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20REDUCED SEXUAL DYSFUNCTION IN YOUNG ADULTS WITH OVERWEIGHT AND ARTERIAL HYPERTENSION
Kristina Samvelovna Pulatova
Samarkand State Medical University, magister of the Therapy Department
Postgraduate Education Faculty e-mail: davitty girl@mail.ru
Shokhruh Shavkatovich Inoyatov
Samarkand State Medical University, 6th year student at the Medical Faculty
Davlatshoh Usmonovich Numonov
Samarkand State Medical University, resident of the Therapy Department
Postgraduate Education Faculty.
ABSTRACT
Excessive body weight in both men and women adversely affects the quality of sexual life. It is associated with impaired self-perception and low body performance. Excessive body weight reduces desire for sex, causes problems with erection in men and reproductive organ dysfunction in women (vaginal dryness, pain during sexual intercourse). Problems are exacerbated by diseases caused by obesity, such as diabetes or hypertension.
Key words: sexual dysfunction, obesity, hypertension, excess body weight.
INTRODUCTION
Excessive body weight negatively affects the entire body. Often in the context of overweight pounds is said to be an increased risk of cardiovascular disease, but problems related to the sexual sphere are much more prominent. As it turns out, being overweight has a negative effect on libido. People who are overweight have a much lower desire for intimacy than people of normal weight. This is due to a number of different factors. In many cases, discomfort in intimate situations is associated with self-perception problems, complexes and low self-esteem. Weight problems may even contribute to depressive states, which negatively affects relationships, especially with the opposite sex. Also important is the slowness characteristic of obese people, reduced physical fitness and lowered energy levels. Obesity, especially abdominal obesity, reduces testosterone levels, the main hormone responsible for maintaining normal sex drive. Moreover, metabolic disturbances associated with altered insulin
secretion dynamics represent a problem. This leads to the development of insulin resistance, negatively affecting blood vessels and peripheral innervation. In men it causes the above-mentioned problems with erection, and in women - disorders of lubrication - vaginal dryness appears, which increases pain during sexual intercourse. The consequence of this is sexual coldness and avoidance of sex. Nowadays vasculogenic factors such as hypertension, atherosclerosis and diabetes mellitus and/or their combination take the leading positions among different reasons that contribute to sexual dysfunction. According to some literature data, the frequency of detection of sexual dysfunction in patients with cardiovascular disease and diabetes ranges from 30 to 67%. Walczak M. et al. (2004) have shown that almost one in two middle-aged patients with sexual dysfunction has AH and one in four has type 2 diabetes. Seftel A. et al. found that in addition to the above risk factors of CVD, 42.4% of people with sexual dysfunction had hyperlipidemia, 23.9% had a combination of AH and blood lipid profile disorder, and 12.8% had both AH and DM.
The data on the effect of antihypertensive therapy (AHT) on sexual function are quite diverse and quite contradictory. It is believed that the emergence of libido is due to drug treatment in no more than 25% of cases. An ambiguous situation is outlined in relation to the relationship between long-term use of different classes of antihypertensive drugs (AHT) and the risk of sexual dysfunction. It is clear: reaching target BP values is associated with improved quality of life. However, the side effects caused by taking AGPs can completely negate this requirement and in some cases significantly worsen the well-being of patients, especially those where the course of AH was almost asymptomatic. Such deterioration, in particular, sometimes can be caused by various abnormalities of sexual function due to taking hypotensive medication and, as a result, decreased adherence or even complete refusal of the therapy is registered.
Purpose of the study: To reveal the presence of sexual function abnormalities in young people with hypertension (HD) depending on the duration and degree of AH, body mass index (BMI).
MATERIALS AND METHODS
The study involved young men and women with an average age of 35-45 years. A total of 74 people (32 men and 42 women) suffering from AH and obesity of different degrees were examined. The examination was carried out by questionnaire and questionnaire (MIEF in men). The diagnosis of hypertension was made on the basis of the recommendations of the Russian Society of Cardiology. Individuals with
at least one target organ lesion were classified as stage II. Systolic blood pressure (BP) and diastolic blood pressure (DBP) were measured in the sitting position, three times at 1-3-minute intervals, on both arms. Thirty minutes before the measurement, we excluded eating, smoking, physical stress, and exposure to temperature factors (cold and heat). The subjects sat in a relaxed state before the measurement, the measurement was started after a 5-minute rest and in the above position and the average value was analyzed. The measurement was performed using a mechanical tonometer "Adjutor IAD-01-1".
Patients underwent anthropometry (height, weight, waist and hip circumference, abdominal circumference), body weight (BMI) was assessed by body mass index (BMI), which was calculated according to the formula: (Figure 1)
BMI weight ( Height (sm2)
It is the ratio of body weight (in kilograms) to height (in meters) squared. WHO developed a classification of overweight and obesity based on BMI. (See table 1 for data).
Table 1: Classification of underweight, overweight, and obesity in adults according to BMI.
Classification BMI kg/m2
Severe underweight < 16
Underweight (deficiency) 16-18,49
Normal 18,5-24,99
Overweight (obesity) 25-29,99
Overweight I stage 30-34,99
Overweight II stage 35-39,99
Overweight III stage ( morbid) 40>
RESULTS
In our case left ventricular myocardial hypertrophy established by EchoCG. 42 (56.7%) had stage I hypertrophy and 32 (43.3%) had stage II hypertrophy. Stage I AH in 44 (59.4%) and Stage II in 30 (40.6%). The average duration of AH was 5.3±2.4 years, up to 5 years (mean 2.2±0.5 years) - in 47 (63.5%) and over 5 years (mean 6.7±0.5 years) - in 27 (36.5%) people. Of the patients with GB, 36 (48.6%) smoked, 12 (16.2%) had normal body weight (BMI < 24.9 kg/m'), 23 (31.1%) had 1st degree obesity, 19 (25.6%) had 2nd degree obesity, 20 (27.1%) had 3rd degree obesity. According to the MIEF-5 questionnaire, mild ED was observed in 13 patients (41%), while moderate and severe ED was observed in 9 (28.1%) patients.
According to the questionnaire in women, vaginal dryness was observed in 13 (31%) women, pain during intercourse in 7 (16.7%) women, and refusal of intercourse in 4 (9.5%) women.
DISCUSSION
Being overweight is still considered a negative phenomenon, but the fact is that many people have a hereditary tendency to gain excess weight, and they themselves are not to blame for it. Meanwhile, modern life, the rhythm of work and the available food itself already contribute to obesity. It is important to realize that being overweight has a slightly more noticeable effect on men's health and life expectancy than women. Excessive fat suppresses not only the production of "normal" female sex hormones - estrogen and progesterone, but also the tenderness hormone oxytocin, which is responsible for the desire to please, love and be loved. So getting rid of really extra weight a woman becomes more sexy on a physiological level, it's true. In women with diabetes, sexual dysfunction develops due to damage to the capillaries and nerve fibers, which leads to the development of atrophic changes, dryness in the genital tract. Unpleasant or painful sensations during sexual intimacy may occur.
CONCLUSION
From the practical point of view, based on the results of our work, we can recommend patients with AH (especially degree 2 and 3) and at least degree 1 obesity not to neglect consultations with urologists, andrologists and gynecologists even in the absence of complaints of worsening of the quality of sexual relations. Conversely, in the presence of sexual dysfunction combined with overweight or obesity, a comprehensive examination by a cardiologist for early detection of cardiovascular pathology and its correction with properly selected antihypertensive therapy is necessary.
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