The Relationship between Body Mass Index, Body Dissatisfaction and Mood Symptoms in Pregnant Women.

Background: High body mass and adiposity during pregnancy can contribute to psychological distress, and body dissatisfaction may be a potential underlying mechanism of this association. Objective. This study aimed to evaluate the mediational role of body dissatisfaction in the relationship between body mass index (BMI) and depressive and anxious symptoms, respectively. Methods: Given the cross-sectional design of this study, two alternative models were investigated, positing that BMI was related to depressive (Model 1a) and anxious symptoms (Model 2a), which, in turn, predicted body dissatisfaction. Seventy-two pregnant women in the third trimester of pregnancy completed the Body Image Disturbance Questionnaire, the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, as well as a demographic form assessing their BMI. Results: As hypothesized, body dissatisfaction mediated the relationship between BMI and psychopathological symptoms. Moreover, the alternative models of reverse mediation were also significant, suggesting that psychopathological symptoms mediated the relationship between BMI and body dissatisfaction. Findings from both the hypothesized and alternative models suggested that, on the one hand, higher distress symptoms associated with body dissatisfaction would result from high BMI and, on the other hand, that body dissatisfaction may result from the effect of BMI on distress symptoms. Conclusions: The present study suggests that body image theory and practice should be implemented by the inclusion of evidence-based clinical interventions for promoting psychological well-being during the antenatal period.

The Short Version of the Italian Maastricht Vital Exhaustion Questionnaire (MVEQ): Psychometric Properties and Relationships with Anxiety, Depression, and Stress in a Community Sample of Older Adults.

Vital Exhaustion (VE) refers to a physical and mental state of excessive fatigue, feelings of demoralization, hopelessness, and increased irritability. The short form of the Maastricht Vital Exhaustion Questionnaire (MVEQ) is a widely used measure to assess VE. Despite its utility is broadly recognized, the validity and reliability of the scale have yet to be examined in the Italian context. The present study aimed to evaluate the psychometric properties of the shortened MVEQ in a community sample of Italian older adults. A total of 722 older adults (Mage = 72.97, SD = 7.71; 60.4% females) completed the MVEQ, as well as other self-report questionnaires assessing anxiety, depression and stress in order to evaluate the criterion-related validity of the scale. A confirmatory factor analysis (CFA) was conducted to examine the original MVEQ latent structure. Internal consistency was assessed through model-based omega coefficient. Test-retest reliability was examined by re-administering the MVEQ after three months to a subsample of 568 participants. Factorial invariance tests across gender were conducted by means of multi-group CFAs. The one-factor model showed an acceptable fit to the data. The MVEQ yielded a reliable total score (ω = 0.822) and showed moderate-to-large correlations with measures of anxiety, depression, and stress (r range 0.30 to 0.75, ps < 0.001). Test-retest reliability was supported by an Intraclass Correlation Coefficient (ICC) of 0.661. Lastly, the scale was factorially invariant across gender. Overall, the MVEQ provided evidence of reliability and criterion-related validity in a sample of Italian older adults and may be useful for both clinical and research practices.

Predicting postpartum depressive symptoms by evaluating self-report autonomic nervous system reactivity during pregnancy.

OBJECTIVE: Altered self-reported autonomic reactivity is associated with worse mental health in the general population. Although dysfunctional changes in ANS during pregnancy have been investigated in relation to depressive symptoms, no studies addressed the relationship between self-report autonomic reactivity during pregnancy and depressive symptoms after the delivery. The present study aimed to assess the impact of prepartum self-reported autonomic reactivity on the development of postpartum depressive symptoms. METHODS: In this longitudinal study, 170 women were assessed during pregnancy (i.e., second or third trimester) and after childbirth (i.e., one month after the delivery). Self-reported autonomic reactivity was assessed through the Body Perception Questionnaire - Short Form that evaluates the autonomic functions related to organs above (i.e., supradiaphragmatic reactivity) and below (i.e., subdiaphragmatic reactivity) the diaphragm. In addition, prepartum and postpartum depressive symptoms were evaluated using the Patient Health Questionnaire - 9. RESULTS: Findings showed that higher prepartum supradiaphragmatic reactivity predicted higher depressive symptoms in the postpartum period (ß = 0.112, p = 0.009) after controlling for prepartum depressive symptomatology and other potential covariates. CONCLUSIONS: Evaluation of self-reported autonomic activity may be a useful tool to identify antenatally women at risk of postpartum depressive symptoms. Future studies are needed to evaluate the effectiveness of interventions aimed at reducing the threat-responsive autonomic reactivity at rest and improving adaptive autonomic regulation to prevent postpartum depression.

The impact of prepartum pandemic-related perceived stress on anxiety symptoms in the postpartum: The role of perceived childbirth experiences.

Postpartum anxiety is a significant component of postpartum maternal distress and is related to adverse outcomes for both the mother and the child. Although previous research reported higher anxiety symptoms in pregnant women during the Covid-19 pandemic, no studies evaluated the negative impact of pandemic-related perceived stress on postpartum anxiety symptomatology over time. This study aimed to examine the impact of prepartum pandemic-related stress on postpartum anxiety and to evaluate the role of subjective labor and delivery experiences on this relationship. A sample of 172 pregnant women completed an online questionnaire evaluating pandemic-related perceived stress and anxiety symptoms in the second or third trimester of pregnancy. In the postpartum, they completed a second questionnaire retrospectively evaluating their childbirth experience and assessing anxiety symptoms in the last two weeks. A mediation analysis was conducted. Prepartum pandemic-related perceived stress was significantly associated with postpartum anxiety symptoms. Moreover, childbirth experiences significantly and partially mediated this relationship. Findings highlighted the importance of evaluating perceived stress levels during pregnancy to prevent negative consequences on postpartum mental health. Clinicians need to foster better management of factors included in the childbirth experience that may potentially trigger or counteract anxiety risk.

A prospective study on body image disturbances during pregnancy and postpartum: the role of cognitive reappraisal.

Background: During pregnancy, body size rapidly modifies over a relatively short period. Literature emphasizes the need to identify the factors that influence body image during peripartum as the extent of women's adaptation to these changes has significant repercussions on both mother's and newborn's health. Emotion regulation strategies (i.e., expressive suppression and cognitive reappraisal) were linked to body image in the general and clinical population, but no studies were conducted in the peripartum. The present study aims to investigate the longitudinal impact of prepartum body image disturbances on postpartum body image disturbances and to evaluate the mediational role of emotional regulation strategies. Methods: A total of 133 pregnant women completed a three-phase longitudinal study. Women answered online questionnaires during the second (T1) and the third (T2) trimesters of pregnancy, and at about 6 months postpartum (T3). Results: Findings indicated that body image disturbances at T1 were a significant predictor of body image disturbances in the postpartum (1 year after the first assessment). Moreover, cognitive reappraisal measured at T2 partially mediated this relationship: body image disturbances in the second trimester of pregnancy were linked to less use of cognitive reappraisal in the third trimester of pregnancy, and this, in turn, was associated with worse body image disturbances at 6 months after birth. Conclusion: Findings of this longitudinal study highlight the importance of assessing body image disturbances during pregnancy to early identify women at risk, and suggest cognitive reappraisal as a possible target intervention.

Longitudinal association between saliva and hair cortisol concentration: A systematic comparison.

Cortisol assays from hair have become increasingly common in psychoneuroendocrinological research as indicators of long-term output relevant to stress and health outcomes. Comparisons of hair cortisol concentration (HCC) with salivary samples have produced mixed findings, and it remains unclear which aspects of the diurnal salivary profile correspond most closely to HCC, and what time intervals between saliva and hair sampling are most relevant, taking the rate of hair growth into account. This longitudinal study aimed to evaluate the correspondence between HCC and parameters of total salivary cortisol output in the morning (CARauc and CARi) and during the rest of the day excluding the early morning period (DAYauc), by systematically studying three time periods - two weeks, four weeks, and six weeks - before hair sampling. At each time period, 54 female university students (mean age: 20.85 ± 1.16 years) provided three saliva cortisol samples on day 1 at 11 am, 3 pm, at bedtime, then two samples the following day on waking and 30 min after awakening. Hair strand collection (1 cm nearest the scalp) took place two weeks after the last saliva sample. Results of multivariable regressions indicate that HCC was consistently associated with DAYauc for all three time periods and with the aggregate DAYauc across days after adjusting for age, body mass index, smoking, oral contraceptive use, hair washing frequency and hair treatments. The strongest associations were found for DAYauc two weeks before hair sampling (ß = 0.578, p < 0.001) and the aggregated DAYauc across all three time periods (ß = 0.596, p < 0.001), although the confidence intervals overlapped those for four and six week analyses. There was no significant association between HCC and either CARauc or CARi. Our study confirms that hair cortisol could be a reliable retrospective biomarker of basal and long-term cortisol output secretion at least up to six weeks earlier. The results contribute to a better understanding of the different associations between HCC and salivary cortisol in the morning and the rest of the day, while also having implications for the use of HCC as an outcome measure in intervention and treatment research.

Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture.

BACKGROUND: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. METHODS: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. RESULTS: In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. CONCLUSION: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. LEVEL OF EVIDENCE: III.

The Transition of Care for Patients with Anorectal Malformations and Hirschsprung Disease: A European Survey.

This study aimed at evaluating how transition of care is currently being organized in the European Reference Networks (ERNs) health care providers (HCPs) in pediatric areas and in the Anorectal Malformation Network (ARM-Net) Consortium hospitals. An online questionnaire was sent to a total of 80 surgeons, members of or affiliated members of three networks: ARM-Net Consortium, ERN eUROGEN, and ERN ERNICA. Complete information were obtained for 45 HCPs, most of which deal with transition and still see a few adult patients (ca. 10%). Gynecological, gastroenterological, urological, colorectal, and continence issues were the major problems described by adult patients to their physicians, and in line with these prevalent complaints, they are referred to the appropriate adult specialists. Forty percent of patients complain about sexual and fertility problems, but the percentage of andrologists and sexologists involved in the caring of adult patients with ARM/Hirschsprung's disease is low, just above 10.9%. Most hospitals deal with transition, but three basic criteria (i.e., presence of: [1] an official written transitional program, [2] a transitional coordinator, and [3] written information on transition to be handled to patients) are jointly met only by six HCPs. According to the responders, the most important issue requiring improvement is the lack of interest and of specific preparation by adult specialists. The overall results of this exploratory survey confirm the need for the development of comprehensive programs for transition in these rare and complex diseases, and identify the hospitals that, in collaboration with the networks, could share best practices in organizing structured transitional pathways and well follow-ups.

Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women.

OBJECTIVES: Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women. DESIGN: 155 pregnant women participated in this longitudinal study. METHODS: Expectant mothers completed a questionnaire and then 2-years after the child's birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined. RESULTS: Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers' intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years. CONCLUSION: Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.

Pre-partum HRV as a predictor of postpartum depression: The potential use of a smartphone application for physiological recordings.

BACKGROUND: This study aimed to investigate the role of a time-domain Heart Rate Variability index (the root mean square of successive difference between NN intervals, rMSSD) as a predictor of the onset of postpartum depression. HRV has been related to an increased risk of depression in the general population. However, its role in pregnant women is not clear, and the potential use of smartphone applications to evaluate HRV in this population has not been investigated. METHODS: In study 1, simultaneous electrocardiogram and smartphone photoplethysmography were collected. The rMSSD was determined from each recording to evaluate the accuracy of a smartphone application in the measurement of HRV. In study 2, 135 pregnant women provided rMSSD values measured through a smartphone application in the prepartum (second or third trimester) and filled in the Edinburgh Postnatal Depression Scale in the postpartum (one month after the childbirth). RESULTS: Study 1 showed the excellent accuracy of the smartphone application in the measurement of rMSSD. Study 2 indicated that lower prepartum rMSSD predicted higher depressive symptoms in the postpartum (ß = -0.217, p = 0.010) after controlling for prepartum depressive symptoms and other potential covariates. LIMITATIONS: Artefacts (e.g., hand movements) might have corrupted the physiological signal registered. CONCLUSION: This study showed that a reduced vagal tone, indexed by lower rMSSD, during pregnancy was a predictor of depressive symptoms one month after childbirth. The prepartum period may offer an important timeframe to implement preventive intervention on vagal modulation in order to prevent depressive symptoms in the postpartum.

The Impact of Positivity and Parochial Altruism on Protective Behaviours during the First COVID-19 Lockdown in Italy.

Implementation of COVID-19 protective behaviours, such as social distancing or frequent hand washing during the lockdown, was critical to prevent the spread of the COVID-19 pandemic. In this cross-sectional study, we examined the effect of positivity and parochial altruism on implementing COVID-19 health-protective behaviours during the Italian lockdown. A sample of 460 participants completed an online questionnaire that included demographic measures, Positivity Scale and COVID-19 measures of health-protective behaviours. To measure parochial altruism, we used a hypothetical dictator game played with others who could vary in their social distance from the participants. Results showed that participants in the hypothetical game gave more money to parents and siblings than to best friends, cousins, neighbours, and strangers. Furthermore, both positivity and parochial altruism (more altruism toward close vs. distant people) were positively associated with implementing hygiene behaviours but not with social distancing. Finally, mediation analysis showed that increases in parochial altruism mediated the effect of positivity on hygiene behaviour. These findings extend knowledge about the factors beyond the implementation of COVID-19 health-protective behaviours during a lockdown situation.

Body image dissatisfaction and interoceptive sensibility significantly predict postpartum depressive symptoms.

BACKGROUND: During pregnancy women experience rapid and unique changes in body weight, shape and size over a relatively short time period. While research focused on the role of external bodily modifications during pregnancy, research on internal bodily variations is missing. METHODS: In a longitudinal study, we recruited healthy pregnant women and measured whether and how depressive symptoms, body image dissatisfaction and the subjective tendency to focus on one's own internal bodily sensations, i.e., interoceptive sensibility, changed during pregnancy and postpartum. Pregnant women filled online self-report questionnaires during pregnancy (i.e. second and third trimester) and after (i.e. six weeks) the delivery, including the Body Areas Satisfaction Scale, the Multidimensional Assessment of Interoceptive Awareness, and the Edinburgh Postnatal Depression Scale. RESULTS: While depressive symptoms remained stable in the peripartum, body image dissatisfaction increased in the postpartum compared to the pregnancy period, and interoceptive sensibility increased over pregnancy. Findings showed that the increase of body dissatisfaction through the peripartum and the levels of interoceptive sensibility in the early phase of pregnancy predicted depressive symptoms in the postpartum. LIMITATIONS: Interoception was evaluated as a subjective measure (i.e., interoceptive sensibility). Future studies may include objective measures of interoceptive accuracy and interoceptive awareness. CONCLUSIONS: The current study supports the importance of body image dissatisfaction and interoceptive sensibility in the development of postpartum depressive symptoms. Future studies need to investigate if interventions aimed to increase interoceptive sensibility might be useful in preventing depressive symptoms and identify the mechanisms that can lead to these changes.

Predictors of protective behaviours during the Italian Covid-19 pandemic: an application of protection motivation theory.

OBJECTIVE: The study investigated whether Protection Motivation Theory (PMT) constructs predicted recommended protective behaviours soon after the Italian lockdown and 1-year later. DESIGN: A three-wave longitudinal design was used. Three-hundred-fifty-two adults completed online questionnaires with PMT and intention measures assessed during the Italian lockdown (T1), and behaviour measures assessed after 1-month (T2) and 1-year (T3). OUTCOME MEASURES: Intentions to adopt behaviours (T1) and behaviour adherence at T2 and T3. RESULTS: From T2 to T3, participants reported less adoption of distance behaviours, but higher face masks use. In SEM models, self-efficacy and perceived severity were the strongest predictors of intentions to engage in protective behaviours. Intentions (ß = 0.490, p < 0.001) and fear arousal (ß = 0.134 p = 0.035) predicted protective behaviours at T2. Intentions (ß = 0.302, p = 0.001) and perceived severity (ß = 0.431, p < 0.001) predicted protective behaviours at T3. CONCLUSION: To increase intentions, intervention should highlight the severity of getting infected and target perceptions of one's ability to perform the protective behaviours. In addition, interventions should consider that at the beginning of the pandemic, fear predicted the adoption of preventive behaviours while perceived severity of the disease had a greater impact over time.

Determinants of the intention to donate umbilical cord blood in pregnant women.

BACKGROUND AND OBJECTIVES: Umbilical cord blood (UCB) donation is a behaviour promoted by many countries' health systems. However, UCB donation is not a widespread behaviour among expectant mothers, and little is known about the reasons that may lead to it. The aim of the present study was to analyse the contribution of Theory of Planned Behaviour (TPB) variables among both primiparous and multiparous women in predicting intention to donate UCB. MATERIALS AND METHODS: Three hundred seventy-six expectant mothers completed questionnaires that captured sociodemographic data, parity, previous donation, attitudes, subjective norms, perceived behavioural control (PBC) and intention to donate UCB. Multigroup analysis structural equation modelling was conducted using Mplus (version 8.02). RESULTS: Multigroup path analyses showed that intentions were strongly predicted by subjective norms and moderately predicted by positive attitudes and PBC in both primiparous and multiparous women. TPB constructs explained 71% of the variance in intentions for both groups. CONCLUSIONS: Future interventions to increase intention to donate among primiparous and multiparous women could primarily consider the influence of partner and significant others in determining positive intentions and secondarily target increasing positive attitudes and perceptions of control.

Positive Orientation and Health-related Quality of Life in Adult Patients Born With Anorectal Malformations.

OBJECTIVES: Anorectal malformations (ARMs) are rare congenital colorectal anomalies, which may have a negative impact on health-related quality of life (HRQoL) due to long-lasting consequences, like fecal incontinence. The aim of the present study was to test whether a pervasive mode of appraising and viewing life experiences from a positive stance (ie, positivity) mediates the effect of fecal continence on HRQoL. METHODS: Participants were enrolled from the Italian Association for Anorectal Malformations. Adult patients with ARMs who completed measures of fecal continence (Hirschsprung Disease/Anorectal Malformation Quality of Life Questionnaire), positivity (Life Satisfaction Scale, Rosenberg Self-esteem Scale, and Life Orientation Test), and mental/physical HRQoL (SF-36) were included. Data were analyzed using the PROCESS macro for SPSS statistical software (Model 4). RESULTS: The study included 66 adult patients with ARMs. Mediated regression analyses showed a significant total effect in which patients with higher fecal continence perceived higher physical (ß = 0.210, SE = 0.038, 95% CI [0.133, 0.286]) and mental HRQoL (ß = 0.226, SE = 0.056, 95% CI [0.115, 0.338]) than patients with lower fecal continence. The indirect effects were also significant, indicating that positivity mediated the impact of fecal continence on physical (ß = 0.026, SE = 0.017, 95% CI [0.002, 0.068]), and mental HRQoL (ß = 0.146, SE = 0.058, 95% CI [0.047, 0.275]). CONCLUSIONS: The findings extend previous literature on ARM patients and additional evidence that an optimistic view of oneself, one's life, and one's future contribute to explain the effects of functional impairments on quality of life.

Knowledge and sources of information on umbilical cord blood donation in pregnant women.

The use of umbilical cord blood (UCB) holds promise for the treatment of a wide spectrum of diseases. However, information on UCB donation is not widespread or accurate among expectant women. The aim of this study is to evaluate pregnant women's knowledge of UCB donation, their main sources of information and their satisfaction with the knowledge possessed. Women (N = 375) in the last semester of pregnancy completed questionnaires evaluating sociodemographics, knowledge of UCB donation, past donation, sources of information, satisfaction with the information and the desire to have received more information. Women were aware of the possibility of donating UCB (97.5%) although, on average, they reported not having enough knowledge of donation possibilities, procedures to be followed and uses of UCB (2.51, on a 5-point scale). Considering knowledge satisfaction, 28% were not at all satisfied. Only 2.8% felt fully prepared and the great majority (75.2%) would have liked to have received more information. The main source of information was the Internet (51.2%). Gynecologists and midwives were indicated by only 24.4% and 18.6% of women, respectively. Age and education were significantly correlated with UCB knowledge. Chi-square tests evidenced that those who reported professional sources of information (gynecologists, obstetricians, prenatal courses) did not need additional information. Conversely, mothers who turned to other mothers for information were more likely to desire further information. Most mothers report the Internet as the main source of information. Providing accurate information through official sources may result in a more positive attitude toward donation.

Exploring the relationship between umbilical blood cord donation and the impact of social distance on altruism and trust.

Allogeneic umbilical cord blood (UCB) donation is a pro-social behaviour directed to strangers that has a certain cost for the donor. Although the promotion of such behaviour is an important goal for many countries' health systems, little is known about the reasons that would lead to it. With this study, we explored how the impact of social closeness on altruism and trust could be related to UCB donation in a sample of new-mothers (N = 167). Participants played hypothetical Dictator and Trust games with socially close (e.g., parents) or distant (e.g., strangers) others. They donated more money to parents and siblings compared to cousins, friends and strangers and they trusted more parents, siblings and friends than cousins and strangers. Interestingly, the lower the impact of social closeness on altruism (i.e., generosity towards socially distant others), the higher the intention and the actual probability of UCB donation. A mediation analysis has shown that the relationship between social closeness on altruism and UCB donation was mediated by objective intention to donate (i.e., having followed all the procedures needed). These findings show that other-oriented motivations towards distant others might have important practical implications in identifying the targets of interventions for the promotion of UCB donation.

The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations.

The Breast Size Satisfaction Survey (BSSS) was established to assess women's breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η2 = .02-.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women's psychological and physical well-being.

Sexual well-being in adolescent and young adults born with arm: the perspective of the patients.

PURPOSE: Sexual well-being and sexual functioning are understudied in patients born with ARM. The aim of this exploratory study was to investigate sexual history, main fears, and problems encountered during sexual relationships. METHODS: Before participating in a sexual education intervention, 21 adolescents or young adults (12 males; mean 28.8; SD 10.6) born with ARM, answered a ten-item questionnaire specifically developed to evaluate sexual well-being. Percentages and Chi-square were calculated. RESULTS: 52.4% were married/had a partner. The majority (71%) declared that had sexual relationships. Mean age of the first sexual relationship was 18.8 (2.7) and 22.7 (3.8) for males and females, respectively. Females reported both more fear and experience of pain during sexual intercourse, compared to males. Main experienced problems and fears for male patients were loss of feces and premature ejaculation, followed by the fear of lack of erection and managing contraception. Main experienced problems and fears in females were loss of feces, pain, lack of desire, and lack of lubrication. In only few cases, patients asked for advices to a pediatric surgeon or to an adult surgeon specialized in ARM. CONCLUSIONS: Adult and adolescent patients may benefit of andrological/gynecological evaluation, psychological support, and sexual counseling to improve their sexual well-being.

What do pediatric surgeons think about sexual issues in dealing with patients with anorectal malformations? The ARM-Net consortium members' opinion.

PURPOSE: Since pediatric surgeons aim to follow their patients with anorectal malformations (ARM) into adulthood the aim of this study was to investigate how pediatric surgeons deal with sexual issues related to ARM. METHODS: In 2018, a questionnaire was developed by the working group "Follow-up and sexuality" of the ARM-Net consortium and sent to all consortium-linked pediatric surgeons from 31 European pediatric surgical centers. Obtained data were statistically analyzed. RESULTS: Twenty-eight of 37 pediatric surgeons (18 males/10 females) answered the questionnaire. The majority of pediatric surgeons (82%) think they should talk about sexual issues with their patient. More than 50% of pediatric surgeons do not feel at all or only moderately confident discussing the topic of sexuality. Most pediatric surgeons require more support (96%) and wish to be trained in sexuality and sexual issues (78%) to feel confident towards their ARM-patients/parents. For optimal care, sexual issues with ARM-patients should be managed by a multidisciplinary team. CONCLUSIONS: Pediatric surgeons feel that sexuality is an important issue for their ARM-patients, which they are primarily responsible of but should be managed in concert with a multidisciplinary team. A training in sexuality is wished to feel more confident about this specific issue.