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Sexualität bei Jugendlichen mit rheumatischen Erkrankungen

Verhütung, HPV-Impfung und Schwangerschaft

Sexuality in adolescents with rheumatic diseases

Contraception, HPV vaccination and pregnancy

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Zusammenfassung

Junge Patienten und Heranwachsende mit chronisch rheumatischen Erkrankungen haben in Bezug auf Sexualität und Schwangerschaft dieselben Wünsche, Ängste und Bedürfnisse wie andere Jugendliche. Jugendliche sind häufig bereits sexuell aktiv, bevor die Transition von der Kinder- in die Erwachsenenrheumatologie erfolgt. Schwangerschaften bei jungen Frauen mit rheumatischen Erkrankungen gehen mit erhöhten mütterlichen und fetalen Risiken einher, insbesondere wenn sie bei aktiver Erkrankung oder unter teratogenen Medikamenten ungeplant eintreten. Eine sichere Kontrazeption ist somit essenziell zur Verhinderung ungewollter Schwangerschaften. Bei der Auswahl müssen die Sicherheit der Verhütungsmethode und die altersentsprechende Praktikabilität berücksichtigt werden. Empfohlen werden sollte ein „doppelter Schutz“ durch den Einsatz von Kondomen zur Kontrazeption und zur Prävention sexuell übertragbarer Krankheiten, jeweils kombiniert mit einer weiteren sicheren Kontrazeptionsmethode. Frauen mit rheumatischen Erkrankungen sind anfälliger für persistierende HPV(humane Papillomaviren)-Infektionen und Folgeerkrankungen wie Gebärmutterhalskrebs. HPV-Impfungen erreichen auch bei jungen Frauen mit rheumatischen Erkrankungen gute Serokonversionsraten, werden gut vertragen und scheinen keine Schübe der Grunderkrankung auszulösen. Die Betreuung junger Frauen mit rheumatischen Erkrankungen sollte vor, während und nach der Transition eine offene, frühe und kontinuierliche Beratung zu diesen Themen umfassen, um die individuelle Gesundheit und Lebensqualität zu erhalten und die Versorgung der altersentsprechenden Lebenssituation der Heranwachsenden anzupassen.

Abstract

Young patients and adolescents with chronic rheumatic diseases have the same desires, fears and needs in terms of sexuality and pregnancy as their healthy peers. In most cases adolescents are already sexually active before transition from pediatric to adult rheumatological care takes place. Pregnancies in women with rheumatic diseases are associated with increased maternal and fetal risks, especially when they occur unplanned in the course of active disease or under teratogenic drugs. Safe contraception is therefore crucial in preventing unwanted pregnancies. The choice of contraception should anticipate the safety of the method of contraception as well as age-dependent practicability. A strategy of “double protection” through the use of condoms for contraception and prevention of sexually transmitted diseases combined with another safe contraception method should be recommended. Women with rheumatic diseases are more susceptible to acquire persisting human papilloma virus (HPV) infections and the subsequent progression to cervical cancer. In women with rheumatic diseases HPV vaccination induces high seroconversion rates, is safe and does not seem to induce disease activity. The care of adolescent women with rheumatic diseases before, during and after medical transition needs to encompass an open, early and continuous counselling regarding these topics in order to retain the individual health-related quality of life and to adapt this care to age-specific needs.

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Authors and Affiliations

  1. Poliklinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    R. Fischer-Betz & I. Haase

  2. Klinik für Kinder-Onkologie, Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    P. T. Oommen

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  1. R. Fischer-Betz
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Correspondence to R. Fischer-Betz.

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R. Fischer-Betz, I. Haase und P.T. Oommen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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H.-I. Huppertz, Bremen

P.M. Villiger, Bern

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Fischer-Betz, R., Haase, I. & Oommen, P.T. Sexualität bei Jugendlichen mit rheumatischen Erkrankungen. Z Rheumatol 77, 667–676 (2018). https://doi.org/10.1007/s00393-018-0522-6

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