The Effect of Citrus Aurantium Vaginal Cream on Vaginal Atrophy in Postmenopausal Women: A Quasi-experimental Study.

Background: Vulvovaginal atrophy (VVA) is a common condition and a silent epidemic affecting many postmenopausal women who suffer from it in silence. This study aimed to evaluate the effect of Citrus aurantium vaginal cream on vaginal atrophy in postmenopausal women. Methods: This single-group pretest-posttest quasi-experimental study was conducted on 30 postmenopausal women who were referred to the Gynecology Clinic of Imam Khomeini Hospital in the city of Noor, Iran, from June to November 2020. Citrus aurantium vaginal cream was administered to women diagnosed with vaginal atrophy (based on subjective symptoms of atrophy, descriptive evaluation of the vagina, vaginal pH measurement, and degree of vaginal maturation determined by vaginal smear) every night in the first two weeks and every other night for the second two weeks. Data were collected using the scale of subjective symptoms of vaginal atrophy; descriptive evaluation checklist of vaginal mucosa; laboratory results registration form (vaginal maturation index, vaginal maturation value, and vaginal pH) before the intervention and two and four weeks after the intervention. Data were analyzed using SPSS software (version 24) through the analysis of variance with repeated measurements, and LSD post-hoc test. A P value less than 0.05 (P<0.05) was considered statistically significant. Results: Citrus aurantium vaginal cream improved subjective symptoms of vaginal atrophy (P<0.001), reduced the score of descriptive evaluation of vaginal mucosa (P<0.001), decreased vaginal pH (P<0.001), and increased vaginal maturity (P<0.001). Conclusions: The results showed that citrus aurantium vaginal cream could improve the symptoms of vaginal atrophy without causing serious complications. However, further studies with a control group are suggested to confirm the findings of this study.Trial Registration Number: IRCT20200215046494N.

The effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy in Iran: A randomized clinical Trial.

Background: Unwanted pregnancy is an important public health concern that can have significant health, social, and economic effects on the mother, the baby and her family. The establishment and enhancement of maternal-fetal attachment (MFA) play a role in the promotion of emotional communication between the mother and the child in the future. This study aimed at investigating the effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy. Methods: In this randomized clinical trial, 60 eligible pregnant women with unwanted pregnancy and gestational age of 22-28 weeks who had referred to health centers in Mashhad, a city in the northeast of Iran, were selected and they were through random block assignment divided into two groups of counseling with the cognitive-behavioral approach (n = 30) and the control group (n = 30). In addition to the routine pregnancy care, the cognitive-behavioral counseling group received four group counseling sessions on a weekly basis, while the control group only received the routine pregnancy care from healthcare providers. Maternal-fetal attachment before and after intervention in the two groups was assessed through Cranley's Maternal-Fetal Attachment Scale. Comparison of mean scores within and between the two groups was performed using SPSS 21 through independent and paired t-tests. Results: At the end of the study and after the intervention, the mean scores of maternal-fetal attachment in the intervention and control groups were 94.06 ± 11.73 and 80.16 ± 10.09, respectively, and the difference between the groups was significant. Although the difference between the mean scores of each group at the beginning and the end of the study was significant, this difference between the two groups was also noticeable (21.56 ± 12.16 vs 7.40 ± 12.39) and statistically significant. Conclusions: Cognitive-behavioral counseling can be effective in enhancing the maternal-fetal attachment in unwanted pregnancies; therefore, it is recommended to be integrated into pregnant women's healthcare programs.

Applying the theory of planned behavior for prediction of oocyte donation intention among Iranian women.

BACKGROUND: Oocyte donation is a complex and multifaceted behavior in women. Due to the acute deficiency of donated oocytes, it is necessary to identify the factors affecting the desire to donate. Planned behavior theory is a suitable model for explaining and predicting behavior in many behavioral domains. The aim of this study was to predict oocyte donation intention using the theory of planned behavior. METHODS: This cross-sectional study was performed on 556 women who were covered by the comprehensive health service centers in Gonabad and Neyshabour cities in 2020. Sampling was performed by the two-step method in Gonabad city and by the convenience sampling method in Neyshabour city. Data were collected online using researcher-made questionnaires included oocyte donation awareness questionnaire and oocyte donation intention questionnaire (based on the TPB constructs). The validity of the questionnaires was confirmed by face and content validity and its reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed in SPSS software (version 16) using hierarchical linear regression. The statistical significance was considered as P < 0.05. RESULTS: The results showed that there was a significant positive correlation between the oocyte donation intention with all constructs of planned behavioral theory (P < 0.050). Planned behavior theory constructs explained 47% of the variance of oocyte donation intention. In addition, constructs of perceived power (ß = 0.461), control beliefs (ß = 0.154) and normative beliefs (ß = 0.125) were the strongest predictors of oocyte donation intention, respectively. CONCLUSION: Planning and implementing educational courses according to the constructs of the theory of planned behavior can be a great step toward the elimination of oocyte deficiency and infertility problems. Also performing of intervention or training strategies in the field of oocyte donation requires the enhancement of social norms and perceived behavioral control in the population under study.

The Relationship between Perfectionism and Sexual Function: A Systematic Review.

Objective: Perfectaionism is a common personality trait that can affect various aspects of life, especially sexual relationships. The purpose of this systematic review was to summarize the existing evidence for the relationship between perfectionism and sexual function in studies conducted in Iran and the world. Method : A comprehensive search of databases such as Scopus, PubMed, Cochrane, Science Direct, ProQuest, PsychINFO, IranPsych, Irandoc, SID, and Google Scholar search engine was performed until December 2021 without a time limit. To find studies, we searched for the keywords perfectionism and sexual function in both Persian and English and combined these words with the AND operator. Studies that scored above 15 according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria were included. Data analysis was performed qualitatively. Results: From the total of 878 articles found in databases, six articles met the inclusion criteria and had moderate quality. Reviewing studies corroborated that, notwithstanding the positive association between general/sexual perfectionism and sexual desire, specific dimensions such as socially prescribed perfectionism, partner-prescribed, and socially prescribed sexual perfectionism, have the utmost unfavorable effect on female sexual function, which means that a higher level of perfectionism ultimately decreases the rate of sexual function in women. In addition, studies suggested that by increasing sexual anxiety and distress levels, perfectionism deteriorates sexual function. Conclusion: Perfectionism may cause a variety of problems regarding sexual function. However, to clarify the precise role of each dimension of perfectionism on different areas of sexual function, more research must be conducted in this area in various communities and on age groups other than females of reproductive ages.

Relationship Between Amoxicillin Use in Pregnancy and Congenital Anomalies: A Systematic Review.

OBJECTIVE: Amoxicillin is among the most used antibiotics in the treatment of a wide spectrum of bacterial infections. Although amoxicillin is categorized as group B in pregnancy, the findings of studies regarding its effects on the fetus are controversial. The aim of this systematic review was to review the reported effects of amoxicillin administration in pregnancy on congenital anomalies. METHODS: Published articles in PubMed, Scopus, SID, and Magiran databases, as well as Google Scholar were searched till May 2021 based on a search strategy. Case-control and cohort studies in Persian or English language were included. Four studies, including two case-control and two cohort studies, with an overall sample size of 260491 pregnant mothers, were included in the review. RESULTS: A review of case-control studies revealed an increased risk for cleft palate in one study. Cohort studies did not reveal a significant relationship between amoxicillin use and major congenital anomalies. CONCLUSION: The findings of this systematic review showed that although no major congenital anomaly was reported for the administration of amoxicillin consumption with or without clavulanic acid, there is a possibility that amoxicillin administration in pregnancy might be related to some anomalies, including cleft palate. Amoxicillin should be administered with caution during pregnancy till more evidence is provided regarding its safety.

Effect of Rosemary Cream on Episiotomy Wound Healing in Primiparous Women: A Randomized Clinical Trial.

BACKGROUND: Delay in episiotomy wound healing can lead to infection. The application of natural antimicrobial agents isolated from herbal essences can be a good strategy to prevent the growth of bacteria and promote the wound healing process. Therefore, this study aimed to determine the effect of rosemary cream on episiotomy wound healing in primiparous women. METHODS: This triple-blind randomized clinical trial was conducted on 80 primiparous pregnant women who were referred to the maternity ward of Shahid Motahari Hospital in Marvdasht, Iran, from September 2019 to March 2020. These women were randomly assigned into two groups of intervention (rosemary cream) and control (placebo), using variable quadruple blocks. Both groups applied the prescribed cream (in a dose of 2 cm) uniformly on the sutured area to cover it with the cream. The cream was applied twice a day for 10 consecutive days postpartum, and the rate of wound healing was evaluated by the researcher in the first 12 h and at days 4 and 10 postpartum using the REEDA scale. The data were analyzed using SPSS software (Version 19) through the Chi-square test, Mann-Whitney U test, student's t-test, and Fisher's test. A p-value less than 0.05 (P < 0.05) was considered statistically significant. RESULTS: The mean ± SD REEDA score on the fourth day postpartum was obtained at 3.82 ± 0.93 and 4.25 ± 1.29 in the groups of rosemary cream and placebo, respectively (P = 0.17). However, the mean ± SD REEDA scores on the 10th day postpartum were determined at 0.75 ± 0.74 and 3.32 ± 2.54 in the rosemary cream and placebo groups, respectively, indicating a higher rate of episiotomy wound healing in the group of rosemary cream compared to placebo (P < 0.001). CONCLUSION: Based on the obtained results, it seems that rosemary cream can be effective in healing episiotomy wounds in primiparous women. However, further studies are suggested to confirm the findings of this study. TRIAL REGISTRATION: This trial was registered in the Iranian Registry of Clinical Trials in 24/08/2019 with the IRCT ID: IRCT20190308042971N1. The first participant enrolled in this trial in September 2019. URL of registry: https://en.irct.ir/trial/40092 .

Predictors of the Social Distancing Behaviors during the COVID-19 Pandemic using Protection Motivation Theory in Iran: A cross sectional study.

Background: Social distancing is a key behavior to minimize Coronavirus disease 2019 (COVID-19) infections. Since the change of behavior is the only way to prevent this pandemic, this study aimed to predict the social distancing behaviors during the COVID-19 pandemic using protection motivation theory (PMT). Methods: This cross-sectional study was conducted through a convenience sampling method on 796 individuals over 15 years old from urban and rural areas of different cities in Iran during 2020. The data were collected online using demographic characteristics form, PMT and social distancing behaviors questionnaires. Afterward, the obtained data were analyzed in SPSS software (version 16) through linear correlation coefficient and hierarchical regression tests. Results: The Mean ± SD score of social distancing behaviors was obtained at 4.42 ± 0.31. The results of the hierarchical linear regression model showed that after adjusting the effect of socio-demographic variables, self-efficacy (Beta = 0.238, P < 0.001) was the strongest predictor of social distancing behaviors during the COVID-19 pandemic, followed by intention (Beta = 0.233, P < 0.001) and perceived severity (Beta = 0.083, P = 0.028). PMT constructs and intention was able to predict 40% of social distancing behaviors in total. Conclusions: In the prevalence of infectious diseases, individuals differ in adherence to social distancing behaviors. The PMT was a useful framework for prediction social distancing behaviors during the COVID-19 pandemic. Therefore, this theory can be used as a framework in designing educational programs to increase self-efficacy and encourage individuals to observe social distancing behaviors as a result.

Relationship between Socio-Demographic Factors and Adherence to Social Distancing Recommendations During Covid-19 Pandemic in Gonabad, Iran: A Cross-Sectional Study.

Background: Adherence to social distancing recommendations provided by health authorities plays an important role in the prevention and control of COVID-19 transmission, regarding the lack of effective drug therapies. Therefore, this study aimed to identify the relationship between socio-demographic factors and adherence to social distancing recommendations during COVID-19 pandemic in Gonabad, Iran. Methods: In this cross-sectional study, 587 subjects aged 15 and older were selected using the convenience sampling method from urban and rural areas in Gonabad, Iran, from July to September 2020. Data were collected online using a socio-demographic characteristics form, the adherence to social distancing recommendations scale, and a coronavirus disease awareness survey. Subsequently, the obtained data were analyzed in SPSS software (version 16) using hierarchical linear regression. The statistical significance was considered as P<0.05. Results: 72.23% (95% confidence interval: 68.41%-75.82%) of the participants followed the recommendations of social distancing at the high level. Nevertheless, many differences were observed in the subgroups which resulted from the socio-demographic characteristics of the participants. According to the multiple linear regression model, sex (ß=0.24, P<0.001) was the most important determinant of adherence to social behavioral recommendations, followed by occupation (ß=0.15, P<0.001), age (ß=0.14, P=0.007), awareness (ß=0.13, P=0.001), and history of mental illness (ß=-0.08, P=0.049). Conclusion: For the effective management of pandemics, the general public health policies should also consider the variability in responses and behavioral changes caused by socio-demographic characteristics, rather than focusing only on general measures, such as social distancing.

A randomized clinical trial on the effect of foot reflexology performed in the fourth stage of labor on uterine afterpain.

BACKGROUND: Uterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women. METHODS: This single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue  scale. The collected data were analyzed in SPSS-16 software at a significance level of P < 0.05. RESULTS: The median of the afterpain score in the first hour (P = 0.05) and second hour (P = 0.274) postpartum did not differ significantly between the two groups, but this score was lower in the reflexology group at the third hour (P < 0.001) and fourth hour (P < 0.001) postpartum. The mean total afterpain score in the 4 h postpartum was significantly lower in the reflexology group (P < 0.001). CONCLUSION: The results revealed that foot reflexology in the fourth stage of labor has positive effects on relief from uterine afterpain. Reflexology is therefore recommended as a measure to reduce postpartum uterine afterpains.

Effect of sexual enrichment program on the sexual satisfaction of pregnant women in Iran: A randomized clinical trial.

Background: To improve the sexual satisfaction of pregnant women, there needs to be a culturally appropriate sex education program. This study aimed at determining the effectiveness of a sexual enrichment program on the sexual satisfaction of pregnant women. Methods: This single-blind randomized clinical trial was conducted on 61 pregnant women aged 18 to 35 years old with low-risk pregnancies and gestational ages of 14 to 32 weeks, who had referred to three healthcare centers in Mashhad. The participants were randomly assigned to two groups of control (n = 31) and intervention (n = 30) based on a table of blocks of four. The intervention group, in addition to receiving routine pregnancy training, participated in six one-hour sessions of a sexual enrichment program held on a weekly basis, while the control group received only the routine pregnancy healthcare. Larson's sexual satisfaction questionnaire was used to assess the sexual satisfaction of pregnant women prior to the study and two weeks after the intervention. Comparison of mean scores between and within the two groups was performed using SPSS software (version 21) using independent and paired t-tests. Results: After the intervention, there was a significant difference between the mean sexual satisfaction scores of the two groups (p = 0.02). Comparison of the differences between the mean sexual satisfaction scores of the intervention group before and after the intervention indicated a significant change (p = 0.009), while in case of the control group this change was not significant (p = 0.46). Conclusion: A sexual enrichment program can be effective in improving the sexual satisfaction of pregnant mothers.

Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial.

BACKGROUND: The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section. METHODS: This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35-37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher's exact tests. p-value less than 0.05 was considered statistically significant. RESULTS: After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P < 0.001). Moreover, in the SDM group, the rate of vaginal birth was significantly higher than that in the control group (P < 0.001). Two month after the delivery, the mean score of decision regret was lower in the SDM group, in comparison to that in the control group (15.67 ± 23.37 vs. 27. 30± 26.75; P = 0.007). CONCLUSIONS: Based on the results of the study, shared counseling can be effective in the reduction of decisional conflict and regret, as well as rate enhancement of VBAC. Therefore, it can be concluded that this counseling method can be used in prenatal care to reduce the rate of repeated cesarean section. TRIAL REGISTRATION: IRCT20190506043499N1; Name of the registry: Iranian Registry of Clinical Trials; Registered 10. August 2019. URL of registry: https://en.irct.ir/trial/39538. Date of enrolment of the first participant to the trial: August 2019.

Exploring Infertile Couples' Decisions to Disclose Donor Conception to The Future Child.

BACKGROUND: Despite significant advances in reproductive technology, using donor assisted reproductive technology is a double-edged sword that has numerous challenges. One of the most challenging issues for couples is whether or not to disclose this information to donor offspring. This study, therefore, explored infertile couples' decision to disclose donor conception to their future child. MATERIALS AND METHODS: This qualitative study was conducted using content analysis approach in 2012 in the Milad Infertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile persons including nine couples and 14 women who were selected by purposive sampling. Data were analysed by conventional qualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software. RESULTS: Two categories were emerged: 'not to disclose information to the child' and 'to disclose information to the child'. The first category consisted of three subcategories: 1. child support from probable harms; 2.to maintain healthy family relationships; and 3. lack of a compelling reason to disclose this information. The second category embraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation for the donor; and 4. honesty among family members. The main reason for not disclosing information was to protect the child from probable harm. CONCLUSION: Although protecting children from possible harms was a major reason for infertile couples' secrecy, keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process in order to change the beliefs of community and eliminate the infertile couples' concerns would help them to overcome this problem. Additionally, long-term psychological counselling during and after the donation process is highly recommended.

Development and Validation of A Decision-Making Donor Conception Questionnaire in Iranian Infertile Couples.

BACKGROUND: Despite the fact that many infertile couples have to decide about whether or not to choose donor conception, there is no predictive scale for evaluating the process of decision-making on donor conception and its determinants in such couples. The present study was conducted to develop a decision-making questionnaire for selecting donor conception and assess its psychometric properties in Iranian infertile couples. MATERIALS AND METHODS: This cross-sectional validation study was conducted based on the method developed by DeVellis (2012) in four steps at Milad Infertility Clinic, Mashhad, Iran. The dimensions of the concept of decisionmaking were determined in the first step based on the qualitative results obtained from 38 semi-structured in-depth interviews. Items that were appropriate for the questionnaire were developed in the second step using the qualitative data and a review of the literature. In the third step, the research team reviewed and eliminated some of the items. The fourth step evaluated the face, content and construct validity of the questionnaire through exploratory factor analysis on a sample of 220 infertile couples using convenience sampling and investigated its initial and final reliability. RESULTS: Based on the results of the qualitative study, a pool of 170 items was developed, 101 of which were eliminated after revision due to ambiguity, repetition or their poor face and content validity and initial reliability. The questionnaire was evaluated for its construct validity with 69 items. After the exploratory factor analysis, the decisionmaking donor conception questionnaire (DMDCQ) having 51 items and seven factors, was finalized. All the factors had Cronbach's alpha values of 0.75-0.87 and intra-class correlation coefficients (ICC) greater than 0.7. CONCLUSION: This study led to development of a valid and reliable scale for examining infertile couples' decisionmaking about whether or not to use donor conception as well as the determinants of this decision.

Decision for disclosure: The experiences of Iranian infertile couples undergoing assisted reproductive donation procedures.

Controversy surrounding disclosure among the recipients of assisted reproductive donation procedures is escalating worldwide, but little research has been conducted in this topic. The purpose of this qualitative study was to explore the experiences of infertile couples undergoing assisted reproductive donation procedures. In this exploratory qualitative study, 32 patients (nine couples and 14 women) who were candidates to use donor eggs, donor embryos or surrogacy, and 5 members of infertility treatment team including gynaecologists, midwives and psychologist (total 37) were purposively selected from the Montaserieh Infertility Research Centre at Mashhad, Iran in 2012 and interviewed using a semi-structured in-depth method. Data were analysed using conventional qualitative content analysis with MAXqda software. One overarching theme, entitled 'experiencing uncertainty surrounding the disclosure to others' was identified from the data. This theme contained two subthemes including 'Couples' decisions to not disclose to others' and 'Couples' decisions to disclose to others'. Five categories formed the first subtheme, and the second subtheme emerged from four categories which are discussed in this paper. The main reason for secrecy was concern over societal negative views about assisted reproductive donation procedures. This worry deprived the couples from support from family and friends and as a result requires them to tolerate psychological pressure when using such procedures.