Predictors of social intermediate factors associated with sexual quality of life of women: systematic review and meta-analysis.

BACKGROUND: Sexual problems and diminished sexual quality of life can adversely affect the physical, psychological, and emotional health of women. The present study was done to determine the social intermediate factors of health associated with sexual quality of life in women of reproductive age. DESIGN: Systematic review and Meta-analysis. DATA SOURCES: Embase, Web of Science, PubMed/Medline (NLM), ProQuest, and CENTRAL. ELIGIBILITY CRITERIA: Observational studies (cross-sectional, case-control, cohort) from 2010 to 2022 with no language constraints were included. The sexual quality of life, as the main variable of the study, has been evaluated using Symonds women's sexual quality of life scale (SQOL-F). The health social determinants intermediate factors based on WHO model were considered as exposure variables. DATA EXTRACTION AND SYNTHESIS: The data of included studies were extracted by two independent persons through a researcher-made checklist according to the study aims. Quality assessment of studies was done using Newcastle-Ottawa instrument. R software (Version R-4.2.1) were used for meta-analysis. Publication bias was evaluated by Egger & Begg tests. Sensitivity analysis was done through one-out remove approach. RESULTS: Eventually, 15 studies were eligible to be included in this systematic review and meta-analysis. Variables of depression, quality of marital relation, body image, self-esteem, physical activity, and sexual function were among the health social intermediate factors associated with sexual quality of life. Publication bias had no effect on the obtained results; no study affecting the results was found through sensitivity analysis. CONCLUSION: Considering the relationship between modifiable factors and sexual quality of life, it seems that identification of these factors can be an important step towards designing interventional studies to help women experience enhanced sexual quality of life.

Sexual function among women with vaginismus: a biopsychosocial approach.

BACKGROUND: Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder. AIM: The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model. METHODS: This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus. OUTCOMES: Participants rated their determinants of sexual function based on the biopsychosocial model. RESULTS: The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit. CLINICAL IMPLICATIONS: This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem. STRENGTHS AND LIMITATIONS: This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic. CONCLUSION: Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.

Adolescents' polycystic ovary syndrome health-related quality of life questionnaire (APQ-20): development and psychometric properties.

Several health-related quality of life (HRQOL) questionnaires for adults with polycystic ovary syndrome (PCOS) have been developed so far. However, an adolescent-specific HRQOL questionnaire for PCOS patients is still lacking. Hence, this study aimed to develop and validate a questionnaire to assess HRQOL in adolescents with PCOS. This mixed-method study was conducted in Tehran, Iran, from 2018 to 2020. The qualitative phase was conducted on 18 target participants, and in the quantitative phase, exploratory factor analysis (EFA) was performed on 200 adolescents with PCOS and confirmatory factor analyses (CFA) on the other 200 ones. The item-developing process was finalized with 77 questions. Concerning the optimum cutoff of content validity ratio, content validity index, kappa statistic coefficient, and item impact score, a draft with 55 items was finalized. Then, piloting scale was performed on 40 participants and considering the interitem correlation < 0.3, fifteen items were excluded. Based on the EFA, 20 items in six components (emotion and mood, loss of attractiveness due to the hirsutism, loss of attractiveness due to the acne, self-care, support, and menstrual cycle problem) that explain 60.3% of the variance were extracted. The CFA with acceptable values of goodness-of-fit statistics supports this construct validity. Results of reliability, floor, and ceiling effect were acceptable.  Conclusion: Our study showed that the short questionnaire of APQ-20 is valid and reliable for assessment of the HRQOL of adolescents with PCOS. Further studies are needed to assess the feasibility and reliability of APQ-20 for assessing the HRQOL of adolescents with PCOS. It constitutes a significant step forward in the measurement of HRQOL of adolescents with PCOS. What is Known: • There is no disease-specific questionnaire for assessment of the health-related quality of life (HRQOL) of adolescents with polycystic ovary syndrome (PCOS). What is New: • The short questionnaire of APQ-20 is easy to use, valid, and reliable for the assessment of the HRQOL of adolescents with PCOS. • APQ-20 constitutes a significant step forward in the measurement of HRQOL of adolescents with PCOS.

The relationship between social determinants of health and postpartum weight retention based on the World Health Organization model: path analysis.

BACKGROUND: Postpartum weight retention (PPWR) causes obesity, chronic diseases, and occurring adverse maternal-fetal and neonatal outcomes. Given the social factors' effect on health and disease and considering the lack of information on social determinants of health (SDH) effects on PPWR, this study was conducted to survey the relationship between SDH and PPWR based on the World Health Organization (WHO) model. METHODS: A cross-sectional study was performed on 400 women six months after delivery in 2020. Twelve health centers were randomly selected from the three universities of Medical Sciences in the city of Tehran, Iran. Participants were selected by convenience method and based on eligibility. Questionnaires used included: Lifestyle Profile Health Promoting II, Short Form Postpartum Quality of Life Questionnaire, Multidimensional Scale of Perceived Social Support, Postpartum Social Support, Depression Anxiety Stress Scales, and questionnaires designed by reviewing the literature about breastfeeding, sleep, contraceptive, child health, unhealthy behaviors, postpartum nutritional awareness/beliefs, body satisfaction, access to postpartum care, socioeconomic status, demographic, and obstetric questionnaire. Data analysis was performed in SPSS-23, and the relationship model was examined using the path analysis method in LISREL-8.8. RESULTS: Path analysis indicated the direct effect of six intermediate factors on PPWR including: gestational weight gain (ß = 0.42), access to postpartum care (ß = 0.11), postpartum nutritional awareness/beliefs (ß=-0.17), anxiety (ß = 0.09), sleep duration (ß=-0.09), pre-pregnancy body mass index (ß = 0.09). Among the structural factors, woman's education and socioeconomic status had an indirect negative effect on PPWR. The model fit indices showed good fit (RMSE = 0/05, GFI = 0.92, CFI = 0.92, χ2/df = 2.17). CONCLUSION: The results indicate the effect of structural and intermediate determinants of health on PPWR. It is recommended to use the proposed model as an appropriate framework in the research, design, and implementation of programs to prevent and control PPWR.

Polycystic ovary syndrome and body image concerns during adolescence.

PURPOSE: This study aimed to compare body image concerns in adolescents with and without PCOS. DESIGN AND METHODS: This cross-sectional study included 1076 adolescents, including 344 with PCOS and 732 without PCOS. The participants were asked to complete a comprehensive questionnaire that included demographic and reproductive parameters and the body image concerns inventory (BICI) which comprised two factors (1-dissatisfaction and embarrassment about one's appearance and 2-social function due to appearance concerns). Linear regression analysis was conducted to evaluate the effect of hyperandrogenism and/or abnormal uterine bleeding (AUB) and/or obesity on BICI and its domains both before and after adjustment for potential confounders. RESULTS: The result showed that adolescents with PCOS had a worse total BICI score and its domains (p < 0.05). In multivariable-adjusted regression models, adolescents with PCOS were more likely to have a high body image concern (ß = 0.05, P < 0.001), while those with high household income were less likely to have body image concern (ß = -0.08, P = 0.004). Considering hyperandrogenism status, those with high household income were also less likely to have high body image concern (ß = -0.08, P = 0.004), and age of menarche (ß = -0.01, P = 0.013) were also inversely associated with total BICI score. Likewise, considering obese status, only high household income (ß = -0.08, P = 0.004) was inversely associated with total BICI score. Also, considering menstrual irregularity status, high household income (ß = -0.08, P = 0.005), and age of menarche (ß = -0.01, P = 0.01) were inversely associated with the total BICI score. CONCLUSION: Adolescents with PCOS had higher body image concerns. Apart from the being PCOS label, abnormal uterine bleeding was also a predictor of body image concern. PRACTICAL IMPLICATIONS: Clinicians should pay attention to the greater influence of the PCOS label on altered body image in adolescents.

Predictors of the relationship between the duration of cancer and care time with the supportive care needs of patients and the quality of life of their caregivers: a path analysis.

BACKGROUND: Breast cancer (BC) patients face various physical and psychological challenges. The mutual impacts of patients and caregivers on each other show the need for further supportive care from the community and family. This study aimed to identify the predictors of the direct and indirect relationships of the duration of cancer (CANCERT) and care time (CARET) with the supportive care needs (SCN) of the patients and the quality of life (QOL) of their family caregivers. METHODS: This descriptive study included 150 patients and their caregivers in Iran. Data were collected using the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Caregiver Quality of Life Index-Cancer (CQOLC) scale, and a socio-demographic checklist. The data were then analyzed in SPSS-24 and Lisrel-8.8 software using descriptive statistics and path analysis. RESULTS: The mean age of the patients and caregivers was 45.76 ± 10.44 and 43.46 ± 9.5, respectively. The majority of patients (96%) were in stages II and III of the disease. There was no statistically significant relationship between cancer stages with SCN of the patients and also caregivers' QOL (P > 0.05). Based on the test results, the CANCERT was positively correlated with the patients' care and support needs (SN) in total effect (ß = 0.24). The patients' sexuality needs had the highest negative correlation with their CANCERT in the direct path (ß = - 0.27) and had the highest negative correlation with psychological needs in the indirect path (ß = - 0.174). The CARET (hours per day) had positive correlation with health systems and information needs in both the direct (ß = 0.26) and indirect paths (ß = 0.15). The highest positive correlation with physical needs was in the direct path (ß = 0.34). The caregivers' QOL had a negative and direct relationship with the CANCERT (ß = - 0.19), and there was a positive and direct relationship between CARET and the caregivers' QOL (ß = 0.18). CONCLUSIONS: The correlations obtained from this study are not necessarily strong, yet they are important and should be noticed and tested in the future studies. The present findings reveal the need to provide comprehensive care, planning to provide supportive care, and counseling to both BC patients and their family caregivers, especially when the duration of the disease is prolonged.

Development and psychometric assessment of the sexual-reproductive health profile of women with type-1 diabetes mellitus.

BACKGROUND: To improve the sexual-reproductive health (SRH) of women with type-1 diabetes mellitus (T1DM), plans should be formulated on the basis of the existing situation. The situation can be examined by a valid tool conforming to the specific domains of SRH in the target group. The present study seeks to develop and assess the psychometric properties of the SRH Profile of Women with T1DM. METHOD: Based on the extracted concepts of SRH Profile of Women with T1DM in a previously conducted study, a tool was designed using the following steps: The selection of the conceptual model, explaining the objectives, designing the roadmap and development of the tool. In the psychometric assessment phase, the content, face and construct validity (convergent validity and principal component analysis) were assessed with the participation of 365 married women of reproductive age with T1DM. The reliability of the tool was determined by the internal consistency method (Cronbach's alpha) and its stability using the test-retest method (Intraclass Correlation Coefficients). RESULTS: The SRH Profile of Women with T1DM was formed with 53 items in two sections. Twenty-six items were about safe motherhood and reproductive system; 27 items were about the three components of concerns about the reproductive system health and function, sexual health and function, and violence related to T1DM. The three components in the second section explained 49.44% of the total variance. Cronbach's alpha was 0.872 and the total intra-cluster correlation coefficient was 0.946. CONCLUSION: SRH Profile of Women with T1DM is a valid, reliable, and specific tool for assessing sexual-reproductive health in women with type-1 diabetes mellitus.

Psychometric properties of the Persian translation of maternal postpartum quality of life questionnaire (MAPP-QOL).

BACKGROUND AND OBJECTIVE: Many studies have been conducted in Iran on the postpartum quality of life, and the majority have used the general quality of life questionnaire. With a specific tool in this context, the dimensions of maternal postpartum quality of life can be more accurately determined. The present study was conducted to determine psychometric properties and validate the Persian version of the Maternal Postpartum Quality of Life Questionnaire (MAPP-QOL). MATERIALS AND METHODS: The present methodological study was conducted in 2018. The original version of MAPP-QOL was translated into Persian by both forward and backward translation. In a cross-sectional study, the Persian version was completed by 407 eligible postpartum women aged 18 to 47 and living in Tehran. Reliability of the questionnaire was assessed using Cronbach's alpha coefficient and test-retest. For construct validity, exploratory and confirmatory factor analyses were used. RESULTS: The MAPP-QOL showed good content validity; content validity ratio (CVR) ranged from 0.6 to 1.00, and content validity index (CVI) ranged from 0.7 to 1.00. Using exploratory factor analysis, five factors, including Socioeconomic; Relational/Family-Friends; Psychological/Baby; Health & functioning; and Relational/Spouse-Partner, were extracted, which together explained 78.84% of the total variance. After modifications of CFA, the confirmatory factor analysis showed an acceptable goodness-of-fit. AVE value Above 0.5 exhibited appropriate convergent validity, and AVE greater than MSV confirmed divergent validity. The Cronbach's alpha, McDonald's Omega, Composite reliability and maximum reliability H of the five extracted factors were excellent (> 0.9). Also, the AIC values of the factors were good (between 0.721 to 0.859). CONCLUSION: The 38-item Persian version of the postpartum quality of life questionnaire is adequately reliable for postpartum women in Iran. Given its appropriate psychometric properties, this scale is fit to be used in future studies on postpartum women.

The effect of sexual health education on sexual activity, sexual quality of life, and sexual violence in pregnancy: a prospective randomized controlled trial.

BACKGROUND: Some women avoid sexual intercourse during pregnancy due to the physiological changes they undergo during this period as well as their fear of causing harm to the fetus and to themselves, which can lead to problems in sexual health. The aim of the present study was to investigate the effects of a sexual health education package on the dimensions of sexual health in pregnant women. METHODS: This randomized, longitudinal, clinical trial was carried out in 2018-2019 on 154 pregnant women in early to late pregnancy who presented to comprehensive health centers in Rasht, Iran, and were divided into three groups: Group A or the training group (50 participants), Group B or the self-training group (53 participants), and Group C or the control group (51 participants). The study tools included the Pregnancy Sexual Response Inventory (PSRI), the Sexual Quality of Life-Female (SQOL-F) and the Sexual Violence Questionnaire. The dimensions of sexual health were examined before beginning each intervention in each trimester of pregnancy and then at the end of pregnancy using these questionnaires. The collected data were analyzed using statistical tests, namely the Chi-square test, one-way ANOVA, Cochrane's test, and the repeated measures ANOVA at a significance level of P < 0.05. RESULTS: There was no statistically significant difference in the mean total scores of SQOL-F and PSRI in the three groups at baseline. As for the intergroup results, there was a statistically significant difference in the mean score of SQOL-F and PSRI at the end of pregnancy. The mean scores of PSRI and SQOL-F in the training group (Group A) increased from the beginning to the end of pregnancy compared to the control and self-training groups. As for the intergroup comparisons, there was no statistically significant difference in the mean total scores of sexual violence among the pregnant women in the different groups in the third trimester of pregnancy and at the end of the third trimester. Although sexual violence was not statistically significant, the number of sexually-violated women in the training group decreased during the training period compared to the self-training and control groups. CONCLUSION: The results obtained in the intervention group compared to the control group revealed the effectiveness of the sexual health education package in terms of improvement in the dimensions of sexual health. According to the results, in order to maintain and promote the sexual health of pregnant women, health care providers are recommended to offer sexual health training during pregnancy along with other health care services. TRIAL REGISTRATION: IRCT20190427043398N1 ; the trial was registered on June 2, 2019. (retrospective registration).

The effect of PLISSIT based counseling model on sexual function, quality of life, and sexual distress in women surviving breast cancer: a single-group pretest-posttest trial.

BACKGROUND: Diagnosis and treatment of breast cancer potentially leads to sexual dysfunction and sexual distress in women and negatively affects their quality of life (QoL). This study aimed at determining the effect of PLISSIT based counseling on sexual function, sexual distress, and QoL in women surviving breast cancer. METHODS: In this pre-test, post-test, single-group semi-experimental study, 65 women surviving breast cancer who were referred to the selected centers were included in the study via the available sampling method. Data gathering tools included a researcher-made demographic questionnaire, female sexual function index, beck depression inventory-II, State-Trait Anxiety Inventory, World Health Organization QoL-Brief, and Female Sexual Distress Scale-Revised. The counseling program (7 sessions 60 min each) was designed based on the PLISSIT model. The sexual function, sexual distress, and QoL were evaluated before, and 2 and 4 weeks after the intervention. To compare the mean scores of variables before and after the intervention, repeated-measured ANOVA was used. RESULTS: The findings showed that PLISSIT based counseling significantly reduced sexual distress and increased the scores of QoL and all its domains, as well as sexual function and all its domains in women surviving breast cancer (p < 0.05). There was no significant difference in the mean scores of variables 2 and 4 weeks after the intervention. CONCLUSIONS: It seems that PLISSIT based counseling reduces sexual dysfunction and sexual distress and improves the QoL of women surviving breast cancer. So, it is recommended that these counseling programs be integrated into the health care program of this group of women. TRIAL REGISTRATION: TCTR202103170010, 17 March 2021, Retrospectively registered, at https://www.thaiclinicaltrials.org/ .

Bio-psychosocial factor of vaginismus in Iranian women.

BACKGROUND AND AIM: Various physical, psychological, social and cultural factors contribute to vaginismus. Therefore, given the multidimensionality of this disorder and the need to pay more attention to all biological, psychological and social dimensions in its treatment, the present study was conducted to investigate the bio-psychological factors contributing to vaginismus. METHODS: This descriptive cross-sectional study was conducted on 180 Iranian women with vaginismus who had been referred to sexual health clinics of Tehran province in 2020. Multistage random sampling method was used in this study, and vaginismus was diagnosed in women by a specialist through using a questionnaire. Data collection tools included demographic and obstetric information form, valid and reliable Sexual Function Questionnaire, Depression Anxiety Stress Scales (DASS), Sex Fear Questionnaire, Vaginal Penetration Cognition Questionnaire, Sexual Self-Efficacy Scale, Sexual Knowledge and Attitude Scale, Sexual Quality of Life-Female, Inventory of Sexual Satisfaction, ENRICH Marital Satisfaction Scale, Sexual Intimacy Scale and Questionnaire for Diagnosis of Vaginismus. In order to determine the factors related to vaginismus, multiple linear regression model was used through SPSS software version 25 (SPSS Inc., Chicago, IL). RESULTS: Based on the results of the present study, the mean age of women and the mean duration of their marriage were 27.77 ± 5.36 and 4.07 ± 3.87 years respectively. As the results of multiple linear regression revealed, the variables of fear of sex (B = 0.141, P = 0.036), positive cognition (B = 0.197, P = 0.046), self-image (B = 0.651, P = 0.001), sexual intimacy (B = -0.116, P = 0.021), quality of sexual life (B = 0.115, P = 0.002) and education (B = 2.129, P = 0.024) from the bio-psychosocial model were the final predictors of vaginismus diagnosis score in women with this disorder. According to the results of multiple linear regression, 45.5% of the variance of vaginismus diagnosis total score was explained by these variables (R = 0.706, R2 = 0.498 and ADJ.R2 = 0.455). CONCLUSION: The results of the present study showed that the variables of fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education were the final predictors of vaginismus diagnosis score. This disorder is, thus, considered to be multidimensional.

As a sexual dysfunction, Vaginismus prevents sexual penetration through involuntary and frequent spasms of the muscles in the one-third of vagina's outer part. Factors such as negative beliefs about sex, cultural factors, fear of pain, injury, bleeding and so forth play significant roles in the prediction of vaginismus. Therefore, given the multidimensionality of vaginismus and the need to pay attention to all biological, psychological and social dimensions in treating it, and since the bio-psychosocial model is a strong framework for the factors contributing to sexual problems whose recognition will lead to the design of multidimensional treatments, the present study was conducted on 180 Iranian women with vaginismus to investigate the bio-psychological factors associated with vaginismus. The present study showed that the fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education from the bio-psychosocial model were the final predictors of vaginismus diagnosis score. Therefore, this model can be used in designing interventions for the treatment of vaginismus, especially in the psychological and interpersonal domains.

Effect of Zingiber officinale Roscoe rhizome (ginger) capsule on postpartum pain: Double-blind randomized clinical trial.

BACKGROUND: Postpartum pain contributes to increased irritability and excessive stress in the mother and consequently may inhibit successful breastfeeding, reduce a mother's ability to take care of her baby, and cause an imperfect mother-baby interaction. Evidence suggests the positive effect of ginger on reduction in uterus-associated pain. The objective of this study is to investigate the effect of ginger capsules on postpartum pain. MATERIALS AND METHODS: The present double-blinded, randomized, placebo-controlled trial was conducted in Mahdiyeh Educational Hospital, Tehran. One hundred and twenty-eight mothers having moderate-to-severe pain following vaginal delivery were included. The participants were divided into two groups (A and B). Interventions were performed every 8 h in 24 h. In the first intervention (2 h after the delivery), Group A received 500 mg of placebo capsules (containing chickpea flour) and Group B received 500 mg of Zintoma (ginger rhizome) capsules. In the second and third interventions, Group A received 250 mg placebo capsules and Group B received 250 mg Zintoma capsules. All participants received 250 mg capsules of mefenamic acid in each intervention in addition to ginger or placebo capsules. The pain severity was measured before and half an hour, an hour, and 2 h after each intervention. Statistical analysis was performed using the SPSS software version. 22. The Chi-square, Fisher's, and t tests and the GEE model were applied to assess the pain severity. RESULTS: The average pain severity was not statistically significant between the groups in the beginning of the intervention (P = 0.623). The mean score of pain significantly decreased within the duration of intervention in both groups (P < 0.001); however, the pain severity was significantly lower in the intervention group as compared to the control group at any point after the intervention (P = 0.006). CONCLUSION: Ginger can be used as an effective remedy for postpartum pain relief.

Prevalence, dimensions, and predictor factors of sexual dysfunction in women of Iran Multiple Sclerosis Society: a cross-sectional study.

BACKGROUND: Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS. METHODS: This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis. RESULTS: Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002). CONCLUSION: According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.

Correction to: The translation and psychometric assessment of the perception of empowerment in midwifery scale: the Persian version.

An amendment to this paper has been published and can be accessed via the original article.

The translation and psychometric assessment of the perception of empowerment in midwifery scale: the Persian version.

BACKGROUND: A major part of midwifery care involves the empowerment of women and their families for the control of factors affecting their health. To this end, midwives should experience their own empowerment first. The present study was conducted to translate and determine the psychometric properties of the Perception of Empowerment in Midwifery Scale among Iranian midwives. METHODS: A total of 380 people participated in this cross-sectional study. A demographic questionnaire and the 22-item Perception of Empowerment in Midwifery Scale were sent to the participants online. The validity of the scale and the analysis of its main components were carried out through exploratory factor analysis with Varimax rotation and confirmatory factor analysis. The reliability of the scale was assessed using the internal consistency method with Cronbach's alpha coefficient, average inter-item correlation (AIC) and McDonald's omega. RESULTS: Seventeen scale items were retained after the exploratory factor analysis, and five factors were extracted, including "effective management", "professional practice", "authority", "advocacy", and "professional informant", with factor loadings ranging from 0.489 to 0.899. The five latent factors explained 53.07% of the overall variance of the scale. The confirmatory factor analysis showed an acceptable goodness of fit. The internal consistency of the scale was confirmed with a Cronbach's alpha above 0.7. CONCLUSION: The Persian version of the Perception of Empowerment in Midwifery Scale with 17 items has adequate reliability for midwives working in Iran. Given its appropriate psychometric properties, this scale is fit to be used among midwives in future studies.

Psychometric properties of the Iranian version of Birth Satisfaction Scale-Revised.

BACKGROUND: The precise measurement of childbirth satisfaction demands a reliable tool specifically designed for maternal care and birth satisfaction. It was designed to measure the degree of women's satisfaction with childbirth. The purpose of the present study was to translate and analyze the psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) in Iranian women. MATERIALS AND METHODS: This is a methodological cross-sectional study. Five health centers in various regions of Kashan were affiliated to Kashan University of Medical Sciences, Kashan, Iran. Two hundred and twelve mothers who were referred to the health centers and had childbirth during the last year were included. The face and content validity were obtained after backward-forward translation of the Iranian version of BSS-R by 12 faculty board members in midwifery and reproductive health fields. The construct validity of the tool was determined using confirmatory factor analysis on 212 women in the postpartum period. The internal consistency and reliability of the tool was evaluated by Cronbach's alpha coefficient and intraclass correlation coefficient (ICC). The collected data were analyzed in SPSS (version 16.0) and EQS 6.1. RESULTS: The result of face and content validity was minor modifications in some words. Confirmatory analysis results indicated that there was an acceptable fit with a three-factor model. Cronbach's alpha was estimated for the whole tool 0.74, and the alpha of the three subscales ranged from 0.698 to 0.801. ICC for determining reliability was 0.77. CONCLUSION: The Iranian version of BSS-R was a reliable and valid tool for assessing the women's satisfaction with their childbirth care.

Effect of Vitamin D Therapy on Sexual Function in Women with Sexual Dysfunction and Vitamin D Deficiency: A Randomized, Double-Blind, Placebo Controlled Clinical Trial.

PURPOSE: We investigated the effect of vitamin D therapy on sexual function in women with low vitamin D levels and sexual dysfunction. MATERIALS AND METHODS: We performed this randomized, double-blind, placebo controlled trial in women 18 to 45 years old with sexual dysfunction, defined as a FSFI (Female Sexual Functioning Index) score less than 26.55, and serum 25[OH]D less than 30 ng/ml. Participants received an intramuscular injection of 300,000 IU cholecalciferol or a placebo at baseline and then after 4 weeks. Sexual function was evaluated with the FSFI at baseline, and 4 and 8 weeks. The serum level of 25[OH]D was measured and depression symptoms were evaluated by the BDI (Beck Depression Inventory) at baseline and 8 weeks. RESULTS: A total of 38 women in each group completed the study. Serum 25[OH]D levels increased only in the cholecalciferol group by a mean ± SD of 14.4 ± 3.2 ng/ml (p <0.001). The FSFI score was higher in the intervention group at study week 4 (19.6 vs 16.3, p = 0.002) and week 8 (25.0 vs 17.1, p <0.001). The BDI score was significantly decreased only in the cholecalciferol group by a mean of -21.0 ± 12.3 (p <0.001). The effect of treatment on sexual function was independent of its effect on depression symptoms. CONCLUSIONS: Vitamin D therapy in women with sexual dysfunction and vitamin D deficiency can improve sexual function. This effect does not seem to be mediated by an improvement in depression symptoms.

Threats to Feminine Identity as the Main Concern of Iranian Adolescents with Polycystic Ovary Syndrome: A Qualitative Study.

PURPOSE: Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder in adolescents; this study seeks to elaborate the main concerns of adolescents with PCOS. DESIGN AND METHODS: This qualitative content analysis was conducted on 15 adolescents with PCOS using purposive sampling in 2018. Semi-structured in-depth interviews were held for data collection, and data saturation occurred when no new data were being obtained. Data were analyzed concurrently with data collection. RESULTS: Fifteen adolescents with PCOS aged 13-19 years were enrolled into the study. Thirteen were single and two were married. The data analysis led to the extraction of "threats to feminine identity" as the main theme of this research, which was then divided into two categories: 1) concerns about attractiveness, with subcategories including fashion-related stress and the loss of physical beauty 2) concerns about femininity, with subcategories including the underlying issues of worrying about future marriage prospects, anxiety about infertility in the future and stress about menstrual abnormalities. CONCLUSION: According to the results of this study, attractiveness and threat to femininity is the main concern of adolescents with PCOS that should be further considered in the management of their treatment. IMPLICATIONS FOR PRACTICE: Understanding the main concerns of adolescents with PCOS can help healthcare professionals better manage this disease in this population subgroup.

Iranian version of Pelvic Girdle Questionnaire: Psychometric properties and cultural adaptation.

BACKGROUND: The Pelvic Girdle Questionnaire (PGQ) is a tool designed to evaluate pain and disability in pregnant women with pelvic girdle pain (PGP). This study was conducted with the aim of translating and determining the psychometric properties of PGQ in pregnant women in Iran. MATERIALS AND METHODS: The present methodological cross-sectional study was conducted on 150 pregnant women living in Tehran in 2017. The original English version of PGQ was translated into Persian version after the permission of the tool designer using the back-translation method. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) methods were used to determine the construct validity, as well as Cronbach's alpha and intraclass correlation coefficient (ICC) to determine the reliability of the questionnaire. RESULTS: The results of factor analysis showed that the study of this scale consists of two extracted subscales as activities and symptoms. EFA and CFA confirmed two factors that determined 70.22% variance. Furthermore, findings showed that high internal consistency with Cronbach's alpha = 0.961, for the total score of instrument and for the factors, ranged from 0.87 to 0.91. Cronbach's alpha symptoms and activities and total were 0.91, 0.87, and 0.87, respectively. ICC of symptoms and activities and total was 0.91 (95% confidence interval [CI]: 0.88-0.93), 0.81 (95% CI: 0.66-0.92), and 0.83 (95% CI: 0.68-0.93), respectively. CONCLUSION: The Persian version of PGP, as a valid and reliable tool, has the potential for studying and evaluating the activity and symptoms of PGP in pregnant women in Iran.

Domestic violence in Iranian infertile women.

BACKGROUND: Millions of men and women suffer from infertility worldwide. In many cultures, infertile women are at risk of social and emotional problems. Infertility may affect the public health in many countries. Domestic violence is the intentional use of physical force, power or threat against oneself, another person or another group or community which leads to injury, death, mental harm, lack of development or deprivation. This study aimed to assess the prevalence of domestic violence against infertile women who referred to the infertility centres of Tehran, Iran in 2011. METHODS: This was cross- sectional descriptive study conducted on 400 infertile women who were selected through convenient sampling method. The questionnaire used in this study included two sections: a demographic section with questions about demographic characteristics of the infertile women and their husbands; and the domestic violence questionnaire with questions about physical, emotional and sexual violence. Data were analysed by SPSS16; descriptive statistics, Spearman's test, t- test, one-way analysis of variance (ANOVA) and logistic regression were used for data analysis. RESULTS: Four hundred women with the average age of 30.50 ± 6.16 years participated in the study; of whom, 34.7% experienced domestic violence physical violence (5.3%), emotional violence (74.3%) and sexual violence (47.3%). Domestic violence was significantly associated with unwanted marriage, number of IVFs, drug abuse, emotional status of the women, smoking and addiction or drug abuse of the spouse, mental and physical diseases of the husband (p< 0.05). CONCLUSION: Many of the current problems in this society, particularly in families are due to the transition of the society from a traditional model to a modern one. The majority of the infertile women experience violence in Iran. Domestic violence against infertile women is a problem that should not be ignored. Clinicians should identify abused women. Providing counseling services to women in infertility treatment centers is suggested to prevent domestic violence against infertile women.