Genital infantilism, what is it? Causes, treatment. Genital infantilism
INFANTILISM (infantilismus; lat. infantilis infantile, childish, from infantis non-speaking) - clinical syndrome of various origins, characterized by a delay in the development of the body with preservation of the patient’s morphological, physiological and mental characteristics characteristic of an earlier age.
The term was proposed by E. Ch. Lasegue in 1864. A detailed description of the wedge, I.’s painting belongs to Lorain (P. J. Lorain, 1871). Anton (G. Anton, 1908) identified general I. (delayed general development) and partial I. (relatively isolated disorder of somatic sexual or mental development), considered the etiology of the syndrome. Falta (W. Fait a) and Tsondek (N. Zondek, 1929) proposed excluding from the concept of “infantilism” forms of developmental delay in which features of certain endocrine diseases are observed, i.e., the so-called. endocrine forms I. old authors. For example, thyroid I. (Brisso's disease), which develops as a result of decreased function thyroid gland and characterized by retarded growth, mental development and severe symptoms hypothyroidism, is considered by modern authors as a symptomatology of hypothyroidism (see). Issues of etiology, clinical picture and treatment of I. were developed by M. Ya. Breitman, A. A. Kisel, D. M. Rossiysky, N. A. Shereshevsky and others.
Etiology
The cause of I.’s development may be hron, diseases in childhood(diseases of the gastrointestinal tract, liver, pancreas, kidneys, cardiovascular and hematopoietic system, tuberculosis, syphilis, malaria, etc.), diseases and injuries of the brain (especially birth injury). I. may be a manifestation of functional or organic hypothalamic-pituitary insufficiency (total or partial). Great importance have chronic, intoxication in parents (alcoholism, drug addiction, etc.) and poor material conditions (malnutrition, hypo- and vitamin deficiency) in early childhood. In some cases, I. is hereditary.
So-called late I. (reversible, or regressive of the old authors), occurring in the postpubertal period, at the age of 20-40 years (thyroidogenic, sexual, pituitary) can arise as a result of tumor, traumatic, vascular, infectious-toxic damage to the hypothalamus or pituitary gland, as well as auto-aggressive immune process, disrupting functions endocrine glands. In men, sexual intercourse is possible due to dysgenesis of the testicles and seminiferous tubules (see Klinefelter syndrome), cryptorchidism (see), as a result of damage or surgical intervention in the posterior part of the urethra in children. When assessing the genesis of late puberty, it is necessary to exclude genetic pathology.
Pathogenesis
Regardless of the etiology patol, process, delay-causing development of the body is always mediated by a delay in the development of c. n. With. and insufficient functional activity one or more endocrine glands with corresponding metabolic disorders. There is always underdevelopment of the organs of the reproductive system - primary (gonadal dysgenesis, Hypergonadotropic hypogonadism) or secondary (hypogonadotropic hypogonadism).
Hormonal deficiency can occur due to primary pathology of the endocrine organs (pituitary gland, thyroid, gonads), but more often it is associated with a violation of the central (hypothalamic) regulation of endocrine functions, which determines the pluriglandular (multiglandular) nature of the disease. The main symptoms of general I. are determined by a violation of the somatotropic and gonadotropic functions of the anterior pituitary gland and hormonal insufficiency, often secondary, of the gonads, as well as a delay in the development of c. n. pp., expressed in the weakness of active inhibition, insufficiency of cortical control over the activity of subcortical centers, the predominance of the first signaling system over the second.
Clinical picture
The clinical picture depends on the etiology, damage to one or another system, the degree of developmental delay and the age at which the disease developed. The course of I. (regardless of genesis) is chronic. The influence of etiol and factors in the prepubertal period leads to the development of general I., including sexual and mental I. However, sexual or mental I. can be the main wedge, a manifestation of the syndrome (partial I.).
Based on the principle of correspondence of the appearance, structure and size of the organism to a certain period of normal development, M. Ya. Breitman (1949) distinguishes three forms: 1) I. in in the narrow sense words - preservation of signs infancy, 2) puerilism (lat. puer boy) - preservation of signs of the pre-pubertal period, 3) juvenileism (lat. juvenilis youthful) - preservation of signs of adolescence. Some authors highlight embryonicism - the preservation of embryonic characteristics (in premature babies).
General infantilism
The most striking symptom of general I. is retardation of height and weight while maintaining child-like body proportions: the body does not acquire the appearance and sexual development of an adult. According to D. G. Rokhlin (1931), with I., in contrast to pituitary dwarfism (see), we're talking about only about insufficient height (140-149 cm). Characterized by fragility of the skeletal structure (often bone age lags behind true age), thin skin that is not tender for age. Typically there is a sharp lag in the development of the external and internal genital organs; Secondary sexual characteristics are, as a rule, absent, sometimes weakly expressed. From the outside internal organs the greatest hypoplasia is found in the cardiovascular system (narrow aorta, drip heart), blood pressure is often low. There is often a delay in intellectual development.
Sexual infantilism in women
Sexual infantilism in women is expressed in the underdevelopment of the reproductive system (partial). The main wedge syndrome is hypogenitalism (see Hypogonadism): delayed development of the external and internal genital organs, the mammary glands and other secondary sexual characteristics are undeveloped or poorly developed, the menstrual cycle is disrupted (see) according to the type of oligo-, opsomenorrhea, possible dysfunctional uterine bleeding (see), amenorrhea (see), infertility (see) or spontaneous abortion (see).
Gynecological examination reveals insufficient development of the clitoris, labia majora and minora, narrow, short vagina, insufficient depth of the vaginal vaults, thin vaginal mucosa with mild folding. The cervix is elongated and conical. The body of the uterus is reduced in size, located high in the pelvis, and often tilted to the side. Sometimes only the uterus is underdeveloped when good development external genitalia and a completely female general physique. Sexual I. can be combined with general obesity or with exhaustion. With sexual intercourse, there is constant pain in the sacral area, a feeling of pressure in the depths of the pelvis, pain during sexual intercourse, and decreased libido.
Body features depend on the genesis of I. Thus, growth can be low in case of gonadal agenesis of the type of Shereshevsky-Turner syndrome (see Turner syndrome), normal or high in other syndromes. At congenital form hypogonadism is often accompanied by acrocyanosis, sometimes bedwetting and lack of smell.
Sexual infantilism in men.
Delayed sexual development in men is observed less frequently than in women; in men it is more often combined with general I. With short stature, almost complete absence secondary signs gender and underdevelopment of the genital organs. Patients look younger than their age, have a fragile physique, and retain a high-pitched voice; hair on the face, pubis and armpits is weak or completely absent. The penis is conical in shape with transient phimosis (see). The scrotum is underdeveloped and depigmented. The testicles are small and have a jelly-like consistency. Prostate so small that palpation examination, as a rule, is not detected. Sexual desire, spontaneous and adequate erections (see) and emissions (see) are absent. Sometimes erections occur, but with a small penis, sexual intercourse is difficult.
Partial I.- predominant underdevelopment of the genital organs - can be observed with clearly defined forms of primary and secondary hypogonadism. Wedge, the picture of partial I. is determined by the form of hypogonadism that underlies it.
Mental infantilism
Lasegue wrote that people suffering from mental illness remain “children for life”; Lauren noted that the disorders that make up mental illness relate more to the entire constitution than to individual systems of the body.
Mild signs of mental illness can also occur in normal physical conditions. development. In patol, cases, the features of mental I. are due to the variety of etiol and pathogenetic factors, the conditions under which it manifests itself.
Various classifications of forms of mental I. have been proposed. A distinction is made between endogenous and exogenous I.; congenital and acquired I., “pure” constitutional I., associated with certain types of psychopathy; I., observed in endocrine diseases; I. for organic brain lesions; I. associated with somatic diseases or lesions of individual organs (liver, kidneys, of cardio-vascular system); I., associated with mental illness(schizophrenia, epilepsy, etc.), as well as psychogenically caused infantilization under the influence of improper, pampering upbringing.
G. E. Sukhareva distinguishes harmonious, disharmonious and organic infantilism. V.V. Kovalev distinguishes between simple, or uncomplicated, and complicated mental illness; complicated I. includes cerebrasthenic, neuropathic, disproportionate (a combination of mental I. with partial physical acceleration), as well as mental I. in combination with severe underdevelopment of the emotional-volitional sphere. It is also proposed to distinguish between partial and total mental I.; I. as immaturity that exists throughout life, I. as a manifestation of delayed maturation, which is overcome with age.
Wedge, the picture of mental I. can be conditionally divided into the most general symptoms and into signs associated with the characteristics of the nozol, accessories. In the picture of general I., the features of childishness are equally manifested in both the physical and mental make-up of the patient (psychophysical I.), while both signs of immaturity are harmoniously combined. In infantile children, not only is there a lag in height and weight, but they also retain body proportions, features of facial expressions, gestures and psychomotor skills characteristic of an earlier age. In the mental makeup, the immaturity of the emotional-volitional sphere comes to the fore; with relative preservation of intellectual development, thinking is distinguished by concreteness, immaturity of judgments, a predominance of superficial associations and weakness of abstract thinking. The ability for intellectual tension and concentration of attention is weakly expressed, rapid fatigue occurs from activities that require volitional effort, with tirelessness in games. There is instability of interests, a constant desire for change, a special desire for new sensations and impressions (“sensory thirst”). Characterized by spontaneity and inconsistency in statements and actions, insufficient independence, increased suggestibility. The mood is unstable, affective outbursts easily occur, which also quickly pass.
Disharmonic I. can be designated as psychopathic I., because manifestations of I. are organically included in the structure of a psychopathic personality, often hysterical and unstable. The features of the child’s psyche in these cases are especially sharpened, the disharmony of mental properties, irritability and imbalance, the inability to control one’s behavior, which is subordinated primarily to the desires of the present moment, clearly appears. In addition to the immaturity of thinking, there is a predominance of imagination over logic; traits of mental immaturity are combined with normal or even advanced physical. development and accelerated puberty.
With organically caused I., mental immaturity appears against the background of organic failure caused by encephalopathy or hron, organic process. In these cases, mental illness manifests itself along with signs of organic psychosyndrome. Irritable weakness, increased exhaustion, weakening of memory and attention are clearly evident.
Features of mental I. with endocrine pathology determined primarily by the symptoms of the underlying disease; mental disorders in these cases are different. With congenital hypogenitalism, the most characteristic feature of children is the inability of children to exert long-term volitional tension, the tendency to reason instead of act, emotional lability with a general benign mood. Frivolity and increased self-esteem, boasting are combined with a feeling of inferiority. There is extreme lack of independence and suggestibility, absent-mindedness, slowness and clumsiness of movements. Pituitary subnanism is characterized by a combination of a childish appearance with age-inappropriate solidity (“little old people”); There is a change in depressive and euphoric states, secrecy and distrust. Along with this, increased suggestibility, insufficient independence, and instability of behavior characteristic of I. are manifested.
In schizophrenia that develops at an early age, the signs of general I. and schizophrenia are combined. In other cases of schizophrenia, manifestations of I. appear along with symptoms of the defect as an expression of personality regression. Wedge, I.’s originality is manifested in a special pretentiousness and mannerism, eccentricity of appearance and behavior (exaggerated disharmony up to caricature).
I., noted in some cases of epilepsy in children, is found along with symptoms of personality changes and dementia characteristic of epilepsy.
Mental I. with chronic, somatic diseases manifests itself in the form of cerebrasthenic, disproportionate variants and in combination with pronounced underdevelopment of the emotional-volitional sphere.
Infantile behavior, caused by incorrect, pampering upbringing, is characterized by egocentrism and capriciousness. Constant Striving recognition and sympathy stems from narcissism; unjustified claims are combined with helplessness and sometimes with defenselessness, that is, there is a general failure, despite full intelligence.
Diagnostics
Clinically, the diagnosis of I. is made on the basis of the absence of secondary sexual characteristics at the age when they should develop during normal growth of the body. X-rays can reveal a delay in bone age. Sexual I. is established based on signs of underdevelopment of the genital organs. With bicontrast gynecography (see), women find a decrease in the uterine cavity, an elongation of the cervical canal, long, narrow, tortuous fallopian tubes, and reduced ovaries.
To diagnose the causes of I. in men, a determination of the morphotype, testicular biopsy, etc. are carried out. With severe sexual I., a decrease in the content of sex hormones is detected in the blood and urine. The determination of sex chromatin is of great importance (see); its absence indicates a male genetic type.
Laboratory studies often reveal anemia and lymphocytosis. For differential diagnosis of primary and secondary hypogonadism, the content of gonadotropins in the blood serum is determined to develop treatment tactics.
Treatment
Treatment should be aimed at the underlying disease that caused the developmental delay. It is necessary to carry out therapeutic and health measures (improving living conditions, good nutrition with an increase in the amount of animal protein and vitamins, treat. gymnastics, sanatorium treatment, limiting mental stress). Delicate correction of hormonal disorders and disturbances in protein metabolism is necessary (somatotropin, insulin, anabolic steroids, B vitamins, aloe, blood transfusions, etc. are prescribed). At the same time, treatment of genital I. is carried out in order to cause maturation of the genital organs, the formation of secondary sexual characteristics and normalize the functions of the gonads.
Therapy for sexually transmitted infections in women is determined by the degree and nature of ovarian dysfunction. For mildly expressed symptoms of I. and hypofunction of the ovaries with the presence of ovulation, cyclic hormonal therapy is indicated; Therapy with synthetic progestins has become widespread; Prescribe a combination of drugs such as Infecundin or Bisecurin (from the 5th day from the start of menstruation for 21 days, two or three courses in a row, then at intervals of 2-3 months).
With pronounced I. and uterine hypoplasia, Haller (J. Haller, 1971) recommends treatment large doses synthetic progostins are new for 4-6 weeks. This treatment is aimed at inhibiting the function of the hypothalamic-pituitary-ovarian system during hormone intake and is designed for subsequent activation of the function of this system according to the “withdrawal phenomenon” type. However, with pronounced inhibition of ovarian function, drugs that directly stimulate the function of the gonads are more often prescribed.
In 1961, R. B. Greenblatt proposed using Clomid (syn. clostilbegit - see Clomiphene citrate) to stimulate ovarian function; During treatment, the patient must be carefully monitored (examination and palpation of the abdomen, gynecology, research to determine the size of the ovaries, examination of tests functional diagnostics). If there is an effect, repeat courses of treatment are prescribed with increasing doses of the drug; In total, no more than 3-6 courses of treatment are carried out. In the absence of effect from treatment with clomiphene citrate, treatment with gonadotropins is indicated in patients with severe symptoms of I. and amenorrhea. Most clinicians recommend using this treatment under monitoring of estrogen concentrations in the blood or urine.
To stimulate sexual development in men, choriogonin is used in courses of 15-20 injections. In order to enhance growth, it is recommended to use anabolic steroids or low doses of androgens.
At mental disorders neuroleptics, antidepressants, tranquilizers are also prescribed, as well as, according to indications, dehydration and other symptomatic therapy. Treatment and pedagogical measures are of great importance, especially for children and adolescents.
Forecast
The prognosis depends on the nature and possibility of eliminating the cause and severity of I. Restoration of normal development under the influence of treatment is usually observed in I., concomitant with endocrine diseases that respond well to hormone therapy (hypothyroidism, diabetes mellitus), and mild I., caused by poor nutrition during the period growth. Normalization of the body's development process is questionable in chronic or rapidly progressive diseases, which are often difficult to treat. I. associated with impaired intrauterine development of the fetus or birth trauma is especially unfavorable prognostically.
Prevention
Prevention involves preventing hron, infections, creating the right gig. and dietary conditions during the development of the child, exclusion of hron, intoxications in parents; proper upbringing prevents the occurrence of psychogenically caused mental illness.
Bibliography: Breitman M. Ya. Clinical semiotics and differential diagnosis endocrine diseases, p. 164, L., 1949; B ukhman A. II. X-ray diagnostics in endocrinology, M., 1974, bibliogr.; Artapetov B.A. Primary (testicular) hypogonadism, Kharkov, 1973, bibliogr.; Zhukov-s k*i y M. A. Children's endocrinology, M., 1971; Clinical Psychiatry, ed. G. Grule et al., trans. with German, p. 706, M., 1967; Sokolov D. D. Endocrine diseases in children and adolescents, M., 1957, bibliogr.; Starkova H. T. Fundamentals of clinical andrology, M., 1973; Sukhareva G. E. Clinical lectures on childhood psychiatry, vol. 2, p. 208, 328, M., 1959; T e t e r E. Hormonal disorders in men and women, trans. from Polish, Warsaw, 1968; U i l k i n s L. Diagnosis and treatment of endocrine disorders in childhood and adolescence, trans. from English, M., 1963; In 1 e u 1 e g M. Endokrinologische Psychiatrie, in the book: Psychiatrie der Gegen-wart, hrsg. v. H. W. Gruhle u. a., Bd 1/1 B, S. 161, B. u. a., 1964.
N. A. Zarubina; B. A. Vartapetov, A. N. Demchenko (yp.), M. I. Vrono (psychiat.), T. Ya. Pshenktaikova (gin.).
Infantilism represents a stop in normal development body and is not necessarily related to human growth. Even very large individuals can suffer from underdevelopment of the body. Such disorders are possible not only in women, but also in men. Infantilism can have much more detrimental consequences for a person's sexual functions than for his physical and mental state. In a woman, underdevelopment of the body manifests itself not only in the form of a violation menstrual cycle, complications of fertilization, difficulty breastfeeding, pathological childbirth or a tendency to miscarriage, but very often in weak sexual sensitivity and insufficient excitability. In addition, in very rare cases, sexual intercourse may be difficult or even impossible due to the too small size of the vagina and its insufficient elasticity.The degree of underdevelopment of the female genital organs can vary significantly, so it is impossible to immediately diagnose a woman’s unsuitability for married life. Many women at the beginning of their marriage had difficulties associated with insufficient development of the genital organs, and later became wonderful wives and mothers. Marriage turned out to be for them effective means against this disease. Sexual relationships, a rush of blood to the genitals as a consequence of these relationships, pregnancies, first interrupted, then ending in childbirth, sometimes help eliminate the underdevelopment of the female genital organs.
However, there are cases when marriage turns out to be fatal for a woman due to a severe form of sexual underdevelopment. As a result, a woman’s sexual life becomes impossible, she experiences such physical and mental suffering,
It is safe to say that sexual underdevelopment is one of the most deep reasons, negatively affecting a woman during her marriage (here we do not take into account diseases of the heart, liver, kidneys, etc.). Therefore, we can only welcome the initiative to introduce premarital medical examination. Moreover, it is necessary that every adult girl undergo a thorough medical examination to identify her marital capabilities. Even if a girl is found to have some kind of disorder that poses an obstacle to a normal marriage, it is better to find out about it in time, since it can often be eliminated with appropriate treatment even before the question of marriage arises.
It may also be recommended that future husband was privy to the problems that may arise if his wife suffers from mild underdevelopment of the genital organs. In this case, the doctor can warn the future husband that in the first days of marriage he needs to perform coitus with all caution and attention. The husband should be prepared for the fact that his partner will not be aroused enough, and strive to help her gain self-confidence. In Eq. life together there are many unknowns. The groom, like the bride, has the right to know whether they will show up love union an unpleasant surprise. As for the general physical condition of the partners, the issues that arise are the same for both parties. The situation is different with the genitals. For a girl, it is important whether a man suffers from a sexually transmitted disease.
The question may arise whether the insufficient development of the male genital organs should be taken into account before an upcoming marriage. In our opinion, no or very rarely, according to at least, not to the same extent as underdevelopment of the female genital organs. In men, arrest in the development of the genital organs occurs much less frequently than in women. Underdevelopment of the male genital organs can manifest itself either in a change in the quality of sperm and a decrease in its quantity, or in a small size of the penis (if the partner has a very wide vagina, then the arousal transmitted through friction of the penis against the vaginal wall will be insufficient for to cause orgasm in partners, especially women). In addition, due to insufficient sexual potency and weak sexual desire of a man, a woman will also not be able to receive satisfaction.
The essence of the disease is the underdevelopment of the genital organs, which have prematurely stopped growing. A combination of infantilism and hypofunction of the female reproductive glands is often detected. Insufficient ovarian activity is also accompanied by incomplete development of external sexual characteristics. In some cases, intimate life becomes impossible. The formation of this pathology is due to a failure in the hypothalamus-pituitary-ovarian system.
The female gonads stop responding to the hormones that are produced central authorities- pituitary gland and hypothalamus. In this case, increased production of follicle-stimulating hormone in the pituitary gland is often detected, as well as a lack of hormones responsible for ovulation and the passage of the second stage of the menstrual cycle.
Uterine hypoplasia is one of the causes of infertility. To decide on tactics further treatment, one ultrasound is not enough. Required comprehensive examination of the body, which includes a blood test for hormones, hysterosalpingography, uterine probing, and in some cases, laparoscopy. Mandatory anthropometric measurement to determine the delay physical development. In children, bone age is determined.
Crash hormonal system often begins in adolescence, and the disease is diagnosed in girls over 15 years of age. If, in addition to underdevelopment of the genital organs, a delay in general development is detected, the diagnosis can be made earlier - at 13-14 years of age.
Causes of genital infantilism
There can be quite a few genital causes. Among them:
- hormonal changes, such as thyroid dysfunction;
- poor nutrition and low amounts of vitamins in the diet;
- intrauterine growth retardation;
- genetic disorders;
- previous infections in childhood, for example, scarlet fever, measles, rubella, mumps;
- chronic intoxication;
- chronic diseases ENT organs, for example, chronic tonsillitis;
- previous ovarian surgery;
- rheumatic diseases;
- other chronic pathology, for example, severe diseases of the heart, digestive organs, vascular disorders.
Degrees of the disease
Underdevelopment of the uterus is specific to the disease; the severity of infantilism is determined by the size of this organ.
1st degree of infantilism — rudimentary uterus. Fortunately, this pathology is detected quite rarely. The length of the uterine body is within 1-3 cm, most of which is at the cervix.
Menstrual discharge is completely absent, in some cases its similarity is observed. Completely restore specific female functions with such a pathology it is impossible. The first degree of infantilism is classified as developmental anomalies.
2nd degree of infantilism- underdevelopment of the uterus, the size of which exceeds 3 cm. The ratio of the cervix to the body of the uterus is the same as in girls before puberty and is 3:1. Characterized by a high location of the gonads - the ovaries.
During the examination, tortuous and elongated fallopian tubes are found. Menstrual flow is rare and often painful. The pathology can be restored, but this will require long courses hormone therapy.
3rd degree of infantilism- hypoplasia of the uterus, which develops up to 6-7 cm in length. The reason may be transferred inflammatory diseases reproductive organs in prepubertal and pubertal age.
The length ratio of the uterus and cervix is correct. This pathology may disappear on its own with the onset of regular sexual activity or during pregnancy.
There are 2 forms of sexual infantilism:
- a disease occurring with hormonal ovarian insufficiency;
- sexual infantilism without ovarian failure.
Symptoms of genital infantilism
Most often, the patient is worried about scanty or infrequent periods, which are quite painful, accompanied by headaches, nausea and fainting. With severe pathology, menstruation is completely absent. Sexual desire is reduced. In the anamnesis one can find premature birth, miscarriages, weak labor. Sometimes a woman cannot conceive a child.
An external examination reveals narrow pelvis, scanty pubic hair, lack of hair in the armpits, poorly developed mammary glands. The labia majora and minora are underdeveloped, the perineum is retracted, the vagina is narrow and short, the cervix is elongated, the body of the uterus is short and flattened.
Insufficient sexual development combined with short stature and prolapse of internal organs. The typical appearance of a girl: fragile build, weak external sexual characteristics, narrow hips and narrow shoulders. X-rays reveal the lag in bone age from the actual age; usually the difference between them is 1-4 years.
Often physical underdevelopment is combined with psychological infantilism. Parents could be very protective of a girl in childhood; in subsequent years, she becomes unable to make decisions on her own, enter into relationships with the male sex, or lead an intimate life. Sexual infantilism is also a complete lack of sexual desire.
With X-ray and ultrasound examination They find long, winding fallopian tubes, a small uterus and an elongated cervix.
A typical symptom is a violation of the innervation of the genital organs, their blood supply, and low contractility of the uterus.
Treatment of genital infantilism
Treatment of the disease usually ends successfully, with the exception of severe underdevelopment of the genital organs (rudimentary uterus). The basic principles of therapy are as follows:
- Increase the sensitivity of the genital organs to the action of hormones.
- Eliminate the cause of delayed puberty.
- Select suitable replacement therapy.
Before starting hormone replacement therapy, you should make sure that there are no abnormal gonads and exclude false hermaphroditism. It is also necessary to examine for the presence of hormonally active ovarian tumors. After 3 months of treatment with hormones, it is necessary to give the body a rest. The course is repeated if the first stage of treatment did not lead to success.
Sometimes the situation can be corrected with the help of organization good nutrition, with a sufficient amount of vitamins in food, physical treatment.
At the same time with hormonal drugs physiotherapeutic procedures are prescribed - paraffin applications, electrophoresis with copper, zinc, diathermy. Acupuncture sessions (acupuncture) help. Balneotherapy, therapeutic exercises, and mud therapy are also prescribed. Held gynecological massage and electrical stimulation of the cervix.
All patients with genital infantilism should be under medical supervision. It is recommended to repeat courses periodically replacement therapy. You should know that women with uterine hypoplasia are at risk for developing tumor pathology of the genital organs.
The prognosis with timely treatment and the absence of significant anomalies of sexual development is usually favorable.
Gynecologists at the Otradnoe Polyclinic have extensive experience in the treatment of sexual infantilism and uterine hypoplasia. Here you can undergo a full diagnostics of the body to exclude genetic abnormalities and tumor processes. After this, depending on the results, adequate treatment will be prescribed.
Remember, the sooner genital hypoplasia is detected, the will be more successful treatment. Many women get the opportunity to get pregnant and give birth to a healthy baby.
From time to time, patients turn to fertility doctors with the problem of delayed growth and development of primary or secondary reproductive organs. As a rule, pathology is detected during puberty, but there are many adults whose reproductive system works the same way as in adolescents or even children. In this case, doctors diagnose sexual or genital infantilism.
Medical practice notes 3 stages of development of such a pathology.
- Embryonolism. Developmental anomalies begin inside the womb, resulting in premature babies born with the level of fetal development. Further, infantile infantilism develops, when grown-up babies physiological indicators are not ahead of infants
- Puerilism. IN adolescence Boys and girls do not experience active development of secondary genital organs - they remain at the physiological level of primary schoolchildren
- Juvenalism. In this case, in adults reproductive system corresponds to adolescence
Most often, sexual infantilism is of a chronic nature and requires long-term therapy, including radical surgical methods.
Causes of pathology
The disease is common in both females and males, developing mainly for the following reasons:
- disruption endocrine system, diseases of the pancreas, thyroid or other gland internal secretion during puberty, which leads to hormonal imbalance
- chromosomal abnormalities, heredity
- disturbances in the development of the embryo in the womb, hypoxia or placental abruption, which led to oxygen starvation and shortages nutrients for development
- dietary disorders in childhood and adolescence (forced vegetarianism, anorexia nervosa, bulimia, starvation, therapeutic diets, posts, etc.)
- lack of nutrients in a teenager's menu
- unhealthy living conditions (poor ecology, insufficient water purification, high radioactive background, work in enterprises with chemicals, etc.)
- severe infectious diseases in childhood (measles, mumps, rubella, scarlet fever and others), as well as recurrent chronic diseases of the ENT organs
- plastic or therapeutic surgery on the organs of the reproductive system
- autoimmune processes
- diseases associated with immune deficiency
- malfunctions circulatory system, cardiovascular pathologies
- diseases of the gastrointestinal tract, etc.
Signs of male infantilism
Men with the disease are not difficult to recognize - their appearance, body constitution and voice do not correspond to age and gender parameters. The patient himself notes following symptoms chronic pathology:
- underdevelopment or immaturity of the external genital organs (testicles, penis, etc.)
- lack of libido and sexual desire
- lack of spontaneous erection, emissions, ejaculation
In some cases, psychological infantilism occurs as a consequence of physical infantilism. In this case, the genital organs form normally, but the man experiences fear of the female body and sex, lack of self-confidence, decreased sexual desire, erectile dysfunction, even impotence.
As for physiology, sexual infantilism is often indicated by insufficient size of the penis - 2-2.5 times smaller middle length. It is advisable to prescribe corrective treatment up to 14 years of age.
Signs of female infantilism
In women, the pathology occurs in 3 forms, which determines the symptoms.
Vestigial uterus. Insufficient development of a hollow organ, the diameter does not exceed 30 mm, and the cervix makes up the majority. For medical practice This congenital pathology is quite rare. The patient reports lifelong amenorrhea. Recovery reproductive function in this case it is impossible.
Underdeveloped uterus. Insufficient development of the organ, but the diameter is from 30 mm. There is an unusually high location of the ovaries, and the fallopian tubes are more elongated and tortuous. A woman notes irregular and scanty menstruation, which may be accompanied severe discomfort and pain.
Uterine hypoplasia. The hollow organ does not exceed 60 mm in length. As a rule, sexual infantilism in this case is the result of infections or inflammation in childhood and puberty.
The second and third forms are treatable, but it takes a long time.
Additional signs of female genital infantilism:
- lack of hair growth in the genital area and armpits
- underdevelopment of the mammary glands
- cycle disorders
- headaches and fainting
- nausea
- clinically narrow pelvis
- pathological pregnancy
- infertility
Methods of therapy
Treatment of sexual infantilism includes the following mandatory steps.
- Boosting immunity
- Menu correction, introduction of vitamins and nutritional supplements into the diet
- Hormonal therapy. Aimed at activating the processes of secretion of male or female hormones by the body, replacement treatment with synthetic drugs
- Drug treatment according to symptoms and indications
- Psychotherapy sessions with the possible use of antipsychotics, antidepressants, etc.
- Physiotherapy (electrophoresis, balneological procedures, acupuncture, massage, etc.).
- Radical treatment – plastic and others surgical procedures(eg phalloplasty)
Women often experience therapeutic effect after pregnancy, the body produces enough hormones, develops and grows to bear a child, which eliminates some signs of infantilism.
The success of treatment will depend on an integrated approach, physical health the patient, the psychological climate in his family and immediate environment.
Sexual or genital infantilism, detected over the age of 15 years in individuals with the female genotype, is characterized by anatomical and histological underdevelopment of the genital organs and their hypofunction. If sexual infantilism is accompanied by general infantilism (and this happens in half of all observations), then it becomes possible to establish this diagnosis at an earlier age (13-14 years).
This pathology is found in 4-16% of girls who have undergone a preventive examination.
There are two types of genital infantilism:
A) accompanied by ovarian failure,
B) not accompanied by ovarian hypofunction.
With sexual infantilism, cases of congenital refractoriness or decreased sensitivity of the ovaries to gonadotropins, and derivatives of the paramesonephric ducts to steroid hormones are not at all uncommon.
Algodismenorrhea with infantilism associated, firstly, with insufficient elasticity of the uterus, which makes itself felt during the premenstrual rush of blood to it; secondly, with difficulty passing menstrual blood and fragments of the endometrium along the long and narrow (with a bend due to hyperanteflexion) cervical canal; thirdly, with innervation anomalies, leading to discoordination of contractions of various parts of the uterus and to pathological impulses in the central nervous system.
Clinic. An infantile girl is usually short (or above average) in height, thin-boned; the epigastric angle is obtuse. The pelvis is so unique that in obstetric classifications it is designated as “children’s”.
In 3 out of 4 girls, menarche occurs late (after 16 years). Algodysmenorrhea with genital infantilism occurs unusually often - up to 80%. The pain occurs 2-3 days before menstruation and continues during it. With age, algodismenorrhea decreases, and after childbirth it disappears completely.
In the symptom complex of sexual infantilism, the leading place is occupied by the condition of the uterus, called hypoplasia. There are three degrees of uterine hypoplasia. Rudimentary, or embryonic, uterus (uterus foetalis) - its length along the probe is less than 3.5 cm, with the cervix making up most of it. This option is rare; it is associated more with developmental anomalies themselves than with underdevelopment. Characterized by persistent amenorrhea. Sometimes there is a slight menstrual-like discharge.
Infantile uterus(uterus infantilis) - length along the probe is 3.5-5.0 cm; the ratio of the neck to the body is expressed as 3:1, i.e. the same as in a girl who has not yet entered puberty. In addition, additional research methods indicate hyperanteflexion of the uterus, weak expression of the vaginal vaults, high location of the ovaries, and excessive tortuosity of the fallopian tubes. Menstruation is rare and painful.
Hypoplastic uterus(uterus hypoplastics) - the length of the cavity, measured with a probe, reaches 5-7 cm; The neck to body ratio is correct - 1:3. A hypoplastic uterus is regarded not only as a consequence of damaging effects that took place in the antenatal and early postnatal periods, but also as a result of local inflammatory processes or the hardest common diseases. This pathology often disappears on its own after the onset of sexual activity and pregnancy.
Diagnostics . In childhood, as a rule, no complaints arise. The most typical complaints during puberty are late onset, disorder (hypomenstrual type) and painful menstruation. Concerns are sometimes expressed about a lack of interest in members of the opposite sex.
Upon examination, a typical “infantile” physique attracts attention: growth deviations, an insufficiently formed chest, hypoplastic mammary glands, a narrowed pelvis, scanty pubic hair and axillary areas. The labia minora protrude in front of the labia majora, the clitoris appears enlarged due to some hypoplasia of the external genitalia. Underdevelopment of the external genitalia is quite consistently combined with sexual infantilism; at the same time, there is no direct relationship between the condition of the external and internal genital organs. By the way, with partial sexual infantilism, the mammary glands are sufficiently developed, and in 37% - excessively. Some girls suffering from infantilism have a tendency towards obesity.
To diagnose infantilism, they also use additional methods research. Low performance The physical development of the girl in 35.4% of cases also indicates a delay in sexual development. Particularly indicative in this regard are the external dimensions of the pelvis, in particular the conjugata externa, which by the age of 14 barely reaches 17.5 cm, after which its growth slows down.
Functional diagnostic tests usually reveal an anovulatory cycle. With infantilism, the excretion of gonadotropins is increased, and the excretion of sex steroids is reduced to 4-8 mcg/day; the level of 17-KS corresponds to the age norm.
A rectal-abdominal-wall (or vaginal-abdominal-wall) examination reveals a lag in the size of the uterus, a predominance of cervical length, and an excessive anterior inclination of the uterus. Often, the results of probing the uterus (be careful!) are a good help in diagnosis.
Among X-ray methods the greatest diagnostic value They have pneumogynecography and x-ray hysterography, the latter allowing one to trace the condition of the internal pharynx (no closure), the cervical canal (long, pronounced palm-shaped folds), and the fallopian tubes (thin, tortuous). The lag in bone age, determined, for example, using radiography of the hand, from the calendar age reaches 1-4 years in the case of infantilism.
Registration of the biopotentials of the uterus (reduced) and rheography of the pelvic organs (insufficient blood supply) seem promising.
Treatment . Therapy for sexual infantilism is successful in most cases. If possible, the root cause of the developmental delay of the genital organs is eliminated. If adult women suffering from infantilism undergo replacement or stimulating hormone therapy, then girls who are in puberty or adolescence, hormonal therapy is not always indicated (at least not immediately). Previously, within 3 months, a “background of readiness” should be created, for which it is planned to use substances (vitamins E, C, B1, B6) intended to sensitize the genital organs to the effects of sex hormones on them in the future. At the same time, a course of gangleron (0.04 g once a day) or diphenhydramine or tavegil is administered in a minimum single dose of the same duration.
When starting hormonal therapy, you should once again make sure that there are no vicious gonads with blastomatous potency: male false hermaphroditism, testicular feminization, hormone-producing ovarian tumor, etc. Over the next 3-4 months, cyclic administration of estrogens and progesterone (or pregnin) in minimal doses is undertaken. Both drugs are administered sublingually.
Approximate regimen: from the 1st to the 5th day of the cycle, half a tablet (0.01 mg) of methylestradiol 1 time per day; from the 6th to the 10th day of the cycle - one tablet (0.02 mg) of methylestradiol 1 time per day; from the 11th to the 15th day of the cycle - methylestradiol tablet 2 times a day (0.05 mg per day); from the 16th to the 20th day of the cycle - 2-2.5 tablets of methylestradiol 2 times a day (0.1-0.02 mg per day); from the 18th to the 20th day of the cycle - pregnin, one tablet (10 mg) 1 time per day; from the 21st to the 25th day of the cycle - pregnin, one tablet 3 times a day (30 mg per day).
After the course hormonal treatment it is necessary to take a three-month break; the next course is prescribed only if necessary, i.e., if the irregularity of the spontaneous cycle, algomenorrhea, and infantile appearance persists. A maximum of 3-4 three-month courses can be carried out.
A more powerful hormonal effect is not physiological and is fraught with a number of immediate and delayed complications. To increase the sensitivity of tissues to estrogen, from the 1st to the 20th day of the cycle, thyroidin is prescribed (0.025 g per day), which is especially indicated for obesity.
In parallel with hormonal therapy, it is recommended to carry out physical therapy (paraffin); electroreflexotherapy (acupuncture, electropuncture, intranasal electrophoresis with vitamin B1, Shcherbak collar, electrical stimulation of cervical receptors, abdominal decompression, physiotherapy). The principles of balneophysiotherapy according to V. M. Strugatsky, differentially applied to persons suffering from infantilism, deserve attention.
Treatments such as mud, gynecological massage, tissue therapy, insertion intrauterine device, the administration of gonadotropins, so widely used for the treatment of infantilism in adults, are not popular among gynecological specialists in children and adolescents. Caution is dictated by the fear of causing irreversible disorders of specific functions female body or blastomatous growth.