification of the diagnosis in the most difficult clinical situations, treatment severe forms gynecological pathology with the use of intensive methods of exposure or surgical interventions,

organizational-methodical and scientific-research work, personnel training.

The development of specialized gynecological care for children in various regions of Russia made it possible to find new and improve already known forms of service organization. The traditional three-stage system of building a service in St. Petersburg was supplemented by two stages of consultations in clinical diagnostic centers, specialized research institutes and departments, and the stage of rehabilitation of patients in the system of sanatorium treatment, in Family Planning and Reproduction Centers, youth centers, leading specialized institutions. In St. Petersburg, a 4-stage assistance system has been adopted and is successfully operating, where the first stages correspond to the traditional three-stage system. The third stage of assistance is provided by the city consultative and diagnostic Center for the Reproductive Health of Adolescents "Yuventa", where consultation is provided for the most complex cases of the course of the disease, stage 4 - inpatient treatment.

The experience of creating youth centers capable of fulfilling the tasks of all three levels of traditionally organized assistance deserves special attention. A striking example is Juventa in St. Petersburg and Juventus in Novosibirsk, which are becoming increasingly popular among teenagers who receive a comprehensive and diverse medical, informational and psychological help, organizationally as close as possible to the needs of the patient. The experience of working with adolescents indicates the need to search for new, non-traditional forms of communication with them, with the involvement of psychologists, teachers and parents in this work.

Meanwhile, the rapidly changing social and demographic situation in the country dictates the need to find ways to improve the organization of a specialized service that is as close as possible to the needs of patients.

Specialized gynecological care,

formed in Russia in the late 50s of the last century, has practically no analogues in the world. In most countries Western Europe and there is no dedicated service in the US. The main role in monitoring the development of the child is played by the family doctor, who provides primary care for a wide range of health problems, including reproductive ones.

If necessary, the child is examined by a specialist pediatrician who has undergone special training and provides consultations in large university clinics, pediatric centers, where, in addition to consultations, hospitalization of the child is possible. There are specialized gynecological departments in Germany, the Czech Republic and Greece.

In adolescence, girls can seek help at the outpatient clinic, where “narrow” specialists consult or at family planning clinics. The active development of family planning services in the United States and Western Europe has taken on the main concern for the reproductive health of girls.

Student and even school clinics are actively functioning. Hospitals where, if necessary, adolescents are hospitalized, as a rule, are located at large clinics.

The main attention in building a specialized service for adolescents is aimed at solving problems associated with early sexuality: pregnancies, abortions, STIs, contraception, family planning. Methods of information support with the involvement of volunteers from among adolescents, helplines, psychological support service, etc. have been developed and are being actively implemented. However, only a small number of works are devoted to organizing assistance to girls who are not sexually active or suffering from gynecological pathology. This is primarily due to the fact that the indicated assistance is provided by a family doctor, pediatrician consultant, family planning service and corresponding, often non-specialist beds in large clinics, without separating the system of providing gynecological care to children into a separate independent service.

Thus, the presented literature data testify, on the one hand, to a significant number of works devoted to the study of the reproductive health of girls. At the same time, the lack of unified methodological approaches does not allow comparison and analysis of most of the presented studies. Despite a sufficient number of scientific papers devoted to studying the influence of various environmental factors, behavior and lifestyle of adolescents on the state and function of the reproductive system of girls, some of them are quite contradictory and require additional reflection, the problem of reproductive health formation in real, constantly changing environmental conditions , far from resolution.

reproductive health - this is a state of complete physical, mental and social well-being in the absence of diseases of the reproductive system at all stages of human life.

reproductive system is a set of organs and systems of the body that provide the function of reproduction (childbirth).

The foundations of reproductive health are laid in childhood and adolescence. In order for healthy children to be born, each modern man should know how to maintain their reproductive health.

The sex of a person is laid already in the first weeks of intrauterine development of the fetus. In the eighth week, when the fetus weighs about four grams, the genitals begin to form. The obvious external differences between boys and girls are the result of the work of sex hormones synthesized by the gonads. The male sex hormones are called androgens, and the female sex hormones are called estrogens. Androgens and estrogens are initially present in the body of opposite sexes, but the ability to reproduce is achieved only after the completion of the puberty process.

The predominance of estrogens in the female body causes cyclic processes that are carried out with the participation of the central nervous system. Even during puberty, due to hormones, the contours of the body are rounded in girls, the breasts increase, the pelvic bones become wider - in this way, their body is gradually preparing to perform the future function of reproduction.

The male body due to androgens is stronger than the female, although not always more enduring. It is no coincidence that nature assigned the most important mission of bearing a child to a woman.

The state of reproductive health largely depends on the lifestyle of a person, as well as on a responsible attitude to sexual life. Both affect stability. family relations on the general well-being of the person.

A negative factor affecting the state of reproductive function is an unwanted pregnancy. Often a woman faces a difficult choice: to give birth to a child or to have an abortion. It is especially difficult to solve this problem in adolescence. Abortion, especially during the first pregnancy, can cause serious mental trauma and in many cases even lead to irreversible reproductive disorders. At the same time, the decision to give birth often jeopardizes further studies and other life plans, so each situation should be considered individually and carefully. In order for such situations to occur less often, adolescents need to have a mature understanding of the meaning of reproductive health and the concept of family planning.

Family planning is necessary for the implementation of the following tasks:

the birth of desired healthy children;

maintaining a woman's health;

achieving harmony in psychosexual relationships in the family;

implementation of life plans.

For many years, family planning was limited to birth control. However, first of all, it is ensuring the health of a woman who is able to give birth to children exactly when she herself wants it. In other words, family planning - this is the birth of children at will, and not by chance. The right to family planning is an internationally recognized human right.

Family planning helps spouses consciously choose the number of children in the family, the approximate dates of their birth, plan their lives, avoiding unnecessary worries and anxieties.

The optimal age for having children is 20-35 years. If pregnancy occurs earlier or later, then it usually proceeds with complications, and the likelihood of health problems in mother and child is higher. Intervals between births should be at least 2 - 2.5 years; this allows a woman to restore her strength, preserve her health and the health of her future children. In this regard, it should also be emphasized that abortion is by no means the best method of birth control, it can be avoided by using modern methods of contraception (prevention unwanted pregnancy).

A teenager should not withdraw into himself with his problems. He should know that a wise and tactful adult is always ready to help him.

Reproductive function is negatively affected by stress, especially chronic stress, quality of nutrition, lifestyle. This happens not only under the influence of excessive factors, but also during toxicosis in pregnant women, when adaptation to changes during pregnancy becomes insufficient due to the low level of physical health of the mother.

Smoking affects sexual health, affects the exchange of sex hormones N Shirren found that people who smoke have half the sexual activity

Alcohol somewhat increases sexual desires, since it removes the inhibitory influence of upbringing and the external environment, but it breaks an erection. Shakespeare wrote in \"Macbeta \":\"drink promotes desire, but deprives me of the possibility of being able to do so."

The more a person drinks, the less her sexual strength, the quality of germ cells deteriorates Under the influence of large doses of alcohol, the manifestation of sexual reflexes changes

Human sexuality can bring not only joy and happiness, but also great suffering, since many infectious diseases are sexually transmitted. These diseases are called venereal diseases. Most of them are cured if diagnosed in time, but the damage caused by their pathogens affects reproductive health.

Sexually active people who often change partners should undergo periodic medical examinations, especially after changing sexual partners, and not self-medicate.

In short, in order to maintain reproductive health, one must follow a healthy lifestyle, eat well and properly, do not drink, do not smoke, do not get sexually transmitted infections (remember their consequences), use contraceptives (if you have an abortion, it is also not a fact, that everything will end well)

The environment in which the organism lives affects the ability to fertilize and reproduce healthy offspring. Frequent contact with various chemicals, polluted air, reduced physical activity, stress and bad habits lead to changes in hormonal levels, the development of malignant tumors. Under the influence of these factors, a woman may experience menopause earlier, and a man may begin to weaken erectile function.

Nutrition

Eating disorders have a serious negative impact on fertility. There are studies that show that men with diabetes who need insulin have abnormal changes in sperm DNA. Diseases associated with the gastrointestinal tract can lead to impotence and retrograde ejaculation. Vitamin D deficiency in women contributes to polycystic ovaries and changes in menstrual cycle. Frequent alcohol consumption also seriously inhibits sexual function.

Weight and age

Reproductiveness depends on the weight and age of the person. Girls who have a lot of extra pounds are more likely to suffer from ovulation and cycle disorders. Patients have numerous cystic masses, elevated level blood sugar and estrogen imbalance. In turn, in men with too much weight, the amount of testosterone decreases, which subsequently leads to erectile dysfunction and related disorders of the reproductive system.

With regard to age, the biological ability to fertilize in women begins to fade after 35 years. Girls who approach often have chromosomal changes in the eggs they produce, which increases the risk of birth defects in the unborn baby.

Other factors

Poverty is often associated with unsanitary conditions, in which expectant mothers often contract infections that destroy their reproductive systems. Multiple births also significantly increase a woman's chance of dying from complications during pregnancy and childbirth. Lack of qualified medical personnel in hospitals, unsafe abortions and improper treatment of existing ailments reduce the chance of giving birth healthy child. And psychological trauma can not only have a direct impact on the general condition of the body, but also deprive the desire to ever create offspring at all.

Reproductive health is a condition that includes both physical, mental and social well-being. The basis of reproductive health is the absence of diseases that affect childbearing.

First you need to get acquainted with the concept of "reproductive system". This is not one, but a whole set of organs that are involved in the birth of a child. The foundations of reproductive health are beginning to be laid in childhood. Every parent needs to explain to their children how important it is to take care of it. This will help to avoid many fatal events in the life of your child. A timely heart-to-heart conversation between parents and a child helps to avoid abortions, many diseases of the reproductive system, promiscuity, and so on.

Reproductivity

So, again, reproductive health is a very important component of overall human health. In translation, the word "reproduction" means "reproduction". Reproductive health implies well-being in terms of reproduction and the continuation of the human race. It directly affects the harmony of family relationships.

It is also very important to mention that the Ministry of Health of the Russian Federation has introduced certain norms to reduce the number of abortions and the risk of unwanted pregnancy. These rules have been around for decades. To maintain reproductive health, every person needs to be instilled from childhood with the rules that relate to contraception, a responsible approach to family planning and procreation.

Human Reproductive Health

What is the most terrible diagnosis for people who plan to replenish the family? Of course, this is infertility. It is very important to know that the disease can develop in both the female and male half of the population. For people who want to become parents, infertility is a real verdict, since this diagnosis prevents the continuation of the family.

This disease is often acquired. The reasons for its development in women can be:

• a large amount of prolactin secretion;
• menstrual irregularities (this includes amenorrhea, oligomenorrhea, and so on);
• genital defects;
• obstruction of the pipes;
• endometriosis;
• the formation of adhesions in the pelvis;
• autoimmune diseases;
• psychological disorders associated with sexual life, and so on.

Very often, the reason lies in previous abortions and promiscuity. Reproductive health is, according to WHO standards, the mental, physiological and social readiness of each person for procreation. Although everyone perceives and interprets this phrase in their own way. It is important to prepare your child from an early age for adult life, timely conversations will help to avoid a lot of problems in the future.

Women

The concept of a woman's reproductive health must be explained to the girl's parents in elementary school. Raising little princesses is a very hard job, because you just need to explain a lot of everything that a girl will have to face in the future.

Proper upbringing of a girl directly affects her worldview in the future. Even from the school bench, it is necessary to instill several mandatory character traits:

• modesty;
• decency;
• selectivity for the opposite sex.

If you explained everything to your child in time and instilled in him the very necessary rules, then you should not be afraid for reproductive health at all. Otherwise, an adult girl may face many problems: unplanned pregnancy, abortion, sexually transmitted diseases, which are very often diagnosed in adolescents. According to statistical studies, it becomes clear that all this leads to terrible and tragic consequences for a woman.

Men

It is very important to know that very often infertility is diagnosed in men. The male factor is very common in medicine. When should you sound the alarm? If you cannot conceive a baby for a year, although you have already completely abandoned all means of contraception, then there is a health problem.

What is the reason for reproductive health in men? The place has only two factors:

• spermatogenesis;
• potency.

Reproductive health problems can be caused by:

• stress;
• severe fatigue;
• lack of vitamins;
• wrong way of life;
• the presence of bad habits (drugs, alcohol, tobacco);
• diseases.

If you cannot have a child for a long time, then you can contact the reproductive health center, which can be found in absolutely any city. These medical institutions specialize in restoring or maintaining the reproductive health of the population.

Teenagers

Now we will talk a little about the reproductive health of adolescents. Adolescence is a very important period. At the time of the onset of adolescence, parents should provide the child with reproductive health protection as much as possible. This will help to avoid some actions in their future. When is the transition period? In girls, it begins with the advent of menstruation, in boys - with wet dreams. It is very important to explain to the child that these are not the only changes that will happen to their body.

According to statistics, teenagers often choose the wrong path in life, namely:

• do not follow the rules of personal hygiene;
• enter into early and thoughtless marriages;
• give in to temptation and try drugs;
• often drink alcohol;
• many smoke.

All this significantly reduces the reproductive abilities of both boys and girls. It is very important to know that this problem has acquired a global scale.

Reproductive health of the population

Human reproductive health suffers markedly. This is due to a number of factors, which we will discuss a little later. Now we will touch upon the problem of ecology, which has a strong negative impact on the health of the population at the reproductive level. No matter how sad it may sound, but the problem of ecology is global and is solved at the state level. The state is doing its best to protect the young population from the harmful effects of a damaged ecological environment.

In addition, special social programs have been developed for young people aimed at explaining the concept of reproductive health to the population. In addition, lectures on the prevention of sexual diseases and the use of contraceptive measures are actively practiced in schools.

Reproductive health factors

A woman needs to think about this concept even during pregnancy. After all, even when carrying a baby, she is obliged to ensure his reproductive health.

In this regard, gynecologists recommend taking a responsible approach to replenishing the family and getting acquainted with the concept of “pregnancy planning”. It involves a complete examination of future parents, which allows you to exclude genetic pathologies or congenital diseases in the child. If any diseases are detected, it is urgent to eliminate them, because they can lead to complications in the unborn baby. The factors that influence reproductive health are closely studied by our modern medicine.

Destructive factors

Reproductive health is affected by many factors. Let's get to know them a little more. First, attention must be paid women's health if there are any menstrual irregularities, then this indicates the presence of a reproductive health problem. Family planning involves an accurate calculation of the time when the likelihood of conceiving a baby is high. Disruptions in the menstrual cycle do not allow tracking ovulation in the usual ways, which interferes with pregnancy planning. This problem needs to be addressed at the gynecological level.

We also note that there are a number of other factors that are usually divided into two large groups. You can learn more about them by examining the table in this section.

Prevention

Reproductive health is an integral part of human health. It has great importance, because thanks to the health of the reproductive level, continuation of the family is possible. In order to avoid a lot of problems that are associated with the deterioration of sexual function, you need to know about the available preventive measures. These include: measures that have been developed to treat diseases of the reproductive system; getting rid of the psychological barrier; pregnancy planning; prevention of sexual diseases; activities that are aimed at eliminating maternal and infant deaths; examination and treatment of hormonal disruptions; lectures on the onset of sexual activity; lectures on the rights of a young family; lectures on early pregnancy and diseases of the reproductive system.

Security

The protection of reproductive health is understood as a whole range of measures that help to restore and preserve the function of reproducing healthy offspring. Such measures include: avoiding a large number of sexual partners, unprotected intercourse, timely treatment of diseases of the reproductive system, exclusion of unplanned pregnancy, taking vitamin therapy courses, taking folic acid during pregnancy, preventing abortion, family planning, and so on.

Reproductive health is a rather complicated term, and everyone understands it differently. If we follow the generally accepted definition given to this phrase by the World Health Organization, then it means complete psychological, social and physical readiness to have sexual relations in order to procreate. Moreover, the reproductive health of a person implies the absence of any infections and other adverse conditions of the body that can affect the adverse outcome of pregnancy, the impossibility of re-conception, or the birth of a handicapped child.

Factors destroying reproductive health

There are just an incredible number of aspects that can negatively affect the ability to have offspring. So, what prevents the preservation of reproductive health:

• too early onset of sexual activity and its Negative consequences;
• infections and diseases that are sexually transmitted;
• amoral behavior;
• poor environmental conditions and substandard food;
• genetic failures and hormonal disorders;
• an abundance of bad habits and so on.

The reproductive health of a man, as well as a woman, must be preserved from infancy. This implies a timely examination by the appropriate doctors, compliance with the rules of personal hygiene of the child and the daily routine. can be triggered by many factors, such as alcoholism, steroid use, the habit of wearing tight underwear or taking long baths.

reproductive period

This term refers to the part of the life of a man or woman, during which they are able to safely conceive, bear and give birth to a child. IN different countries this indicator is calculated in different ways, since it is influenced by many statistical indicators. However, it is generally accepted that a woman is ready for procreation when her first menstruation begins, and the reproductive phase ends at the onset. The optimal age of a man should not exceed the mark of 35-40 years. Human ontogenesis and reproductive health are integral parts of each other. This fact is due to the fact that at each stage of its development, a person can, independently or under the influence, worsen or improve the quality of his life and the ability to reproduce his own kind.

Reproductive health

Each state develops a set of legislative acts that establish the rights of the population to procreate. The main measures taken in this area include:

• provision of free healthcare;
• prevention of reproductive health disorders;
• passing mandatory medical examinations;
• carrying out explanatory work by workers of social services;
• raising the level of material and moral well-being of the population and so on.

Reproductive health and behavior largely depends on the parenting tactics that are used in the family. After all, it is close people who have greatest influence on a young member of society and wish him only the best.

Reproductive health criteria

In order to assess a person's ability to procreate, a special system of general and specific criteria was created, such as:

The reproductive health of a person and society should become the norm for the behavior of the population of any country, since it is through joint efforts that an ever-deteriorating demographic situation can be corrected.