Jedn\u00fdm z\u00a0cie\u013eov zavedenia hormon\u00e1lnej antikoncepcie bolo potla\u010di\u0165 plodnos\u0165 \u017eeny, zbavi\u0165 ju strachu z\u00a0po\u010datia, a\u00a0teda poskytn\u00fa\u0165 jej bohat\u0161\u00ed sexu\u00e1lny \u017eivot. Je ale mo\u017en\u00e9 \u017eenu zbavi\u0165 jej plodnosti a\u00a0nezbavi\u0165 ju plnohodnotnej sexuality?<\/p>\n
Pohlavn\u00e9 horm\u00f3ny, ktor\u00e9 riadia plodnos\u0165 \u017eeny, riadia aj jej sexu\u00e1lne funkcie, \u010di u\u017e na \u00farovni fyzickej alebo psychickej. Hormon\u00e1lna antikoncepcia blokuje hypotalamo-hypofyz\u00e1rno-ovari\u00e1lnu os, \u010d\u00edm zabra\u0148uje produkcii pohlavn\u00fdch horm\u00f3nov v\u00a0tek\u00e1lnych (androg\u00e9ny, napr. testoster\u00f3n) a\u00a0granul\u00f3znych (estrog\u00e9ny, napr. estradi\u00f3l) bunk\u00e1ch vaje\u010dn\u00edkov, ako aj androg\u00e9nov (napr. dehydroepiandroster\u00f3n) v nadobli\u010dk\u00e1ch. Pr\u00e1ve androg\u00e9ny hraj\u00fa v\u00fdznamn\u00fa \u00falohu v regul\u00e1cii zvlh\u010denia po\u0161vy<\/strong>, aktivity hladk\u00e9ho svalstva<\/strong>, prietoku krvi a\u00a0inerv\u00e1cii pohlavn\u00fdch org\u00e1nov<\/strong> (Casey a\u00a0kol., 2016<\/em>[i]<\/a>, Battaglia, 2014<\/em>[ii]<\/a>). Hladiny testoster\u00f3nu u\u00a0\u017eien v\u00fdznamne s\u00favisia so schopnos\u0165ou dosiahnu\u0165 orgazmus <\/strong>(Zheng a\u00a0kol., 2020<\/em>[iii]<\/a>). Viacer\u00e9 \u0161t\u00fadie preuk\u00e1zali, \u017ee u\u017e\u00edvate\u013eky kombinovanej peror\u00e1lnej antikoncepcie maj\u00fa hladiny vo\u013en\u00e9ho testoster\u00f3nu zn\u00ed\u017een\u00e9 a\u017e o\u00a0pribli\u017ene 50 % (Coelingh Bennink a\u00a0kol., 2017<\/em>[iv]<\/a>, Zimmerman a\u00a0kol., 2014<\/em>[v]<\/a>).<\/p>\n Podobne aj hladiny estradi\u00f3lu<\/strong> s\u00fa pri u\u017e\u00edvan\u00ed peror\u00e1lnej antikoncepcie v\u00fdznamne zn\u00ed\u017een\u00e9.[vi]<\/a> [vii]<\/a> [viii]<\/a> V \u0161t\u00fadii, ktor\u00fa vykonali Maget a kol.<\/em> (2017), u\u017e\u00edvate\u013eky or\u00e1lnej antikoncepcie obsahuj\u00facej drospiren\u00f3n mali hladiny estradi\u00f3lu pribli\u017ene 3-n\u00e1sobne ni\u017e\u0161ie v porovnan\u00ed so \u017eenami, ktor\u00e9 ich neu\u017e\u00edvali (P<\/em> < 0.001).[ix]<\/a> Zn\u00ed\u017een\u00e9 koncentr\u00e1cie estradiolu sp\u00f4sobuj\u00fa tvarovo-funk\u010dn\u00e9 a\u00a0biohumor\u00e1lne\/sekre\u010dn\u00e9 zmeny vonkaj\u0161\u00edch pohlavn\u00fdch org\u00e1nov a\u00a0zhor\u0161enie ich prekrvenia<\/strong> (Scavello, 2020<\/em>[x]<\/a>, Battaglia, 2014<\/em>[xi]<\/a>). Existuje ve\u013ea \u0161t\u00fadi\u00ed, ktor\u00e9 preuk\u00e1zali negat\u00edvny vplyv hormon\u00e1lnej antikoncepcie na sexu\u00e1lnu t\u00fa\u017ebu, sexu\u00e1lne vzru\u0161enie a dosiahnutie orgazmu.[xii]<\/a> [xiii]<\/a> [xiv]<\/a> [xv]<\/a> [xvi]<\/a><\/p>\n Navy\u0161e, u\u017e\u00edvanie hormon\u00e1lnej antikoncepcie m\u00f4\u017ee sp\u00f4sobi\u0165 dyspare\u00faniu \u2013<\/strong> boles\u0165 pri pohlavnom styku<\/strong> (Lev-Sagie, 2020<\/em>[xvii]<\/a>, Tayyeb a Gupta, 2020<\/em>[xviii]<\/a>, Serati a kol., 2015<\/em>[xix]<\/a>). Jednou z pr\u00ed\u010din dyspare\u00fanie b\u00fdva vestibulod\u00fdnia<\/strong>, boles\u0165 vyskytuj\u00faca sa v\u00a0oblasti po\u0161vov\u00e9ho vchodu. Viacer\u00e9 \u0161t\u00fadie potvrdili v\u00fdznamn\u00fa s\u00favislos\u0165 medzi u\u017e\u00edvan\u00edm hormon\u00e1lnej antikoncepcie a\u00a0v\u00fdvinom vestibulod\u00fdnie (Champaneria a kol., 2015<\/em>[xx]<\/a>, Goldstein a kol., 2014<\/em><\/strong>[xxi]<\/a>, <\/strong>Gardella B, a kol., 2011<\/em>[xxii]<\/a>). Vestibulod\u00fdnia je \u010dast\u00e1 najm\u00e4 u mlad\u00fdch u\u017e\u00edvateliek peror\u00e1lnej antikoncepcie.<\/strong> Bouchard a\u00a0kol.<\/em> (2002) pozorovali 9-n\u00e1sobne zv\u00fd\u0161en\u00e9 riziko vestibulod\u00fdnie u\u00a0diev\u010dat, ktor\u00e9 za\u010dali u\u017e\u00edva\u0165 peror\u00e1lnu antikoncepciu pred 16 rokom \u017eivota a\u00a0u\u017e\u00edvali ju 2 \u2212 4 roky (RR 9.3, 95%Cl: 3.2\u221227.2).[xxiii]<\/a> Harlow<\/em> a\u00a0kol.<\/em> (2008) pozoroval 2.5-n\u00e1sobne vy\u0161\u0161ie riziko vestibulod\u00fdnie u\u00a0diev\u010dat, ktor\u00e9 za\u010dali u\u017e\u00edva\u0165 peror\u00e1lnu antikoncepciu pred 18 rokom \u017eivota (OR 2.5, 95% CI: 1.1\u22125.8).[xxiv]<\/a><\/p>\n Negat\u00edvne zmeny v\u00a0sexualite \u017eeny sp\u00f4soben\u00e9 pou\u017e\u00edvan\u00edm hormon\u00e1lnej antikoncepcie s\u00fa jedn\u00fdm z\u00a0hlavn\u00fdch d\u00f4vodov nespokojnosti a\u00a0ukon\u010denia jej pou\u017e\u00edvania.<\/strong>[xxv]<\/a> Ako povedal nemeck\u00fd filozof Max Horkheimer u\u017e v\u00a0roku 1970: \u201eZa [hormon\u00e1lnu] pilulku zaplat\u00edme smr\u0165ou erotickej l\u00e1sky…<\/em> Pova\u017eujem v\u0161ak za svoju povinnos\u0165 da\u0165 \u013eu\u010fom jasne najavo, \u017ee za tento pokrok mus\u00edme zaplati\u0165 nejak\u00fa cenu, a t\u00e1to cena je ur\u00fdchlenie straty t\u00fa\u017eby, nakoniec smr\u0165 l\u00e1sky.<\/em>\u201c<\/em>[xxvi]<\/a><\/p>\n <\/p>\n <\/p>\n Odborn\u00e9 pramene<\/strong><\/em><\/p>\n [i]<\/a> Casey PM, MacLaughlin KL, Faubion SS. Impact of Contraception on Female Sexual Function. Journal of\u00a0 Womens Health (Larchmt). 2017 Mar;26(3):207-213.<\/p>\n [ii]<\/a> Battaglia C, Morotti E, Persico N, et al. Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study. Journal of\u00a0 Sexual Medicine. 2014 Feb;11(2):471-80.<\/p>\n [iii]<\/a> Zheng J, Islam RM, Skiba, MA, et al. Associations between androgens and sexual function in premenopausal women: a cross-sectional study. The Lancet, Diabetes & Endocrinology. 2020; 8(8):693\u2013702.<\/p>\n [iv]<\/a> Coelingh Bennink HJT, Zimmerman Y, Laan E, et al. Maintaining physiological testosterone levels by adding dehydroepiandrosterone to combined oral contraceptives: I. Endocrine effects. Contraception. 2017 Nov;96(5):322-329<\/p>\n [v]<\/a> Zimmerman Y, Eijkemans MJC, Coelingh Bennink HJT, et al. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Human Reproduction Update. 2014 Jan;20(1):76-105.<\/p>\n [vi]<\/a> Hayes E, Gavrilidis E, Kulkarni J. The role of oestrogen and other hormones in the pathophysiology and treatment of schizophrenia. Schizophrenia Research and Treatment. 2012;2012:540273.<\/p>\n [vii]<\/a> Petersen N, Kilpatrick LA, Goharzad A, Cahill L. Oral contraceptive pill use and menstrual cycle phase are associated with altered resting state functional connectivity. NeuroImage. 2014 Apr;90:24-32<\/p>\n [viii]<\/a> Mareckov\u00e1 K, Perrin JS, Nawaz Khan I, et al. Hormonal contraceptives, menstrual cycle and brain response to faces. Social Cognitive and Affective Neuroscience. 2012;9(2):191-200.<\/p>\n [ix]<\/a> Maged AM<\/a>, Salah E<\/a>, Kamel AM<\/a>. et al. Effect of oral contraceptives on balance in women: A randomized controlled trial. Taiwanese Journal of Obstetrics & Gynecology. 2017 Aug;56(4):463-466.<\/p>\n [x]<\/a> Scavello I, Maseroli E, Di Stasi V et al. Nomegestrol acetate\/17beta-estradiol does not negatively alter the vascular resistance of clitoral arteries: a prospective, exploratory study. International Journal of Impotence Research. 2020 Mar;32(2):239-247.<\/p>\n [xi]<\/a> Battaglia C, Morotti E, Persico N, et al. Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study. Journal of\u00a0 Sexual Medicine. 2014 Feb;11(2):471-80.<\/p>\n [xii]<\/a> Basson R. Clinical practice. Sexual desire and arousal disorders in women. The New England Journal of Medicine. 2006 Apr 6;354(14):1497-506.<\/p>\n [xiii]<\/a> Malmborg A, Brynte L, Falk G, et al. Sexual function changes attributed to hormonal contraception use – a qualitative study of women experiencing negative effects. European Journal of Contraception and Reproductive Health Care.\u00a0 2020 Jun;25(3):169-175.<\/p>\n [xiv]<\/a> de Castro Coelho F, Barros C. The Potential of Hormonal Contraception to Influence Female Sexuality. International Journal of Reproductive Medicine. 2019;2019:9701384.<\/p>\n [xv]<\/a> Malmborg A, Persson E, Brynhildsen J,\u00a0 et al. Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women. European Journal of Contraception and Reproductive Health Care.\u00a0 2016;21(2):158-67<\/p>\n [xvi]<\/a> Wallwiener CW, Wallwiener LM, Seeger H, et al. Are hormonal components of oral contraceptives associated with impaired female sexual function? A questionnaire-based online survey of medical students in Germany, Austria, and Switzerland. Archives of Gynecology and Obstetrics. 2015 Oct;292(4):883-90.<\/p>\n [xvii]<\/a> Lev-Sagie A, Wertman O, Lavee Y, Granot M. Vestibular Anatomic Localization of Pain Sensitivity in Women with Insertional Dyspareunia: A Different Approach to Address the Variability of Painful Intercourse. Journal of Clinical Medicine. 2020;9(7):2023.<\/p>\n [xviii]<\/a> Tayyeb M, Gupta V. Dyspareunia. [Updated 2020 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562159.<\/p>\n [xix]<\/a> M, Bogani G, Di Dedda MC, Braghiroli A, et al. A comparison between vaginal estrogen and vaginal hyaluronic for the treatment of dyspareunia in women using hormonal contraceptive. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2015 Aug;191:48-50.<\/p>\n [xx]<\/a> Champaneria R, D’Andrea RM, Latthe PM. Hormonal contraception and pelvic floor function: a systematic review.\u00a0 International Urogynecology Journal. 2016 May;27(5):709-22.<\/p>\n [xxi]<\/a> Goldstein AT, Belkin ZR, Krapf JM, et al. Polymorphisms of the androgen receptor gene and hormonal contraceptive induced provoked vestibulodynia. Journal of Sexual Medicine 2014;11:2764\u20132771.<\/strong><\/p>\n [xxii]<\/a> Gardella B, Porru D, Nappi RE, et al. Interstitial cystitis is associated with vulvodynia and sexual dysfunction–a case-control study. Journal of Sexual Medicine. 2011 Jun;8(6):1726-34. .<\/p>\n [xxiii]<\/a> Bouchard C, Brisson J, Fortier M, et al.\u00a0 Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. American Journal of Epidemiologyl. 2002 Aug 1;156(3):254-61.<\/p>\n [xxiv]<\/a> Harlow BL, Vitonis AF, Stewart EG. Influence of oral contraceptive use on the risk of adult-onset vulvodynia. The Journal of Reproductive Medicine. 2008 Feb;53(2):102-10.<\/p>\n