Efficacy of mobile-based educational intervention using Instructional Systems Design in promoting preventive behaviors for sexually transmitted infections among Iranian women: a randomized controlled trial.

BACKGROUND: Women who are sexually active are at risk of sexually transmitted infections (STIs), which can cause serious difficulties for their reproductive health. However, despite the high global burden of STIs, most infections are preventable with education for behavioral change. The purpose of this study is to investigate the Efficacy of Mobile-Based Educational Intervention Using Instructional Systems Design in Promoting Preventive Behaviors for Sexually Transmitted Infections among Iranian Women. METHODS: This randomized controlled trial aimed at promoting preventive behaviors related to STIs in Iranian women with an educational intervention based on the Instructional Systems Design (ISD) in 2022. The participants in this study were recruited from a single center, specifically the Health House No. 3 located in District 11 of Tehran Municipality. Two instruments were used in the present study: a) a valid scale titled: "Four-Scale of STI Preventive Behaviors", and b) a researcher-made Questionnaire titled: "Social perception affecting sexually transmitted infections (SOPESTI)". These tools contain 8 demographic items and specific questions with a total of 68 five-point Likert scales. The intervention comprised three phases: a pre-test (baseline), a training program, and two follow-up assessments (4 and 12 weeks after the start of the training program). The experimental group received education through a mobile app, while the control group received no intervention. SPSS v.26 was used, with a significance level of P < 0.05. The chi-square test, Fisher's exact test, independent t-tests, analysis of covariance (ANCOVA), and repeated measures ANOVA were used to analyze the data. RESULTS: A total of 80 women, with a mean age of 36.524 ± 6.91 (experiment group) and 34.78 ± 8.20 (control group), respectively, participated in the trial. The study revealed a statistically significant difference in the mean score for eight domains, including STIs Knowledge, STIs Vulnerability, STIs Preventive Self-efficacy, STIs Prevention intentions, STIs Perceived social exclusion, STIs Perceived cognitive barriers, STIs Perceived social support, and STIs Perceived risks in the experiment group following the intervention compared to before the intervention (p < 0.05). CONCLUSION: The results of this study showed that a mobile-based educational intervention based on the ISD model had a significant effect on the preventive behaviors of STIs in Iranian women. These results highlight the potential benefit of mobile health in enhancing reproductive health. TRIAL REGISTRATION: ClinicalTrials.gov IRCT20200602047638N1. Registered on 22 May 2021 with the IRCTID, V1.0. https://www.irct.ir/trial/55632.

Attitude toward virginity and its determinants among girls in Tabriz: Iran.

BACKGROUND: We aimed to assess the attitude of unmarried girls towards virginity, and its determinants, comparing three age cohorts (born in the 70s, 80s, and 90s) in the city of Tabriz in northwestern Iran. METHODS: We conducted a cross-sectional survey among 700 girls residing in Tabriz in 2021 employing a population-based cluster sampling based on health clinics and households. We collected data using a pilot-tested instrument, which comprised socio-demographic questions, and statements to assess attitudes towards virginity and its importance, the meaning of virginity, ways of losing virginity, and perception of the hymen. The data was analyzed using SPSS, version 21. Analysis of variance and independent t-test was used for bivariate analysis and linear regression was used to identify the determinants of the attitude. A p value under 0.05 was considered statistically significant. RESULTS: Only about one-third (35.2%) of unmarried girls considered preserving virginity as an important issue for girls before marriage in current days. About 27% were uncertain and about 38% believed it was unimportant. The importance of virginity (score range 7-35) was significantly greater for girls born in the 70s than for girls born in the 80s and 90s (p < 0.05). In the multivariate linear regression model, the determinants of the importance of virginity were older age, greater religious affiliation, living with both parents and lower consumption of the internet and social networks for sexual information. CONCLUSIONS: This study indicates significant shifts in sexual attitudes among young females which may have important implications for marriage age and the culturally and age-appropriate sexual health interventions of young people.

Factors affecting sexual health in individuals with spinal cord injury: A systematic scoping review.

PURPOSE: This study aims to review the literature to explore some factors affecting sexual and partnership adjustment in individuals with spinal cord injury (SCI). METHODS: This study was based on the methodological framework of scoping reviews, including 3 methodological steps: (1) identifying relevant studies (searching for related studies); (2) selecting related studies; (3) collecting key findings, summarizing, and reporting the results. The electronic databases were searched including Medline (PubMed), Scopus, Web of Science, Embase, and Cochrane Library. Studies were included if they reported data about the related factors of sexual and partnership adjustment in individuals with SCI. No limitations were considered in terms of time or methodology of the search. RESULTS: After the full-text screening, 52 studies were included from the year of 1978 - 2019 with various methodologies. The present review demonstrated that proper sexual health among individuals with SCI is related to several factors including the anatomical factor, level of the injury, completeness of the injury, psycho-social factor, socio-economic status, and type of relationship. CONCLUSION: With consideration of factors affecting sexual and partnership adjustment in individuals with SCI, a better estimation of sexual health can be achieved in clinical to improve the relationship and quality of life.

Prerequisites of sexual health literacy promoting service: a qualitative study in Iran.

BACKGROUND: Sexual health literacy is one of the determinants of the rate, factors, and outcomes of problems associated with sexual health and reproductive. The prerequisite of having and promoting this type of literacy is the appropriate organization and access to sexual health services. The current study was conducted with the objective of describing the perceptions and experiences of health care providers and recipients of sexual health literacy promoting services. METHODS: The current qualitative study was conducted on 37 individuals in the form of 3 individual in-depth and semi-structured interviews and 4 focus group discussions (26 individuals) with service recipients (women of reproductive age), and 8 in-depth and semi-structured interviews with service providers in Amol from September 2019 to March 2020. The recorded interviews were transcribed and analyzed through content analysis. RESULTS: Data analysis resulted in the extraction of the theme titled "prerequisites of sexual health literacy promoting service" which consisted of two subthemes 'client-oriented service' and 'efficient service'. In the client-oriented service attention must be paid to the client's age, sex, needs and socio-cultural background. Efficient service is a service which is based on continuing sexual education, can reconstruct sexual attitudes, is professional, team-based, integrated into other services, and has a follow-up structure. CONCLUSIONS: The results outline the requirements for sexual health literacy promoting services which should be taken into consideration during the policymaking, planning and design of relevant health programs.

Help-seeking challenges for female sexual concerns: a qualitative study from Iran.

BACKGROUND: To effectively manage sexual health, people must have access to sexual health services. A small percentage of women with sexual concerns seek professional help. Hence, the need to explain the help-seeking challenges is felt from the perspective of women and health care providers. METHODS: This study explored Iranian women's challenges when seeking help for sexual concerns. Using a purposive sampling method, 26 in-depth interviews were conducted in Rasht in 2019-2020. The participants included sexually active women of reproductive age over 18 years old and 8 health care providers. The recorded interviews were transcribed and analyzed through content analysis. RESULTS: From the description of 17 subthemes provided by the participants, two main themes were achieved, "Unfavorable sexuality development context" and "Inefficient sexual health services." CONCLUSIONS: According to the results, it is suggested that policymakers pay more attention to the challenges women and health care providers face in help-seeking and promote sexuality education and sexual health services to achieve a higher level of help-seeking among women.

Development of self-care strategies to promote young Iranian women's sexual health: an explanatory sequential mixed method study protocol.

BACKGROUND: In contemporary Iran, the nation's traditional and deeply religious society is currently experiencing swift transformations in its moral, cultural, and social aspects. It is, therefore, not surprising to observe shifts in people's attitudes toward sexuality, largely attributed to the profound impact of widespread social networks, the proliferation of information technology, and increased levels of education. Unmarried young women may potentially face adverse consequences from engaging in extramarital sexual relationships across various aspects of their lives. Acknowledging the pivotal role of self-care in influencing the sexual behaviors of young women, the objective of this study is to compile a comprehensive list of self-care strategies aimed at improving the sexual well-being of young, single Iranian women. METHODS: The research will unfold in three distinct phases: Phase 1: Explanatory Sequential Mixed-Method Study This initial phase encompasses both quantitative and qualitative aspects. It begins with a cross-sectional survey, where we will gather data from 400 unmarried female students aged 18 to 29 years, utilizing a cluster random sampling method at Kerman University of Medical Sciences. Data collection will involve the use of a researcher-designed questionnaire. Subsequently, the qualitative phase will involve conducting in-depth, semi-structured interviews with female students from the University. To analyze this qualitative data, we will employ the content analysis approach. The findings obtained from both phases will be combined. Phase 2: Narrative Review In the second stage of the study, we will conduct an extensive narrative review to explore existing strategies related to the subject matter comprehensively. This review will serve as the foundational basis for our subsequent analysis. Phase 3: Strategy Prioritization In the final phase, we will prioritize the proposed strategies using a nominal group process, soliciting expert advice. This step will result in the definitive list of strategies that emerge from the study. DISCUSSION: This study pioneers the field of sexual health, with the goal of developing a protocol for creating self-care strategies based on the perspectives of young, unmarried Iranian women. It offers potential evidence-based insights into current developments in the physical, psychological, and social aspects of sexual health within this demographic. Additionally, it aims to furnish essential information to healthcare policymakers regarding the sexual health of young women.

The convergence of the Iranian cultural landscape with the widespread presence of social networks and the growing utilization of information technology has played a significant role in the emergence of extramarital relationships among young women. In this context, fostering sexual health self-care practices can serve as a preventive measure against the potential consequences of such relationships within this demographic.This research unfolds in three stages: 1. Explanatory Sequential Mixed-Method Follow-up Study: Combining quantitative and qualitative phases. 2. Narrative Review: Involving a review of relevant literature. 3. Strategy Extraction through Expert Opinion: Finalizing strategies via a nominal group process. Integrating quantitative and qualitative approaches, this study aims to comprehensively explore the younger generation's perspectives on psychological and social aspects of extramarital relationships, thereby providing robust documentation in this field.

The Effect of Mindfulness-Based Cognitive-Behavioral Sex Therapy on Improving Sexual Desire Disorder, Sexual Distress, Sexual Self-Disclosure and Sexual Function in Women: A Randomized Controlled Clinical Trial.

Sexual desire disorder is the most common form of sexual dysfunction among women and is associated with problems like sexual distress and reduced sexual self-disclosure. As a result, this RCT study was conducted with 70 reproductive-age women in the form of 4 weekly group educational sessions. Compared to the control group, the mindfulness-based cognitive-behavioral sex therapy (MBCST) intervention significantly improved sexual -desire, -distress, self-disclosure and -function immediately, 4 and 12 weeks after the educational sessions were completed in the intervention group (p < 0.001). Overall, our findings underscore the significance of the MBCST intervention on improving sexual dysfunction among women.Trial registration number: Iranian registry of clinical trials. IRCT Id: IRCT20160808029255N4.Trial registration date: 17th September 2018.Date of first patient's enrollment: 19th September 2018.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.2008075.

Women's Help-Seeking Behaviors for Sexual Health Issues and the Related Factors: A Cross-Sectional Study from Iran.

Delay in help-seeking for sexual health issues may lead to relationship discord and impact the quality of life. The study aimed to explore the factors related to HSBs (help seeking behaviors) for sexual health issues and to determine the role of negative attitudes relating to sexual concerns in the HSBs of Iranian women. This cross-sectional study was performed in 2020. Participants were 390 randomly selected women from Rasht, Iran. The data were collected using a demographic and a sexual history checklist, the Female Sexual Function Index-6-item (FSFI-6), the Attitudes-related Sexual Concern Scale (ASCS), and a help-seeking behavior questionnaire. Formal help-seeking in women with sexual concern was 16.2% and 48.6% engaged informal HSB. Informal HSB was associated with younger age (OR = 0.93; CI = 0.89-0.97), having a university degree (OR = 3.42; CI = 1.89-6.18), sexual abuse in adulthood (OR = 2.59; CI = 1.07-6.26) and lower negative attitudes-related sexual concerns (OR = 0.53; CI = 0.32-0.87). Formal HSB was related to having a university degree (OR = 3.03; CI = 1.32-6.98) and history of a chronic disease (OR = 3.43; CI = 1.68-6.98). Negative attitudes relating to sexual concerns greatly impact informal HSBs of women, so it should be considered in their health care programming.

The effect of the EX-PLISSIT model-based psychosexual counseling on improving sexual function and sexual quality of life in gynecologic cancer survivors: a randomized controlled clinical trial.

PURPOSE: Psychosexual support has received considerable attention in the improvement of sexuality in gynecologic cancer survivors. The current study was conducted to examine the effect of EX-PLISSIT model-based psychosexual counseling on improving sexual function and sexual quality of life in this group of patients. METHODS: One hundred ten eligible women with the most common gynecologic cancers were randomized 1:1 to intervention (EX-PLISSIT-based counseling sessions for 4 weeks) and control groups. Sexual function and sexual quality of life were assessed via FSFI and SQOL-F self-reported questionnaires at baseline and 8 weeks post-intervention. RESULTS: One hundred fifty patients were registered; 110 were equally randomized to the intervention and control groups (55 each). Ninety-nine patients completed both questionnaires at baseline and 8 weeks post-intervention. There were no significant differences in the FSFI and SQOL-F scores between the study arms compared to baseline using the independent t-test (P > 0.05). Positive changes in FSFI and SQOL-F scores were observed in patients in both arms at 8 weeks. However, the mean difference was higher in the intervention arm but was statistically significant only in the domains of sexual desire, lubrication, orgasm, pain, overall sexual function, and sexual and relationship satisfaction subscale of SQOL-F (P < 0.05). CONCLUSIONS: Based on our findings, by facilitating communication, the EX-PLISSIT-based psychosexual counseling resulted in positive changes in sexual function and sexual quality of life in gynecologic cancer survivors. Therefore, we recommend this type of counseling in combination with other therapeutic and rehabilitative services for survivors of gynecologic cancers. TRIAL REGISTRATION: This study was registered in Iran's Clinical Trial Registry under registration code IRCT20160808029255N6 on 29 June 2019.

Translation and validation of Persian version of sexual function: vaginal changes questionnaire (SVQ) for women with gynecologic cancers.

BACKGROUND: Changing in the sexual function is an important condition in women with gynecological cancers. A valid and reliable questionnaire is required to assess this condition. The aim of this study was to translate and validate the Persian version of the Sexual-Vaginal Function Changes Questionnaire (SVQ) in women with gynecologic cancers. METHODS: This methodological study with a psychometric design was conducted on 250 women with gynecologic cancers, who visited public and private medical centers in Tehran to receive follow-up services. Convenience sampling was conducted from April 2019 to May 2020. First, the Persian version of the Sexual Function-Vaginal Changes Questionnaire was developed and then, psychometric properties such as content validity, face validity, construct validity and criterion validity were assessed. Reliability of the instrument was assessed by Cronbach's alpha coefficient. RESULTS: Mean age of participants was 53.3 ± 11.8 and mean score of SVQ was 63.0 ± 9.1 in the possible range of 26-104. Content validity was tested through qualitative method and six items were revised as suggested by the expert panel. Cronbach's alpha coefficient was 0.71 for the whole questionnaire and it was 0.93, 0.92, 0.89, 0.78, 0.88 and 0.78 for the 6 subscales, respectively, which shows the optimal internal consistency. Results of exploratory factor analysis revealed six factors as (1) intemacy and sexual interst, (2) arousal, (3) changes in intemacy and sexual interst after cancer, (4) vaginal changes after cancer, (5) vaginal bleeding during coitus, (6) and sexual worry and dissatisfaction after cancer. explained 70.09% of the variance observed. Criterion validity test of the questionnaire showed a significant correlation between the total SVQ scores and the total Female Sexual Function Index (FSFI) scores as well as between SVQ dimensions and dimensions of FSFI (P < 0.001). CONCLUSIONS: The findings from this study indicated that the Persian version of the SVQ is a valid and reliable instrument to assess sexual function-vaginal changes in women with gynecologic cancers.

The effects of self-care education based on the health literacy index on self-care and quality of life among menopausal women: a randomized clinical trial.

PURPOSE: Aging is associated with many different health-related challenges for women such as menopause and its associated problems. Self-care (SC) is a factor with potential effects on menopause and its consequences. SC education based on health literacy has the potential to improve menopausal women's SC. The aim of this study was to evaluate the effects of SC education based on the health literacy index (HLI) on SC and quality of life (QOL) among menopausal women. METHODS: This randomized clinical trial was conducted in Iran. Participants were 100 menopausal women purposively recruited from five comprehensive healthcare centers in the south of Tehran. They were randomly allocated to a control and an intervention group through block randomization. Intervention was an HLI-based SC education program implemented in four 1.5-hour weekly sessions through the lecture, group discussion, and question and answer methods. Data were collected before and eight weeks after the intervention using a demographic questionnaire, the Health Literacy for Iranian Adults scale, the Menopause-Specific Quality of Life Questionnaire, and the Menopausal Self-Care Questionnaire. The SPSS software (v. 22.0) was used to analyze the data through the Chi-square, Fisher's exact, paired-sample t, and the independent-sample t tests as well as the analysis of covariance at a significance level of less than 0.05. FINDINGS: There were no significant differences between the intervention and the control groups respecting the pretest mean scores of QOL (88.15 ± 32.36 vs. 79.6 ± 36.99) and SC (104.75 ± 12.31 vs. 103.32 ± 13.8) (P > 0.05). However, the posttest mean scores of QOL and SC in the intervention group significantly differed from the control group (66.44 ± 28.41vs. 81.3 ± 38.04 and 125.6 ± 11.23 vs. 102.6 ± 14.34) (P < 0.05). CONCLUSION: HLI-based SC education is effective in significantly improving menopausal women's QOL and SC and can be used to improve health-related outcomes among menopausal women. Clinical trial registration This research was registered (24/03/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200324002.

Motivation for protection in sexual relationship during the COVID-19 quarantine: analysis of the sociodemographic variables of the Iranian population.

BACKGROUND: Coronavirus is an infectious disease that has affected sexual life. Sexual activity has decreased for many people, and couples' physical contact has reduced. The present study aimed to determine the sexual relationship of Iranian people and related factors during the Corona home quarantine by focusing on all constructs of the protective motivation theory. METHODS: This cross-sectional online survey was conducted on Iranian people under in-home quarantine from July to December 2020 during the Covid-19 pandemic. Seven hundred sixteen people were selected by the convenience sampling method. The data was gathered by an ad-hoc tool consisting of demographic information and sexual relationship regarding protection motivation behavior in the Covid-19 pandemic. Participants should be able to complete the online questionnaire because the questionnaires were completed online. One-way ANOVA, independent T, and Pearson correlation tests were used to analyze the data in SPSS 16 software. RESULTS: Findings indicate the average age of the participants was 37.78 + 8.34 years. Most of them were women (%85.1), married (%91.3) and had a university education (%90.2). In addition, %42.5% of participants had Full-time jobs and %34.2 lived in Tehran. 49.9% obtained information about corona from TV. 63.3% of the participants and their spouses did not catch Covid-19. Employment status was the only variable that was significantly different from sexual relationships regarding protection motivation (p = 0.031). Perceived response efficiency with an average of 79.12 had the highest, and perceived self-efficacy with an average of 69.92 had the lowest mean score among the areas of sexual relationship. Among the protection motivation domains of sexual behavior that all had significant correlations, there was no significant correlation between perceived severity and perceived self-efficacy (p = 0.067). CONCLUSION AND IMPLICATION: Perceived vulnerability is associated with employment status, place of residence, and age. Sexual relationships regarding protection motivations are only associated with employment status. Overall, participants in the present study reported high levels of perceived severity, perceived vulnerability, perceived response efficiency, and perceived costs Therefore, they reported a high level of motivation for protective and preventive behaviors in their sexual relationship. Our findings suggest that future interventions should focus on general cognition by developing appropriate knowledge about the severity and vulnerability of Covid-19 and sexual behaviors, improving perceived response efficiency, and self-efficacy of protective behavior through skills training.

Effects of the COVID-19 pandemic on sexual functioning and activity: a systematic review and meta-analysis.

BACKGROUND: Since December 2019, when it was first reported in Wuhan, province of Hubei, China, the new virus SARS-CoV-2 has spread rapidly around the world and has become a global pandemic. During the COVID-19 pandemic, due to the public health measures implemented, people's sexual activity has also been affected. Restrictions on people's activities, reduced sports activities, economic issues, increased psychological stress, and reduced entertainment have, indeed, dramatically impacted sexual activity and functioning. The purpose of this study was tosystematically identify, collect and summarize the existing body of evidence from published studies on the effects of COVID-19 pandemic on sexual activity and functioning. METHODS: Several scholarly databases, namely MEDLINE (via PubMed interface), Web of Science (WOS), Embase, CINAHL, the Cochrane Library, Scopus, and PsycINFO databases, were mined from December 2019 to the end of January 2021. We utilized a random-effect meta-analytical model to analyze all the data. More in detail, the Standardized Mean Difference (SMD) was used in order to estimate and evaluate the effects of the COVID-19 pandemic on sexual activity and functioning. RESULTS: Twenty-one studies were included in the present study. In total, 2454 women and 3765 men were evaluated. In the present meta-analysis, sexual functioning and activity were assessed by means of two standardized and reliable tools, namely the "Female Sexual Function Index" (FSFI) and the "International Index of Erectile Function-5 items" (IIEF-5). A total of 5 studies reported the FSFI score before and after the COVID-19 pandemic in female participants. Based on the random-effect model, the SMD was computed to be - 4.26 [95% confidence interval or CI: - 7.26, - 1.25], being statistically significant. A total of 3 studies reported the IIEF-5 score before and after the COVID-19 pandemic in male participants. Based on the random-effect model, the SMD was computed to be - 0.66 [CI 95%: - 0.99, - 0.33], being statistically significant. In the majority of these studies, participants reported a reduction in the number of sexual relations and an increase in the frequency of solo sex activity, especially masturbation, compared to the time prior to the COVID-19 pandemic. CONCLUSION: The results of the present study showed that COVID-19 related restrictions were correlated with higher rates of sexual dysfunction and reduced sexual activity; however, results of the current meta-analytical study show that this change in sexual functioning was greater in women compared to men. Sex is one of the dimensions of every person's life; therefore, researchers should identify the factors that lead to sexual dysfunction due to COVID-19 pandemic in their community. In this regard, sexologists should design and implement effective programs to reduce the heterogeneous causes affecting sexual functioning, given the psychological strain that the COVID-19 pandemic puts on individuals.

Development of strategies to promote healthy sexuality based on Iranian girls perspective about the role of virginity in the construction of their sexuality: an explanatory sequential mixed method study protocol.

BACKGROUND: The modern Iran is a blend of tradition and modernity, but its dominant culture is still traditional and takes pride in female virginity. On the other hand, the influential factors such as modernity, education, social networks, global communication, influence from advanced Western societies, have obviously led to the emergence of a freer sexual attitude associated with less significance of virginity. Since the traditional, cultural and religious significance of virginity among Iranian girls can shape their sexual behaviors, therefore, the aim of the present study is development of strategies to promote healthy sexuality based on Iranian girls perspective about the role of virginity in the construction of their sexuality. METHODS/DESIGN: This is a two-stage study; an explanatory sequential mixed-methods follow-up design will be employed in the first stage, which consists of two quantitative and qualitative phases. The first phase is the cross-sectional survey that will be conducted on 700 single girls born in the 1970s, 1980s and 1990s. The sample will be selected using the cluster sampling method in the health centers of Tabriz-Iran. The determined sample size will be divided among the selected health centers based on the quota criterion, and eligible households will be selected randomly from the said centers using the SIB website (sib.tbzmed.ac.ir). To collect the required data in the quantitative phase, we will use a researcher-made questionnaire to evaluate the girls' views about virginity and its influential factors, designed based on the theory of "social construction of sexuality". After quantitative data collection and analysis, the findings inform qualitative data collection and analysis. The qualitative phase of the study will be conducted on girls living in Tabriz using in-depth and semi-structured individual interviews and purposive sampling method to collect the required qualitative data. The collected data will be analyzed using the conventional content analysis approach. The findings of two phase will be integrated for further explanation and interpretation to be used in the second stage. In the second phase of this study, a nominal group meeting will be held with the participation of reproductive and sexual health experts. The strategies extracted from the results of the first phase and review the texts in this meeting will be provided to experts and after receiving the opinions and ideas of the relevant group of experts and prioritizing them, appropriate strategies to improve and promote the healthy sexuality of Iranian girls will be presented. DISCUSSION: This study is one of the few studies conducted in the field of sexual health and culture in Iran, that using a "mixed-methods" approach to determine and explain the role of virginity in the construction of the sexuality from the Iranian girls perspective. We hope that this study can present evidence-based documents from the latest physical, psychological and social developments in young Iranian girls' sexuality and that the presented healthy sexuality promotion strategies, which will be based on Iranian socio-cultural developments, can provide the basic information required for policy-making and planning for young girls' sexual health. It is also hoped that the findings of this study will be useful in culture-based sexuality education and support for reproductive and sexual health care for the young Iranian generation.

Stakeholders' perspectives of comprehensive sexuality education in Iranian male adolescences.

BACKGROUND: A coherent sexuality education program for adolescents is part of their sexual and reproductive rights and can help them have a healthier future. Therefore, the aim of this study was to explore the perspectives and intervention preferences of Iranian stakeholders regarding comprehensive sexuality education (CSE) in male adolescents based on the IMB model (information, motivation, behavioral skills). METHODS: This study was a qualitative study that was analyzed through a directed content analysis approach. Individual interviews and focused group discussions (FGDs) were used for data collection. The data were collected through in-depth semi-structured interviews with stakeholders in two schools and the Education Department in Sari and the Ministry of Health and Ministry of Education in Tehran from March 2019 to August 2019. Data saturation was achieved after 28 interviews and 1 FGDs with 9 participants. Finally, two sets of data were coded and analyzed using directed content analysis. RESULTS: In this study, five themes emerged as (1) role of institutions; (2) role of organizations; (3) need for stakeholder's partnership; (4) need for adolescent sexuality socialization management; and (5) need for enhancing the teachers' professional competence, which seemed to influence the implementation of CSE in male adolescents. Participants also expressed a number of intervention preferences for CSE. The most important of these was the change in macro policies, helping to create a culture against all forms of violence and breaking the taboo of sexuality education for children and adolescents. CONCLUSIONS: The results of this study revealed the need for a CSE program for adolescents' sexuality socialization. The finding showed that teachers required training to enhance their professional competence about sexuality issues. Therefore, it is necessary to design and implement culture-appropriate skill based programs to enhance the teachers' professional competence regarding the adolescents' sexual health.

Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul-Afghanistan.

BACKGROUND: To determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan. METHODS: An observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH. RESULTS: Among the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%). CONCLUSIONS: According to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.

A mobile-based educational intervention on sexo-marital life in Iranian men with spinal cord injury: a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVE: To assess the effectiveness of a mobile-based educational intervention on sexo-marital life in Iranian men with spinal cord injury (SCI). SETTING: Foundation of Martyrs and Veterans Affairs', "Spinal Cord Injury Association", and the "Protection Center of Spinal Cord Disables". METHODS: Participants were men with SCI aged at least 18 years old. The effectiveness of a mobile App was evaluated on 70 married men with SCI. Sexual adjustment, sexual satisfaction, marital adjustment, and marital satisfaction were assessed by valid and reliable questionnaires at baseline, 4 and 8 weeks after the intervention. RESULTS: The between-group mean difference (95% CI) of sexual adjustment (4.2, CI: 3.6-4.8) after 4 weeks as well as 8 weeks (8.6, CI: 7.6-9.5) after baseline was significant (P < 0.001). The between-group mean difference (95% CI) of sexual satisfaction (6.9, CI: 8-11.2) after 4 weeks as well as 8 weeks (16.4, CI: 14.1-18.7) after baseline was significant (P < 0.001). There were significant increases in all the domains of marital satisfaction's between-group mean differences after 4 weeks as well as 8 weeks after baseline (P < 0.001). Repeated measures ANOVA showed there was no statistically significant increase in marital adjustment's between-group mean difference (95% CI) after 4 weeks (-0.1, CI: -0.1- 0, P < 0.16) as well as 8 weeks (0.4, CI: -0.3-1.1, P < 0.25) after baseline. CONCLUSION: The application-based educational intervention showed the positive effect of education on sexo-marital life in men with SCI. We recommend the rehabilitation team's healthcare providers embrace this educational strategy for individuals with SCI.

Concerns and educational needs of Iranian parents regarding the sexual health of their male adolescents: a qualitative study.

BACKGROUND: Parents play an important role in promoting the sexual health of their adolescents. However, many parents experience several challenges. The purpose of this study was to explore the concerns and educational needs of Iranian parents regarding the sexual health of their male adolescents. METHODS: This qualitative study was designed based on the conventional content analysis approach. Semi-structured and in-depth interviews were conducted with 16 parents of male adolescents aged 12-18 years. All interviews were audio recorded and transcribed verbatim. The data were collected through purposeful sampling and continued until data saturation. Finally, the Graneheim and Landman strategies were used to analyze data. RESULTS: According to the participants' comments, four main categories were extracted as follows: fear of emotional and sexual harms, quality of parent-child relationships, effect of media and cyberspace, and necessity of sexuality health education. CONCLUSIONS: The findings highlighted the need for sexuality health education through cooperation with schools for offering appropriate education to the students, parents, and school staffs. The results showed that parents required training to enhance their knowledge and skills to improve their communication with their adolescents about sexuality issues. Therefore, it is necessary to design, implement, and evaluate culture-appropriate educational programs to address the parents' concerns regarding adolescents' sexual health.

The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial.

BACKGROUND: Considering different dimensions of life, special sex life for survivors of breast cancer (BC) is important because their life expectancy has increased. OBJECTIVE: We designed this study to improve the sexual function, satisfaction and quality of sexual life. METHODS: In a randomized controlled clinical trial study, from a total 286 breast cancer survivors (BCS), 118 women enrolled to the study. After providing informed consent, the participants were randomly assigned either to the intervention group or to the waitlist control group. The intervention consisted of six weekly psychosexual counseling sessions that lasted from 90 to 120 min. Data were collected by the demographic and clinical forms, Beck Depression Inventory, Female Sexual Function Index (FSFI), Larson Sexual Satisfaction Questionnaire and sexual quality of life-female (SQOL-F) questionnaire. RESULTS: Mean age of patients in control and intervention groups were 43.8 ± 6.6 and 44.84 ± 6.7, respectively. More than 65% of the patients in the both groups were either normal or showed a low level of depression. Sexual function (FSFI) scores and sexual quality of life (SQOL-F), showed a significant statistic differences after intervention (P < 0.001 in both tools). Sexual satisfaction (Larson) has showed improvement in some subclasses, however, change in total score was not statistically significant (P = 0.073). CONCLUSIONS: The psychosexual intervention program was effective in improving sexual function and quality of sexual life among BCS. This intervention has clinical significance as it provided an opportunity for the women to discuss their sexual issues.

Effect of the EX-PLISSIT model on sexual function and sexual quality of life among women after hysterectomy: a randomised controlled trial.

Background After hysterectomy, most patients experience psychological problems and sexual dysfunction that can affect their sexual quality of life (QOL). This study determined the effects of counselling based on the Extended Permission-Limited Information-Specific Suggestion-Intensive Therapy (EX-PLISSIT) model on sexual function and sexual QOL after hysterectomy among women attending hospitals in Sari, northern Iran. METHODS: A randomised controlled trial was conducted between 2016 and 2017. Of 354 women undergoing hysterectomy, 80 women without anxiety, stress or depression who showed signs of sexual dysfunction were selected and, using blocked randomisation, were assigned to the intervention and control groups. The intervention group received two 1-h counselling sessions each week based on the EX-PLISSIT model. The control group received no counselling. Mood and sexual function and quality of life were measured using established tools (i.e. Depression, Anxiety and Stress Scale, Female Sexual Function Index (FSFI), and the Sexual Quality of Life - Female (SQOL-F)). Eight weeks after completion of counselling, outcomes were compared between the intervention and control groups using independent t-tests and Chi-squared, Mann-Whitney U, Wilcoxon, and Fisher tests. RESULTS: There were no significant differences between the two groups in terms of demographics and most other outcome variables. However, there were significant differences between the intervention and control groups in terms of sexual functioning (median (interquartile range (IQR) FSFI score 32.45 (28.47-33.52) vs 23.85 (20.52-26.45) respectively) and sexual quality of life (median (IQR) SQOL-F score 107.50 (91-108) vs 87 (62.75-96.25), respectively) at the 8-week follow-up (P < 0.001 for both). CONCLUSION: Use of the EX-PLISSIT model is recommended to sexual health care professionals.