Saúde sexual, reprodutiva e risco de neoplasias ginecológicas em mulheres assistidas no serviço de transplante hepático do Hospital Walter Cantídio da Universidade Federal do Ceará

Abstract

Few studies attempt to assess women in hepatic insufficiency or already transplanted thus, clinicians, surgeons and gynecologists are still insecure about the monitoring of these patients. These women may experience changes in menstrual function and reproductive health and greater risk of malignancies because of the hyperestrogenism due to the diseased liver, as well as the chronic immunosuppression. Liver transplantation has occurred in Ceara for just over 10 years, as the only therapeutic option for patients in hepatic insufficiency. Women represent about 30% of all transplanted patients, thus it was evaluated the sexual and reproductive health of patients with hepatic insufficiency and transplanted besides the risk of gynecological cancers compared to healthy women (control group). It was analyzed 41 patients (17 on the waiting list for transplantation and 24 transplanted) followed in the outpatient surgical liver transplantation of the Walter Cantidio Hospital, from January 2012 to September 2013 and matched for age and parity to 27 healthy women without liver diseases of the Department of Gynecology of Assis Chateaubriand Maternity School of the Federal University of Ceara, Brazil. It was performed gynecological care: clinical interview, gynecological examination breasts, vulva and speculate with collection of cervical cytology and request of ultrasound (breast and pelvic), and mammography. It was applied the Female Sexual Satisfaction Index (FSSI) and evaluation of vaginal health according to researcher Manoniani’s parameters (2004). The average age of women in three groups was similar. Viral hepatitis were the most frequent indications for transplantation in the two study groups. The menstrual alterations found in most patients at the waiting list was amenorrhea (23.5%); at transplanted, menorrhagia (16.7%), with 45% of these having regular cycles. At control group, 63% had regular cycles. It was 29.6% of menopausal women at control group, 41% on waiting list and 25% on transplanted. Menstrual cycles returned within six months after transplantation in 66.6% of patients in amenorrhea. The breast ultrasound found a BI-RADS 5 lesion in 5.9% of patients in the waiting list and the mammography showed 5.9% of BI-RADS 4 and 5 lesions at the same group and 4.1% BI-RADS 4 at transplanted. At control group, there were 3.7% of BI-RADS 4 lesions at mammography, without suspicious lesions at breast ultrasound. About the sexual health, 50% of women from the waiting list were no sexual activity with significant difference between this group and the control in questions about the frequency of excitation, orgasm, pain, and emotional and sexual satisfaction with partner. In observational assessment of vaginal health there was no significant difference among the three groups. The incidence of malignancies, especially those estrogen-dependent (breast and endometrial), increases in patients with hepatic insufficiency and also in those transplanted using immunosuppressive drugs, where virus-induced neoplasms are more prevalent, like the cervical cancer induced by HPV. Understands the urgency of a liver transplant to save lives, but a gynecological evaluation before and post-transplant can become a reality giving these women a better quality of life.