Genital self-image and sexual function in Iranian women from pregnancy to postpartum: a cohort study.

BACKGROUND: Genital self-image is among the factors affecting women's sexual function. AIM: The present study aimed to determine changes in the genital self-image and its relationship with women's sexual function in the third trimester of pregnancy and postpartum. METHODS: The participants of this prospective cohort study included 301 eligible pregnant women chosen through stratified random sampling with proportional allocation from comprehensive health centers in Gorgan, Iran. The Persian version of the 7-item Female Genital Self-Image Scale, the 6-item Female Sexual Function Index, and Depression Anxiety and Stress Scale 21 were filled in a self-report manner on 2 occasions: (1) 30 to 37 weeks of pregnancy and (2) 12 to 16 weeks (± 2 weeks) postpartum. Finally, the data were analyzed using SPSS 24 software. OUTCOMES: Outcomes included Female Genital Self-Image Scale and Female Sexual Function Index changes from pregnancy to postpartum according to the childbirth mode. RESULTS: The mean age of participants was 29.66 ± 5.27 years. These values for the genital self-image scores of women during pregnancy (19.18 ± 3.25) and postpartum (19.43 ± 3.57) were not significantly different (P = .30). Also, this difference was not statistically significant regarding the mode of delivery in 2 groups of women with vaginal birth (P = .62) and cesarean section (P = .14). The mean Female Sexual Function Index scores during pregnancy (15.15 ± 6.73) and postpartum (17.52 ± 6.46) were significantly different (P = .001). In addition, this difference was significant in women with vaginal birth (P = .004) and cesarean section (P = .001). CLINICAL IMPLICATIONS: Clinicians should inform women/couples about changes in female sexual function and address genital self-image as a factor involved in female sexual function during pregnancy and postpartum.Strengths and Limitations: Because the participants of this study were women in the third trimester of pregnancy, the obtained results may not be generalized to pregnant women in the first and second trimesters of pregnancy or even to different postpartum periods (ie, midterm and long term). CONCLUSION: The results showed that the female genital self-image is not significantly different during pregnancy and postpartum, or with the mode of delivery. However, the female sexual function score in postpartum is higher than in pregnancy, regardless of the mode of delivery.

Explaining Iranian midwives' experiences of providing healthcare services during the COVID-19 pandemic: a qualitative study.

BACKGROUND: COVID-19 has changed and challenged the way health and maternity care is provided. Midwives are among the first and most influential maternity care providers during the COVID-19 pandemic; however, there is inadequate information about their experiences in providing healthcare services, particularly in Iran. The present study was conducted to explain the midwives' experiences of providing healthcare services during the COVID-19 pandemic in Gorgan. METHODS: The present study was conducted qualitatively through the inductive content analysis method in 2022. Data were collected through semi-structured interviews. A total of 21 individuals were selected as participants using a purposeful method and the maximum diversity strategy. RESULTS: Data analysis led to the emergence of 377 codes, 12 subcategories, and 3 main categories, including, the laborious occupational challenges for midwives during the pandemic, identifying and creating new opportunities for the development of the midwifery profession, and the lack of perceived organizational and social support. CONCLUSIONS: During the COVID-19 pandemic, midwives experienced various challenges in providing healthcare services, yet sacrificed themselves to perform their duties and provide quality care incessantly. The COVID-19 pandemic was a combination of laborious occupational challenges and individual and professional growth opportunities for midwives in Iran. Strong and managed organizational support is essential to overcome the crisis, maintain the workforce, and empower them to deal with future crises.

Comparing the self-awareness and problem-solving skills training on sexual desire of newly married women: A field trial study.

BACKGROUND: Sexual desire of women is one of the most important factors affecting marital and sexual satisfaction. Regarding the association of life skills level with sexual dissatisfaction and sexual desire, the present study aims to compare the effect of self-awareness and problem-solving skills training on the sexual desire of newly married women. MATERIALS AND METHODS: This was an experimental field trial study conducted since October 2019 to September 2020. The participants included 105 married women with a history of up to 5 years of cohabitation assigned randomly to either of the two intervention or control groups. The data collection tools include a demographic form, Hulbert index of sexual desire (HISD), and ENRICH couple scale that were completed by the participants before (T1), immediately (T2), and one month after the intervention (T3). The first intervention group received self-awareness skills training, whereas the second one received problem-solving skills training (four sessions of 90 min) weekly. On the other hand, the control group received no training. Statistical analyses were performed using SPSS 16 software and descriptive-analytical statistical tests including one-way ANOVA, Kruskal-Wallis, Bonferroni test, tests of within-subjects effects, and analysis test with repeated measures. P value < 0.05 was considered significant. RESULTS: The effect of time (statistic test: 51.24, P-value < 0.001) and the interaction effects of Time and Group on sexual desire (statistic test: 2.87, P-value: 0.03) were statistically significant. The mean score of sexual desire both in interventions and control groups showed statistically significant improvement. The mean score of sexual desire in the self-awareness group was 44.31 ± 9.08 (T1), 51.34 ± 10.92 (T2), and 59.48 ± 13.76 (T3) (P < 0.001); in the problem-solving group was 48.74 ± 10.21 (T1), 52.08 ± 10.59 (T2), and 57.40 ± 12.40 (T3) (P < 0.001); and in the control group was 47.74 ± 11.60 (T1), 50.08 ± 10.04 (T2), and 54.94 ± 12.15 (T3) (P = 0.02). CONCLUSION: The present study showed the effectiveness of both self-awareness and problem-solving skills training on newly married women's sexual desire. Moreover, this study showed simply participating in a study related to sexual desire as a control group could be effective on women's sexual desire.

Preferred mode of delivery association with the body image and genital image in pregnant women - a cross-sectional study.

BACKGROUND: Pregnant women experience several changes in their appearance, body shape and body image. In some studies, there has been a relationship between these changes and the type of delivery. This study aimed to investigate the relationship of the prenatal body image and genital image with the mode of delivery preferred by pregnant women in Gorgan in 2020. METHODS: In this cross-sectional study, 334 pregnant women were selected by stratified sampling. The Prenatal Body Image Questionnaire (PBIQ), Female Genital Self-Image Scale (FGSIS), pregnant women's preferences for mode of delivery questionnaire (PPMDQ) and DASS-21 were completed on line. The data was analyzed using Spearman test and linear regression. RESULTS: The average score of PBIQ, FGSIS, and PPMDQ was 68.24 (standard deviation = 17.71), 19.25 (standard deviation = 3.3), and 63.12 (standard deviation = 3.3) respectively. Vaginal delivery as a preferred mode of delivery was inversely correlated with dissatisfaction with body image (r=-0.32, P < 0.001), and directly correlated with satisfaction with the genital image (r = 0.19, P < 0.001). There was a significant inverse correlation between prenatal body image dissatisfaction and genital image satisfaction (r=-0.32, P < 0.001). While FGSIS score could not predict PPMDQ, PBIQ score could. CONCLUSIONS: Satisfaction with the prenatal body image or genital image is associated with the choice of vaginal delivery. These results can be the basis for prenatal care and childbirth counselling.

The Comparison of the Effects of Training Self-awareness and Problem-solving Skills on Marital Satisfaction of Married Women: A Randomized Controlled Trial.

Background: One of the most important causes of marital dissatisfaction is the lack of life skills. This study aimed to compare the effects of training self-awareness and problem-solving skills on marital satisfaction of married women. Methods: This study was a randomized field trial conducted in Gorgan since October 2019 to September 2020. A total of 105 married women were allocated to one of two interventions or a control group based on triplex block randomization. Data collection tools were the Persian version of the self-awareness questionnaire, problem-solving questionnaire and Four ENRICH Couple Scales. The participants completed the questionnaires before (T1), immediately (T2), and one month after the intervention completion (T3). The first intervention group received self-awareness skills training and the second received problem-solving skills training one session per week for four weeks. The control group did not receive any training. Data were analyzed using One-way ANOVA, Kruskal-Wallis, Chi-square, Fishers exact test, exact test, repeated measure ANOVA, and Bonferroni test, using SPSS 16. A P value <0.05 was considered significant. Results: The mean score of ENRICH Scales in the three groups, immediately and one month after the intervention, were not statistically significant (P>0.05). However, in the problem-solving group, the scale of marital satisfaction was significantly different at T2 and T3 (31.40±4.55, 33±5.21, P=0.008). In the self-awareness training group at T1 and T3, the mean of the conflict resolution scale (32.60±63.28, 33.94±5.74, P=0.03) was significantly different. Conclusion: The results showed that problem-solving skills training was more effective in increasing the score of marital satisfaction compared to self-awareness skills training.Trial Registration Number: IRCT20190721044290N1.

Development and Psychometric Properties of the Sexual Health Scale for Middle-Aged Married Women (SHIMA): a Mixed Methods Study.

PURPOSE: This study aimed to develop and psychometrically validate the Sexual Health Scale for Middle-Aged sexually active women (SHIMA). METHODS: This study was a sequential exploratory study consisting of two phases. In phase one, we interviewed 19 middle-aged women and reviewed the existing instruments to generate an item pool. Then, a panel of experts (n = 16) examined the items. In the second phase, the psychometric properties of the scale were assessed. For content and face validity, a panel of experts (n = 8) and a group of middle-aged women (n = 10) reviewed the items. For construct validity, a cross-sectional study was carried out on a sample of 427 married women. Finally, SHIMA's reliability was assessed. RESULTS: In the first phase, the sexual health concept was explored, and a provisional scale including 60 items was generated. Next, 21 items were removed based on content and face validity. Accordingly, the results obtained from the exploratory factor analysis (EFA) indicated acceptable loading for 34 items tapping into six factors that jointly explained 48.67% of the total variance observed. The internal consistency evaluation revealed that Cronbach's alpha and McDonald's omega were greater than 0.7, and the average inter-item correlation was greater than 0.4, except for one factor that showed borderline results. Test-retest reliability over a 2-weeks interval was 0.90, indicating its high stability. CONCLUSION: The SHIMA is a reliable and valid scale for measuring sexual health in middle-aged married women. It can be used as a sexual health screening scale by healthcare professionals and for research purposes.

Sexual Experience of Iranian Women in Their Middle Life: A Qualitative Approach.

BACKGROUND: Sexual problems are common among the middle-aged women; however, there is no deep understanding of sexuality in midlife. The current study aimed to investigate Iranian women's attitudes and experiences about sexual life changes in midlife. METHODS: This is a descriptive qualitative study. Seventeen women aged 40 -65 years old were purposively selected from urban health centers in Gorgan, Iran, in 2015. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was attained. The resulting data were analyzed based on Graneheim and Lundman's approach. MAXQDA 10 was used for organization of data. RESULTS: Data analysis demonstrated seventh sub-themes and three themes. The emerged themes were entitled (1) "Continuous paradox over being a sexual agent" with three subthemes of beliefs on asexuality as socially accepted view for women in midlife, changing in motivation for sex and changing in sexual performance, (2) "Considering menopause; opportunities and threats for sexual life" with two subthemes of menopause related cons for sexual life and menopause related pros in sexual life, and (3) "Coping strategies for changes in sexuality in midlife" with two subthemes of different psychological reactions to changes that have influenced the sex and take practical steps for restoration of sexual attraction. CONCLUSION: The findings demonstrated that middle-aged women in a male-dominant culture encounter paradox over being a sexual agent. In a bio-psycho-social approach, they perceived menopause as an opportunity or threat for their own sexuality. Following the conflicts, threats and changes of sexuality in midlife, they adopt diverse coping strategies to improve their sexual relationships and preserve their family.

Middle-Aged Iranian Women's Accounts of Their Sexual Health Care Practices: A Conventional Content Analysis.

CONTEXT: Little research has been done to examine sexual health care among middle-aged women, particularly in developing countries that are socioculturally conservative, such as Iran. METHODS: In 2015, as part of a descriptive qualitative study, face-to-face interviews were conducted with 17 women aged 40-65 residing in Golestan Province, Iran. Graneheim and Lundman's approach to conventional content analysis was used to interpret the sexual health care narratives of the women. RESULTS: Sexual health care for middle-aged Iranian women often took the form of self-care to preserve their privacy and confidentiality, and in general, any information on sexual health was appreciated. Data analysis identified three main categories of strategies for sexual self-care: sexual risk protection, prevention of sexual problems and undesirability, and sexual information seeking. Also, sexual self-care emerged as the central theme. CONCLUSIONS: To meet the needs of middle-aged Iranian women, health care providers should become familiar with such women's sexual health care and self-care practices. Socioculturally sensitive policies and interventions should be developed to improve the sexual and reproductive health care conditions of middle-aged women.

RESUMEN Contexto: Se ha realizado poca investigación para examinar la atención de la salud sexual en mujeres de mediana edad, especialmente en países en desarrollo que son socioculturalmente conservadores, como Irán. Métodos: En 2015, como parte de un estudio cualitativo descriptivo, se realizaron entrevistas personales con 17 mujeres de 40 a 65 años de edad, que residían en la provincia de Golestan, Irán. Se utilizó el enfoque de Graneheim y Lundman en el análisis de contenido convencional para interpretar las narrativas de atención de la salud sexual de las mujeres. Resultados: En el estudio, la atención de la salud sexual para mujeres iraníes de mediana edad con frecuencia adoptó la forma de autocuidado para preservar su privacidad y confidencialidad; y, en general, cualquier información sobre salud sexual fue apreciada. El análisis de los datos identificó tres categorías principales de estrategias para el autocuidado sexual: protección contra el riesgo sexual; prevención de problemas sexuales y de carácter indeseable; y búsqueda de información sexual. Además, el autocuidado sexual surgió como el tema central. Conclusiones: Para satisfacer las necesidades de las mujeres iraníes de mediana edad, los proveedores de servicios de salud deben familiarizarse con la atención de la salud sexual y las prácticas de autocuidado de esas mujeres. Se deben desarrollar políticas e intervenciones socioculturalemente sensibles para mejorar las condiciones de atención de la salud sexual y reproductiva de las mujeres de mediana edad.

RÉSUMÉ Contexte: La recherche sur les pratiques de santé sexuelle des femmes d'âge moyen est rare, en particulier dans les pays en développement soumis au conservatisme socioculturel, comme l'Iran. Méthodes: En 2015, dans le cadre d'une étude qualitative descriptive, des entrevues en personne ont été menées avec 17 femmes âgées de 40 à 65 ans résidentes de la province iranienne du Golestan. Les descriptions données par les femmes de leurs soins de santé sexuelle ont été interprétées par analyse de contenu conventionnelle, selon l'approche de Graneheim et Lundman. Résultats: Les soins de santé sexuelle des Iraniennes d'âge moyen relevaient souvent de l'auto-traitement, pour protéger leur vie privée et confidentialité, et toute information relative à la santé sexuelle était généralement appréciée. L'analyse des données a identifié trois grandes catégories de stratégies sous-tendant l'auto-traitement sexuel: se protéger contre le risque sexuel, prévenir les problèmes sexuels et de l'absence de désirabilité et rechercher une information sexuelle. L'auto-traitement en matière sexuelle s'est du reste révélé le thème central. Conclusions: Pour répondre aux besoins des Iraniennes d'âge moyen, les prestataires de la santé doivent se familiariser avec les pratiques de soins et d'auto-traitement de ces femmes en matière sexuelle. Des politiques et des interventions socioculturellement sensibles doivent être élaborées pour améliorer l'état des soins de santé sexuelle et reproductive des femmes d'âge moyen.

The Metabolic Syndrome among Postmenopausal Women in Gorgan.

Introduction. The present study aimed to assess the metabolic syndrome among postmenopausal women in Gorgan, Iran. Materials and Methods. The study was conducted on hundred postmenopausal women who were referred to the health centers in Gorgan. Metabolic syndrome was diagnosed using Adult Treatment Panel III (ATP III) guidelines. Results. The mean body mass index, waist circumference, hip, circumference waist-to-hip ratio, diastolic blood pressure, and triglyceride and fasting blood glucose levels were significantly high among postmenopausal women with metabolic syndrome, but the mean HDL-cholesterol was significantly low (P < 0.05). Overall prevalence of metabolic syndrome was 31%. Body mass index and waist circumference had a positive correlation with a number of metabolic syndrome factors (P < 0.001). Body mass index, waist circumference, and waist-to-hip ratio had a positive correlation with each other (P < 0.001). BMI had relatively high correlation with WC (P < 0.001). Conclusions. Our results show that postmenopausal status might be a predictor of metabolic syndrome. Low HDL-cholesterol level and high abdominal obesity are the most frequent characteristics in comparison to other metabolic components. Our study also showed some related factors of metabolic syndrome among postmenopausal women. These factors may increase cardiovascular risk among postmenopausal women with metabolic syndrome.