Allergic reactions of the lower genital tract in women cause significant chronic vulvovaginal discomfort and require active diagnosis and treatment. Modern approaches to therapy, which combine allergen elimination and anti-inflammatory therapy, can achieve improvement or cure in most cases. Obstetricians-gynecologists are recommended to involve dermatovenerologists and allergists for joint management of patients in case of non-standard cases of vaginitis. From a scientific point of view, further studies of immune mechanisms in the genital tract and the development of new methods of specific therapy and prevention remain relevant. In the future, the results of such studies will help to develop more accurate clinical guidelines and improve the effectiveness of care for these patients. Successful treatment of allergic diseases of the vulva and vagina significantly improves the quality of life, restores a woman's confidence and comfort in everyday and intimate life. Developing an interdisciplinary approach, education, and a thoughtful method for addressing symptoms can help overcome many difficulties in diagnosing and treating this condition. The identified unresolved issues will serve as the starting point for new research and progress in this field of medicine.

Introduction. In the context of the demographic crisis in modern Russia, the focus of the state’s demographic policy is aimed at young people. The reproductive health (RH) and positive reproductive attitudes (RA) of young people, whose number is progressively declining, are especially important for ensuring population reproduction. Aim. To assess the RH and RA of the student-age population from the standpoint of demographic potential. Materials and methods. A cross-sectional study was conducted based on an anonymous online interview of young people using a specially created questionnaire. The statistical database was developed based on 2005 questionnaires completed by I–VI-year students and residents of medical universities of four subjects of the Far Eastern Federal District: Amur State Medical Academy (Amur Region), Chita State Medical Academy (Trans-Baikal Territory), Banzarov Buryat State University (Republic of Buryatia), Ammosov North-Eastern Federal University (Republic of Sakha, Yakutia). Mathematical analysis of the results was performed using the IBM SPSS Statistics version 25.0 software. Differences were considered significant at p 0.05. Results. 11.4% of female and 1.1% of male respondents had chronic diseases of the reproductive system. Reproductive diseases accounted for 82.8% of gynecological pathology: 54.2% of polycystic ovary syndrome, 11.3% of pelvic inflammatory disease, 8.9% of external endometriosis, 5.4% of menstrual disorders, 3% of female infertility [pχ2 0.001, odds ratio 22.97 (95% confidence interval 13.05–40.46)]. In 32.7% of respondents, sexual debut occurred before the age of 18. The majority of respondents (67.8%) do not consider early onset of sexual activity to be a risk factor for RH (pχ2 0.001), and 68.2% received information about the contraception method for the first time in their lives from unreliable sources of information (friends/relatives, Internet resources), and only 31.8% from healthcare professionals. Contraceptive methods currently used include condoms (88.2%), oral contraceptives (20.5%), withdrawal (18.8%), rhythm method (8.6%), and intrauterine contraceptives (1.2%). 5.8% of respondents have children, 94.2% are childless, of which 6% are childfree. In the future, 94% of respondents plan to have children at 20–24 years (11.8%), 25–29 years (62.7%), 30–34 years (15.7%), 35 years and older (3.8%). Causes of delayed childbearing and voluntary childlessness include getting an education (77.7%; pχ2 = 0.019), fear of financial difficulties (56.8%; pχ2 = 0.619), career priority (47.7%; pχ2 = 0.680), common law marriage (46.8%; pχ2 = 0.103), not sure about the future (33.0%; pχ2 = 0.620), relationship problems within a couple (27.0%; pχ2 0.001), do not want to be responsible (22.4%; pχ2 0.001). In general, 70.5% of respondents consider the state policy aimed at supporting motherhood to be effective; 29.5% do not or rather do not consider it effective (pχ2 0.001). The majority of respondents considered the improvement of housing conditions to be the most effective measure for deciding on the birth of a child in a young family [66.2%; pχ2 0.001, odds ratio 1.29 (95% confidence interval 1.13–1.48)]. The desired number of children was 2.05 ± 0.9 [0; 4], and in case of adequate living, material, and financial conditions available, it was 2.37 ± 1.0 [0; 4] (p 0.05). Conclusion. The state of RH and RA in modern youth can have a negative impact on the quality of the demographic potential of the population. Active cross-departmental work with young people on education in the field of RH and the fostering of commitment to its protection, education of family-oriented values, and positive RA is necessary.

Background. There is currently a growing interest in the benefits of taking probiotics during pregnancy, but evidence supporting their positive impact remains scarce. The study evaluated the effect of probiotics on the incidence of urogenital infections and bacterial vaginosis in pregnant women, pregnancy complications, and delivery outcomes. Aim. To evaluate the effect of an oral probiotic on the course and outcomes of pregnancy. Materials and methods. A prospective study included 60 pregnant women divided into three groups. All patients underwent pH-metry of the vaginal contents at registration. Group 1 included 15 pregnant women with a pH level of 3.8–4.5 (control group). Forty-five pregnant women with a pH 4.5 without growth of opportunistic flora, who underwent a study of the vaginal microflora using the Femoflor-16 test were divided into two subgroups: Group 2 (n = 25) received the synbiotic Enterolactis Duo, containing lyophilized live Lacticaseibacillus paracasei DG, or DSM 34154, as well as inulin at a dose of 4 g and Group 3 (n = 20) patients did not receive the probiotic. Before the start of therapy and 2 months after the therapy, the change of the symptoms, the level of vaginal pH, as well as the course of pregnancy, and delivery outcomes were evaluated. In addition, as part of a comprehensive assessment of intestinal function, the frequency and consistency of stool were analyzed. Results. In 15 (60.0%) patients with increased vaginal pH who took a probiotic (Group 2), normalization of the microflora was observed after 21 days, characterized by an increase in Lactobacillus spp. and a decrease in pH to 4.5. Symptoms, such as vaginal dryness and discomfort, did not differ significantly between the groups, except for a decrease in the severity of itching in the group taking the probiotic. There were no significant differences in the incidence of delivery complications (preeclampsia, premature rupture of membranes, chorioamnionitis, etc.) between the groups, probably due to a small sample. In Group 2, statistically significant (p 0.05) clinical signs of improvement were observed: stool frequency normalized to 5–6 times a week, constipation relieved, and normal stool (types 3–4 according to the Bristol Stool Form Scale [BSFS]) prevailed. Conclusion. The study suggests that oral probiotics may help normalize vaginal microbiota in pregnant women with elevated vaginal pH. In addition, the data indicate their potential to improve intestinal motor function. The observed decrease in constipation among patients taking a probiotic underscores its positive effect on stool regulation. However, more studies in a larger sample are needed to confirm the effect of probiotics on the incidence of labor complications and other pregnancy outcomes and the persistence of the effect on stool normalization. The results of this study emphasize the importance of further research on the role of probiotics in obstetrics and gynecology.

Background. Pelvic organ prolapse (POP) significantly reduces quality of life, including sexual function. Despite the high prevalence (up to 50% of women over 40 years of age), the effect of POP on intimate health has not been sufficiently studied. Aim. To assess sexual function in women with genital prolapse using a validated FSFI questionnaire. Materials and methods. A prospective comparative study was conducted with 170 females; however, 53% (n = 90) refused to complete the FSFI questionnaire and did not sign the informed consent form. The test group included 40 patients with POP; the control group included 40 females without POP (groups were comparable in age; p 0.05). The prospective sample study is ongoing, and this paper presents interim results. Sexual function was assessed using the FSFI self-administered questionnaire (19 questions, 6 domains). Statistical analysis was performed using SPSS 26.0 and R 4.2.0 (t-test, p 0.05). Results. Total FSFI score in the test group was lower by 11.35 points [19.05 vs. 30.4; 95% confidence interval (CI) (-12.94; -9.76); p 0.05]. Key domain deficits included orgasm (53% decrease [Δ = -2.77, 95% CI (-3.25; -2.29); p 0.05]); pain (44% increase in symptoms [Δ = -2.26; 95% CI (-2.68; -1.84); p 0.05]); lubrication (45% decrease [Δ = -2.19, 95% CI (-2.55; -1.83); p 0.05]), and arousal (48% decrease [Δ = -1.76; 95% CI (-2.10; -1.42); p 0.05]). The following barriers were observed during the study: 68.3% of women with POP refused to be surveyed (the “stigma paradox”). Conclusion. POP is associated with critical impairment of sexual function, especially in the domains of orgasm, pain, arousal, and lubrication. The results of the study justify the need to include the assessment of sexual function in the standard of POP diagnostics, the development of rehabilitation programs that combine surgical correction and restoration of intimate health, and the introduction of anonymous questionnaire methods with the participation of psychologists to overcome stigma.

Changing the features of the menstrual cycle to certain limits up to a short anovulation can be considered as a normal and transient response to adverse living conditions, including stress factors. The line separating such a normal reaction from a disease is very fluid and can be crossed in the setting of a predisposition. Stressful exposures include objectively adverse and subjectively significant factors of different duration and intensity. The predisposition to menstrual irregularities can have genetic prerequisites and be triggered by epigenetic factors. This literature review provides up-to-date data on the issue of stress-dependent menstrual disorders. Due to the significant role of prolactin metabolism disorders in the etiology of such disorders, the prospects of using plant-origin dopaminomimetics, including in young patients, have been considered.

The vaginal microbiota of a healthy woman is a unique microecosystem comprising more than 300 bacterial species. The main vaginal bacteria of a healthy woman are Lactobacillus spp. (90–95%), with the most common being L. crispatus, L. iners, L. jensenii, and L. gasseri. Based on the dominant Lactobacillus species, five types of communities are distinguished: CST I, II, III, IV, and V. Lactobacilli ensure a normal vaginal pH (3.8–4.4) and inhibit the growth of other microorganisms, particularly Escherichia coli, Trichomonas vaginalis, Gardnerella vaginalis, Prevotella bivia, etc. Different lactobacilli species produce different levels of reactive oxygen species. Many studies demonstrated a close relationship between vaginal microbiota disturbance and the development of malignancies, particularly cervical, vagina, and vulvar cancer. This review analyzes published studies, which showed a positive correlation between a low content of lactobacilli, an increase in the abundance of pathogenic bacteria, and cancer of the anogenital region; the association between some bacteria, the persistence of the human papillomavirus, and the development of dysplasia of the lower reproductive system was demonstrated. Timely diagnosis and treatment of vulvovaginal infections and vaginal dysbiosis would reduce the risk of human papillomavirus persistence and, consequently, the development of dysplasia and cancers of the lower genital tract.

Background. Intrauterine pathology remains a relevant topic due to its impact on the reproductive function and possible oncological risks. It is also essential to optimize the diagnosis and use of non-invasive methods to reduce the risk of complications of diagnostic manipulations. Aim. To determine the level of accuracy and the required non-invasive diagnostic tests for endometrial polyps (EP) to reduce unnecessary hysteroscopies in the absence of endometrial pathology and the risk of possible complications. Materials and methods. The study included case histories of 147 patients with histologically confirmed EPs. Patients' case histories were retrospectively reviewed to determine the diagnostic value of the diagnostic studies. The results obtained during pelvic ultrasound (US), sonohysterography, sonoelastography, hysteroscopy, and histological examination are compared. Results. Diagnostic inaccuracies in the context of EP diagnosis are possible when performing a pelvic US. Dopplerometry did not significantly affect the diagnostic value of EP ultrasound imaging. Sonohysterography improves the accuracy of EP diagnosis compared to pelvic US, with an odds ratio of 4.5 [2.5; 8.2]. However, the disadvantages of this method include invasiveness and the risk of complications. Using sonoelastography, the accuracy of EP diagnosis compared to pelvic US was significantly higher with an odds ratio of 8.7 [4.2; 17.9]. Conclusion. Sonoelastography is necessary to improve the accuracy of non-invasive diagnostic methods for EP and reduce unnecessary hysteroscopies in patients without endometrial pathology.

Aim. To evaluate the safety and acceptability of a combined oral contraceptive (COC) containing estetrol 15 mg and drospirenone 3 mg when taken for 6 cycles in real clinical practice. Materials and methods. An open-label prospective multicenter (in 20 cities of the Russian Federation) epidemiological observational program "Estetiko" ("Safety and tolerability of combined oral contraception in real clinical practice") was conducted from 01.11. 2023 to 21.08.2024. The data of 2495 participants aged 18 to 50 years who received a COC containing estetrol 15 mg and drospirenone 3 mg (E4/DRSP) for 6 cycles were analyzed. Results. The average age of women was 30.7±7 years. In comparison with the initial values, after 3 and 6 months of using COC E4/DRSP the following indicators remained stable (p0.05 for all comparisons): blood pressure (mmHg) – systolic (113.7±9.8, 112.6±9.8, 112.6±22.6) and diastolic (71.7±7.8, 71.0±7.3, 70.9±14.9), body mass index (kg/m2) – 23±3.6, 23±3.5, 23±3.5. Adverse events were noted after 3 months of using COC E4/DRSP in 611 (24.5%), after 6 months – in 204 (8.2%) women; there were mild adverse events in 91 and 96% of the participants respectively. The most frequently reported side effects after 3 and 6 months were: breast engorgement (17.2%; 7.5%), intermenstrual bleeding/spotting (11.5%; 6.1%), mood swings (10.3%; 5.4%), decreased libido (9.2%; 7.1%), headache (9.1%; 5.2%), nausea (8.4%; 4.6%). Less than 1% of women stopped taking E4/DRSP because of side effects. There were no serious adverse events. All patients had planned bleeding. There were no cases of pregnancy. 99.5% of study participants planned to continue taking E4/DRSP after 6 cycles. Conclusion. E4/DRSP is a COC with a high level of safety and a low incidence of adverse events; well tolerated, with a predictable bleeding pattern in most women. Satisfaction with the drug is high.

Background. Placental disorders underlie the development of a large number of pregnancy complications, such as growth retardation, fetal hypoxia and distress, preeclampsia, etc. Fetal hypoxia occurs in 10% of all pregnancies and is the cause of perinatal losses in 40% of cases. Uteroplacental hypoxia is associated with impaired placental formation in early pregnancy and its angiogenesis in later stages. Meanwhile, there are currently no technologies that can predict the development of placental disorders with a high degree of probability. Aim. To evaluate the capabilities of neural network data analysis in predicting placental disorders. Materials and methods. The prospective analysis of the features of the course of 99 pregnancies was conducted. Based on the results of the study, 2 groups were formed: the control group included 51 patients whose pregnancy was not complicated by the development of placental disorders, the main group included 48 patients whose pregnancy proceeded against the background of placental disorders. Results. The technology for predicting placental disorders is implemented on the basis of the multilayer perceptron, the percentage of incorrect predictions during the training of which was 7.1%. The structure of the trained neural network included 8 input neurons, which were the parameters included in the Astraia protocol (height of the pregnant woman, coccygeal-parietal size, thickness of the collar space and heart rate of the fetus, pulsation index in the uterine arteries, the content of β-hCG and PAPP-A in the blood of the pregnant woman), as well as the volume of amniotic fluid. Conclusion. An integrated approach based on neural network analysis of study parameters available for widespread clinical practice (Astraia protocol), as well as amniotic fluid volume, should be considered promising for predicting placental disorders due to its high information content (Se=0.87, Sp=0.98, ROC-AUC 0.921±0.04 [95% CI 0.843–0.998]; p0.001). In our opinion, the use of this technology will be useful for identifying patients at risk in order to prevent the development of placental disorders and will reduce the incidence of adverse perinatal outcomes.

Hyaluronic acid (HA) is a key component of the extracellular matrix involved in regulating inflammation, fibrosis, and tissue repair. Its biological properties depend on molecular weight: high-molecular-weight HA (HMW-HA) exhibits anti-inflammatory effects, whereas low-molecular-weight fragments (LMW-HA) induce inflammation and fibrosis by activating CD44, TLR, and RHAMM receptors. An imbalance between these forms may contribute to chronic inflammatory and fibrotic processes. HA metabolism is regulated by synthases (HAS) and hyaluronidases (HYAL). During chronic inflammation, HYAL-2 degrades HMW-HA into LMW-HA, which accumulates and sustains the inflammatory response. Native hyaluronidase preparations have limited efficacy due to rapid inactivation. Conjugation of the enzyme with azoximer enhances its resistance to inhibitors and proteases while prolonging its action. Bovhyaluronidase azoximer (Longidaza) breaks down pro-inflammatory LMW-HA into safe ultra-low-molecular-weight fragments, suppressing inflammation and fibrosis. The drug is active in the acidic environment of inflamed tissues without damaging healthy tissue. Its anti-fibrotic and anti-adhesive properties have been confirmed experimentally and clinically. Clinical studies demonstrate the drug’s efficacy in various fields: preventing postoperative adhesions, treating fibrotic changes in pulmonology, and correcting scars in dermatology. Thus, modulation of HA metabolism using conjugated hyaluronidase represents a promising approach for managing chronic inflammatory and fibrotic conditions.