Aim: to evaluate the quality of life parameters dynamics in patients with vulvar cancer I and II stages during postoperative rehabilitation.Materials and Methods. A prospective comparative randomized study included 47 women with vulvar cancer I–II stages, aged 38 to 70 years, with an average age of 56.3 ± 3.9 years. Patients were randomized into 2 groups: 24 of them underwent postoperative rehabilitation and 23 were included in the comparison group. Quality of life and sexual function, as well as psycho-emotional state were assessed using a set of questionnaires: quality of life of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, Functional Assessment of Cancer Therapy-General (FACT-G) with an extension for vulvar cancer, Female Sexuality Index (FSFI) and WAM (well-being, activity, mood).Results. Patient who receiving postoperative rehabilitation even during the first three months, a reliable positive dynamics of all parameters of FSFI and EORTC, except cognitive function, was noted. At the same time, in the patients not undergoing postoperative rehabilitation program there was no reliable difference in the results of the questionnaires, except for FSFI, but the severity of changes was significantly less than in the patients of the research group. Dynamics in the EORTC parameters in women in postoperative rehabilitation averaged 14.8 points with 7.8 points in the comparison group. In the FACT-G questionnaire, the dynamics were even more pronounced with 19.9 and 6.8 points respectively. There was a reliable positive trend in improving the quality of sexual life and a decrease in the percentage of women suffer from pain and discomfort during sexual intercourse: from 25,0 % (n = 6) to 4,2 % (n = 1) in the study group and from 21,7 % (n = 5) to 13,0 % (n = 3) in the comparison group. Improvement in sexual desire and satisfaction during the year was noted in 5 (20.8 %) women in the study group and only 2 (8.7 %) in the comparison group.Conclusion. The developed program of postoperative rehabilitation of patients with vulvar cancer, which includes individual and group psychotherapy, "anti-cancer diet therapy", dosed physical activity, dynamic correction of vaginal biocoenosis showed high efficiency already during the first 6 months. All patients with vulvar cancer in the postoperative period should receive active rehabilitation aimed at correction of psycho-emotional state and sexual function, which will improve the quality of life and improve further prognosis.

1 ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Россия, 109004 Москва, ул. Земляной Вал, д. 62; 2 Ереванский государственный медицинский университет имени Мхитара Гераци; Армения, Ереван 0025, ул. Корюна, д. 2 Для контактов: Антонина Григорьевна Солопова, e-mail: antoninasolopova@yandex.ru Резюме В статье представлен современный взгляд на реабилитацию пациенток с онкогинекологической патологией. Рассмотрены физиологические и психологические проблемы (постовариоэктомический и болевой синдромы, нарушения сексуальной функции, дистресс, общая интоксикация, хроническая усталость, ассоциированная со злокачественным новообразованием), которые возникают у женщин после противоопухолевого лечения, а также намечены пути их решения. Освещены не только традиционные методы коррекции осложнений, но и возможности альтернативной и адъювантной (вспомогательной) терапии. Особое внимание уделяется важности профилактики рецидивов в реабилитационном периоде. Подчеркивается необходимость развития и внедрения мультидисциплинарного подхода к данной группе больных с обязательным участием врачей разных специальностей -онкологов, акушеров-гинекологов, реабилитологов, психиатров, психологов и т. д. Ключевые слова: онкогинекология, злокачественные новообразования, реабилитация, качество жизни, постовариоэктомический синдром, дистресс, сексуальная функция Статья поступила: 03.12.2019; в доработанном виде: 20.01.2020; принята к печати: 12.03.2020. Конфликт интересовАвторы заявляют об отсутствии конфликта интересов в отношении данной публикации. Вклад авторовВсе авторы сделали эквивалентный вклад в подготовку публикации.

Vulvar cancer is a rare malignant tumor with the incidence rate of is 3–8 % of the total incidence of female genital malignant diseases. This disease is the 4th common cause of mortality (after cervical, endometrial and ovarian cancers) and accounts for 18.2 % of the total lethal outcomes. The anatomical structure of the external female organs with their extensive lymphatic and vascular networks contribute to the aggressive course, the trend to metastasize and rapid tumor growth. Progress in the timely diagnosis of vulvar and vaginal cancer is directly linked to increased competence and oncological vigilance among general practitioners and healthcare institutions. It is up to the primary care providers to identify women at risk or at the initial stages of cancer, and refer them to specialized medical facilities for further diagnostics and treatment. The high mortality from these diseases may be linked to the late detection and to the suboptimal therapy, which necessitates further research in this area.

Aim: to comparatively assess sexual function and intensity of vulvovaginal symptoms in patients with vulvar lichen sclerosus and mixed vulvar dystrophy. Materials and Methods. There were examined 57 patients with vulvar lichen sclerosus and 63 patients with mixed vulvar dystrophy, with mean patient age 35.0 ± 0.6 (18–45) years. Prior to therapy, the study participants completed the Female Sexual Function Index (FSFI) and the Vulvovaginal Symptoms Questionnaire (VSQ). Results. Severe sexual dysfunction (FSFI score 2) was detected in 14 % of cases (n = 8) in group 1 (sclerotic lichen vulva) and 17 % (n = 11) in group 2 (mixed dystrophy). Remaining respondents had total score below the normal cut-off. The mean FSFI score for group 1 and 2 was 17.68 and 16.78, respectively. VSQ testing found that most common complaint in both groups was itching (91 and 95 %, respectively). The majority of patients also noted a deteriorated emotional state and disease-related limitations in everyday life. The maximum VSQ score was 20 corresponding to the peak negative disease impact found in 23 % and 37 % patients in group 1 (n = 13) and group 2 (n = 23), respectively. Many patients also noted lack of lubrication most likely associated with discomfort and pain during intercourse, as well as worsened relationship with partner. Conclusion. The vulvar dystrophy negatively affects sexual function in young women. Symptoms typical to such conditions impose marked restrictions on intimate life, relationships and quality of general life. It accounts for why it is important to include questionnaires in the set of measures to assess sexual function and vulvovaginal symptoms both before and after treatment.

Leukoplakia, kraurosis and pointed condylomas (papillomas) of the vulva represent the group of background benign vulvar diseases. Vulvar and vaginal intraepithelial neoplasms are classified as premalignant conditions. The etiology and pathogenesis of these diseases are not entirely clear due to their complexity. Despite the easy visual assessment of anatomic areas involved in the pathological process, these diseases are rarely diagnosed at an early stage, which might indicate insufficient vigilance of doctors and patients in relation to the early symptoms. Therefore, this field of oncogynecology needs further development ln terms of diagnosisprevention, screening and treatment.