Development and psychometric evaluation of the sexual satisfaction questionnaire for postmenopausal women (PWSSQ): an exploratory mixed method study protocol.

BACKGROUND: The concept of sexual satisfaction in menopausal women is very different from that in premenopausal women, and this difference is due to aging and physical, hormonal, cultural, and psychological changes. Therefore, the first step in discovering methods for assessing sexual satisfaction in postmenopausal women is to develop a measurement instrument. This study was conducted to develop and evaluate the psychometric properties of a sexual satisfaction instrument for postmenopausal women. METHODS: The current study is an exploratory-sequential mixed-methods research project that will be divided into two parts: qualitative and quantitative. Aligned with the primary objective of the research, which is to elucidate the concept of sexual satisfaction in postmenopausal women, the hybrid concept analysis model developed by Schwartz and Kim will be employed. This model comprises three key phases: the theoretical phase, the fieldwork phase, and the final analytical phase. Those who met the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, and menopausal duration were recruited. The conventional content analysis will be carried out following the steps proposed by Graneheim and Lundman. Second, in the quantitative phase, the psychometric properties of the instrument were evaluated, including the content, face and construct validity and reliability via internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument. DISCUSSION: A valid and reliable scale for evaluating the sexual satisfaction of postmenopausal women should be developed, and educational content should be designed to improve the sexual satisfaction of this group of women.

Menopause is a natural event that is accompanied by numerous physical and psychological changes that create a complex period in the life of postmenopausal women. Sexual satisfaction is a component related to human sexuality and is known as the last stage of the sexual response cycle. Sexual satisfaction is defined as the emotional response resulting from the mental evaluation of positive and negative things in a sexual relationship. Sexual satisfaction is one of the important factors of satisfaction in married life. People who have sexual satisfaction have a significantly better quality of life than those who do not have sexual satisfaction. The concept of sexual satisfaction in menopausal women is very different from that in premenopausal women, and this difference is due to aging and physical, hormonal, cultural, and psychological changes. Sexual satisfaction is important for researchers for two reasons. First, sexual satisfaction provides a mechanism through which to assess a relationship partner's performance. Second, sexual satisfaction is a predictor of other aspects of the relationship, such as marital quality and stability. To discuss feelings and discover methods for achieving sexual satisfaction in postmenopausal women, it is necessary to understand the factors affecting sexual satisfaction and dissatisfaction in this group. The existing tools in the field of women's sexual satisfaction are not designed for this age group (menopausal women) and do not have the necessary comprehensiveness and adequacy to assess sexual satisfaction in menopausal women. Therefore, this study will be conducted to develop and evaluate the psychometric properties of the sexual satisfaction of postmenopausal women.

Comparing the effect of sexual counseling based on BETTER and PLISSIT models on sexual assertiveness in women with breast cancer after mastectomy.

BACKGROUND: Sexual changes in breast cancer occur after diagnosis and treatment, including a mastectomy. Sexual assertiveness is an effective factor in sexual satisfaction, which means the ability to convey sexual feelings, beliefs, and thoughts. Given the limited studies on sexual assertiveness in breast cancer and different client participation, this study was conducted to compare the effect of sexual counseling based on two models of PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and BETTER (Bring Up, Explain, Tell, Time, Education, Record) on sexual assertiveness in women after mastectomy. MATERIALS AND METHODS: This quasi-experimental intervention was conducted in 2021 in Mashhad, Iran. Seventy-eight mastectomized women with breast cancer were assigned to the BETTER (n = 39) and PLISSIT (n = 39) groups using permuted block randomization with a block size of 4 and an allocation ratio of 1:1. Both groups received four individual counseling sessions, one week apart. The research tools included a demographic information form and the Hulbert index of sexual assertiveness. Changes in the mean scores of sexual assertiveness between the two groups were evaluated before and four weeks after the intervention, and the mean changes were compared between the groups. Data analysis was conducted using the Kolmogorov-Smirnov test, independent t-test, paired t-test, and Chi-square tests using Statistical Package for the Social Sciences (SPSS) version 25 (P < 0.05). RESULTS: The results of the study showed that before the intervention, there was no significant difference in the score of sexual assertiveness in both groups (P = 0.253). The mean score of sexual assertiveness changes before and after the intervention in the BETTER group (8.07 ± 4.9) was significantly higher than in the PLISSIT group (5.58 ± 4.7) (P < 0.001). CONCLUSION: The results indicated that BETTER sexual counseling was more effective in increasing the sexual assertiveness of mastectomized women than PLISSIT counseling. Due to its simplicity and client-centeredness, this model can be used in breast cancer care programs.

"Family and society empowerment": a content analysis of the needs of Iranian women who experience domestic violence during pregnancy: a qualitative study.

BACKGROUND: Domestic violence threatens maternal physical, psychological and emotional safety. Victim/survivor pregnant women required interventions based on their actual needs with the purpose of reducing domestic violence and its negative consequences. The present study aimed to explore the experiences of victimized Iranian pregnant women and identify their neglected needs. METHODS: This qualitative descriptive study was performed from September 2019 to August 2021 in Mashhad, Iran. Semi-structured interviews with 14 women (8 pregnant and 6 after birth) who were the victims of domestic violence, and 11 key informants with various discipline specialties until the data saturation was achieved. Participants were selected through purposive sampling. Qualitative data were analyzed based on the conventional content analysis adopted by Graneheim & Lundman. FINDINGS: The main theme emerging from the data analysis was "family and society empowerment" that implied the necessity of family, health system, legal, social and inter sectoral empowerment to reduce domestic violence during pregnancy. "Family and society empowerment" was comprised of three categories such as "need to empower couples to reduce domestic violence during pregnancy", "demand for improved health care services", and "need to strengthen inter-sectoral, legal and social supports". CONCLUSION: Victim/survivor pregnant women experienced individual, interpersonal and inter sectoral needs. Family and society empowerment constituted the actual needs of victimized pregnant women. Awareness of policymakers and health system managers of these needs could be the basis for designing a supportive care program according to victim/survivor women's actual needs. In addition to the educational and skill empowerment of couples, it is essential that supportive organizations cooperate with each other to provide integrated and coordinated services to victim/survivor pregnant women and strengthen and facilitate their access to supportive resources.

Prevalence of Polycystic Ovary Syndrome in Iranian Adolescent Girls Based on Adults and Adolescents' Diagnostic Criteria in Mashhad City.

Background: PCOS is a common endocrine disorder of reproductive age with high morbidity that its prevalence ranging from 5.6% to 26%. The aim of this study was to evaluate the prevalence of PCOS in Iranian adolescent girls aged 14-19 years based on adults and adolescents' criteria. Methods: This cross-sectional study was carried out with 650 high school adolescent girls in Mashhad city, north-east of Iran. PCOS was defined as the presence of three or two of the three features including oligo/amenorrhea, clinical or biochemical hyperandrogenism, and polycystic ovaries. Descriptive statistics, chi-square, and t-test were used to analyze the data through SPSS vs 22 (SPSS Inc., USA) and the significance level was set at p≤0.05. Results: The mean age of adolescent girls was 16.73±3.4 years. The prevalence of PCOS using Rotterdam, National Institutes of Health (NIH), Androgen Excess-PCOS Society (AES), European Society of Human Reproduction and Embryology (ESHRE)/American Society for Reproductive Medicine (ASRM) (2012), and Endocrine Society Clinical Practice (2013) criteria was 4.2%, 3.6%, 3.6%, 0.7%, and 3.6%, respectively. Conclusion: The rate for prevalence of PCOS calculated based on Rotterdam, NIH, AES, and Endocrine Society (2013) criteria was higher in comparison to ESHRE/ASRM (2012) criteria. According to the results of our study, in order to prevent overestimation of this syndrome's prevalence in the adolescents due to its overlap with signs of pubertal development, all above-mentioned three criteria should be considered together, which is in line with the recommendations proposed by Carmina et al. and ESHRE/ASRM working group.

'It is a hard decision': a qualitative study of perinatal intimate partner violence disclosure.

BACKGROUND: Perinatal intimate partner violence is a hidden under reported and difficult to identify problem which has negative effects on mother and child. The present study aimed to explore barriers and facilitators of perinatal intimate partner violence disclosure. METHODS: This qualitative study was carried out from October 2019 to January 2021 in Mashhad, Iran. Participants included 23 abused women (11 pregnant and 12 after birth) which were selected via purposive sampling. Semi-structured in-depth interviews and focus group discussion were conducted until the data saturation was achieved. The data analysis was performed based on conventional content analysis adopted by Graneheim & Lundman. RESULTS: The main themes "barriers to disclosure" and "facilitators of disclosure" were emerged as the result of data analysis. Barriers to disclosure included negative disclosure consequences and protection of family privacy. Facilitators of disclosure included maternal self-efficacy, threats to security, and formal and informal supportive networks. CONCLUSIONS: Most abused women did not disclose violence despite routine screening for perinatal intimate partner violence in antenatal care. Recognizing the barriers to and facilitators of violence disclosure play an important role in eliminating barriers, strengthening facilitators, providing effective supportive services for abused women, and reducing perinatal violence. Focus on the barriers to and the facilitators of disclosure will be useful to policymakers, health program planners, and health care providers to identify and manage intimate partner violence, appropriately.

Disclosure of perinatal intimate partner violence is a difficult decision. Several barriers prevent abused pregnant women from disclosing violence. The present study explained barriers and facilitators of perinatal intimate partner violence disclosure. 23 women (11 pregnant and 12 after birth) who experienced perinatal intimate partner violence were interviewed in Mashhad, Iran. The results showed the barriers to disclosure include negative disclosure consequences and protection of family privacy and the facilitators of disclosure include maternal self-efficacy, threats to security, and formal and informal supportive networks. In conclusion eliminating barriers and strengthen facilitators play an important role in providing effective supportive services for abused women and reducing perinatal violence. The result will be useful to policymakers, health program planners, and health care providers for appropriate management of perinatal intimate partner violence.

Women's strategies for managing domestic violence during pregnancy: a qualitative study in Iran.

BACKGROUND: Domestic violence during pregnancy is a severe public health problem. Abused pregnant women are confronted with the threats posed by domestic violence. Pregnancy and protection of the unborn child could affect maternal strategies for managing violence. The purpose of this study was to explore Iranian women's strategies for managing domestic violence during pregnancy. METHODS: This qualitative study was conducted in October 2019 to June 2021 in Mashhad, Iran. Data were collected through individual semi structured interviews with 13 women who experienced perinatal domestic violence, two relatives and 24 related specialists as well as two focus group discussions with attendance of 20 abused mothers until the data saturation was achieved. Data were analyzed by the conventional content analysis approach of Graneheim and Lundman. RESULTS: The main themes "escape strategies" and "situation improvement strategies" were emerged as the result of data analysis. Escape strategies was comprised of three categories including concealment, passive dysfunctional behaviors and neutral behaviors to control maternal emotional distress. Situation improvement strategies was comprised of three categories including active self-regulation, protecting family privacy and help seeking to control violence. CONCLUSION: Understanding the experience of managing domestic violence among pregnant women is essential to design evidence based violence prevention programs, which enable supportive healthcare and social systems to encourage abused mothers to use more effective strategies and seeking help to overcome domestic violence.

Domestic violence during pregnancy threatens the health of the mother and the fetus. Mothers who experience domestic violence often use several strategies to decrease the violence. This study sought women's experiences in managing domestic violence during pregnancy. 13 women who experienced perinatal domestic violence, one daughter, one husband and 24 specialists as well as two focus group discussions with attendance of 20 abused mothers were interviewed in Mashhad in the north east of Iran. The results showed abused mothers used escape strategies and situation improvement strategies for managing domestic violence. Mostly abused mothers used emotion oriented strategies such as escape strategies for managing violence. These strategies included of concealment, passive dysfunctional behaviors and neutral behaviors. Some mothers with regard to individual decision-making and individual abilities tried to improve their situation by active self-regulation, protecting family privacy and help seeking. The results of these various strategies vary from reducing domestic violence to not changing the intensity of the violence or intensifying the perinatal domestic violence. In conclusion: inappropriate strategies against domestic violence could be threatening for fetal and maternal safety and appropriate strategies should be considered in perinatal education. Understanding the experience of managing domestic violence among abused pregnant women is essential to design evidence based domestic violence prevention strategies and programs.

Women's interdependence after hysterectomy: a qualitative study based on Roy adaptation model.

BACKGROUND: Hysterectomy is a difficult process that some women encounter that can affect their interdependence, but its impact on women's Interdependence has received less attention. Therefore, this study aimed to explain women's Interdependence after hysterectomy. METHODS: This qualitative study was performed using a directed content analysis approach in Mashhad (Iran). Thirty women with a history of hysterectomy were included in the study by purposive sampling method. Data were collected from August 2018 to November 2019 using semi-structured interviews based on the interdependence mod of the Roy adaptation model until data saturation. Data analysis was performed using MAXQDA software and the deductive approach of Elo and Kingas (J Adv Nurs 62(1):107-115, 2008. https://doi.org/10.1111/j.1365-2648.2007.04569.x ). RESULTS: Data analysis led to the production of 537 initial codes from participants' experiences. By merging and categorizing them, the theme of "increasing interdependence" emerged, which consists of 2 categories: "Evolution independence and interaction with important people in life" and "Reinforced support system", that include six subcategories. CONCLUSION: After hysterectomy, women not only feel a strong need for support from family members, especially their husbands, they are also seeking support from health care providers and their colleagues. Before the hysterectomy, it is recommended that family members be consulted to ensure the emotional support and care of women after the hysterectomy. It can help the adaptation to hysterectomy.

Squill oil for decreasing dyspareunia and increasing sexual satisfaction in menopausal women: A triple-blind randomized controlled trial.

OBJECTIVE: The present study aimed to investigate the effect of squill oil on dyspareunia and sexual satisfaction in menopausal women. MATERIALS AND METHODS: The present triple-blind randomized two-group controlled trial was conducted on 60 menopausal women (n=30 in placebo group and n=30 in squill oil group) in Mashhad in northeast of Iran in 2019. The Sabbatsberg Sexual Self-Rating Scale and Marinoff dyspareunia scale were the main tools used in this study. The participants were randomly assigned to two groups namely, squill oil group and placebo group and they received the treatments for 4 weeks. Questionnaires were completed before and 4 weeks after the intervention in both groups. Data analysis was performed using SPSS 24 by Mann-Whitney, t-test, and repeated measures ANOVA with a significance level of less than 0.05. RESULTS: The average age in the squill oil group and placebo group were 53.5±2.2 and 51.7±4.5 years, respectively. There was a significant difference (p<0.001) between the two groups in terms of dyspareunia score before (1±3.6 vs 1±3.5) and after intervention (0.7±0.1 vs 1.2±1.2) in two groups.Results of independent t-test indicated that there was a significant difference (p<0.001) between the two groups in terms of sexual satisfaction before (23.4±5.7 vs 23.1±2.8) and after intervention (36.5±5.6 vs 24.8±2.5) in two groups. CONCLUSION: Using squill oil can cause a reduction in painful sexual intercourse and an increase in sexual satisfaction in postmenopausal women.

Iranian Women's Self-concept after Hysterectomy: A Qualitative Study.

BACKGROUND: The loss of female organs leads to profound changes in one's perception of oneself. There is limited information about the impact of hysterectomy on women's self-concept and culture. Therefore, this study was conducted with the aim to deepen our understanding of the self-concept of Iranian women after hysterectomy. MATERIALS AND METHODS: This qualitative study was conducted using directed content analysis approach. The participants included 30 women with a history of hysterectomy who were selected through purposive sampling method. Data were collected from August 2018 to November 2019 using in-depth and semi-structured interviews based on the self-concept mode of the Roy Adaptation Model (RAM) in Mashhad, Iran. Data analysis was performed using the deductive approach of Elo and Kyngäs in MAXQDA software. RESULTS: As a result of the analysis of the interviews, the main category of "incoherent cognition of self-concept" emerged, which included the two generic categories of "heterogeneous feelings toward and imaginations of the body" and "changed self-perception", and five subcategories. CONCLUSIONS: Women's self-concept changed after hysterectomy in both its physical and psychological aspects. Therefore, counseling before and after hysterectomy is recommended to improve women's self-concept after hysterectomy.

Comparing the Effectiveness of Sexual Counseling Based on PLISSITand BETTER Models on Sexual Selfdisclosure in Women with Sexual Problems after Childbirth: A Randomized Trial.

BACKGROUND: Sexual self-disclosure is one of the factors that affect sexual satisfaction. The aim of this study was to assess the efficacy of individual therapy using the Bring up, Explain, Tell, Timing, Educate, and Record (BETTER model) in comparison to individual therapy using the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT model) in terms of increasing sexual self-disclosure in women with sexual problems after childbirth. MATERIALS AND METHODS: This randomized trial was conducted in 2017 in Mashhad, Iran. 80 women with sexual problems within 4 weeks to 6 months after childbirth were randomized into two equal groups and received the interventions in 2 sessions of 60-90 minutes. The research instruments included a demographic questionnaire, the Female Sexual Function Index (FSFI) and Hulbert sexual self-disclosure index. Changes in mean (SD) scores of sexual self-disclosures between groups were assessed before and 4 weeks after the intervention and the results (mean changes) were compared between groups. The data analysis was conducted using independent t-test, paired t-test, Chi-square, analysis of covariance (ANOVA), and Mann-Whitney U test in SPSS (p < 0.05). RESULTS: In the PLISSIT group, the mean (SD) sexual self-disclosure score at baseline was 43.80 (9.50) and after 4 weeks was 51.60 (8.30). In the BETTER group, at baseline and after 4 weeks the mean (SD) sexual self-disclosure score was, respectively, 44.10 (10.30) and 55.60 (8.20) (Z = -2.5, p = 0.013). CONCLUSIONS: The findings confirm the effectiveness of the BETTER counseling model in increasing sexual self-disclosure after childbirth.

Iranian adolescent girls' barriers in accessing sexual and reproductive health information and services: a qualitative study.

INTRODUCTION: Adolescence is a critical period of transition from childhood to adulthood. In today's world, to pass through this period successfully it is necessary to have adequate information and knowledge about sexual and reproductive health (SRH) issues. In Iran, it is crucial that special attention be paid to reproductive health services for adolescents, especially for girls. PURPOSE: This study aimed to explore the views and experiences of adolescent girls and key adults around the barriers to access of Iranian adolescent girls to SRH information and services. METHODS: In this qualitative study, data were gathered through focus groups and semi-structured interviews with 247 adolescent girls and 71 key adults including mothers, teachers, health providers, governmental, nongovernmental and international managers of health programmes, health policymakers, sociologists and clergy in four Iranian cities. Data were coded and categorised using content analysis by MAXQDA10. RESULTS: The main barriers identified were classified in four categories: (1) social and cultural barriers such as taboos; (2) structural and administrative barriers such as inappropriate structure of the health system; (3) political barriers such as lack of an adopted strategy by the government and (4) non-use of religious potential. CONCLUSIONS: Adolescent SRH in Iran should be firmly established as a priority for government leaders and policymakers. They should try to provide those services that are consistent with the community's cultural and religious values for adolescent girls.

Assessing Iranian adolescent girls' needs for sexual and reproductive health information.

PURPOSE: To explore the views and experiences of adolescent girls and key adults regarding the necessity of providing sexual and reproductive health (SRH) information and services for adolescent girls in Iran. METHODS: This was a qualitative study; the data were coded and categorized in content analysis by MAXQDA10 and were gathered through focus groups with adolescent girls and their mothers and semi-structured interviews with school counselors, sociologists, health providers, state and nongovernmental directors of health programs, clergy, and health policy makers in the Iranian cities of Mashhad, Tehran, Shahroud, and Qom. RESULTS: There were six main reasons for the need to provide SRH services for adolescent girls: a lack of adequate knowledge about SRH, easy access to inaccurate information sources, cultural and social changes, increasing risky sexual behaviors among adolescents, religion's emphasis on sex training of children and adolescents, and the existence of cultural taboos. CONCLUSIONS: Most participants confirmed the necessity of providing SRH services for adolescent girls, so instead of talking about provision or non-provision of these services, it is important for policy makers to plan and provide SRH services that can be consistent with cultural and religious values for adolescent girls.

Changes in sexual desire and activity during pregnancy among women in Shahroud, Iran.

OBJECTIVE: To evaluate women's perception of sexual activity during pregnancy in Shahroud, Iran. METHODS: Data were gathered during 4 semi-structured group interviews with 33 pregnant women attending 2 obstetric outpatient clinics of a teaching hospital in Shahroud. The interviewers taped the interviews, coded and categorized their content, and performed a qualitative content analysis. RESULTS: Most women reported a decrease in sexual desire and frequency of intercourse during pregnancy (69.7% and 81.8%, respectively). Sexual desire, however, increased for 18.2% of the women. Some felt that accepting intercourse prevented spousal infidelity, but 65.2% worried that it might cause injury to the fetus. Only 24.2% received information on the advisability of sexual activity during pregnancy from their physicians or midwives, and the other 75.8% sensed that they should discuss the topic with a professional but were not comfortable starting the conversation. CONCLUSION: Along with excessive anxiety, insufficient information is the major reason why sexual intercourse is often considered dangerous, and sometimes avoided, during pregnancy in Iran. Healthcare professionals, especially midwives, should educate and counsel women, and reassure them that intercourse is safe in women with healthy pregnancies.