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.

Possible cognition changes in women with polycystic ovary syndrome: a narrative review.

Nowadays, polycystic ovary syndrome (PCOS) and cognitive dysfunction are major health problems among female. This narrative review aimed to investigate cognitive dysfunction in female with PCOS. English and Persian articles published in PubMed, Scopus, Web of Science, Google Scholar, PsycINFO, Scientific Information Database, and Cochrane Database of Systematic Reviews until May 2022 were searched. Sixteen studies involving 850 female with PCOS and 974 controls were assessed. In these studies, the association between biochemical factors and symptoms of PCOS and memory, attention, executive functioning, information processing speed, and visuospatial skills was evaluated. The literature review revealed the possible cognitive changes in female with PCOS. This study summarized the different aspects of cognitive function in female with PCOS due to medication, psychological problems (mood disorders caused by disease symptoms and complications), and biochemical markers, such as metabolic and sex hormone abnormalities. Considering the existing scientific gap regarding the possibility of cognitive complications in female with PCOS, further biological studies should be conducted to evaluate the potential mechanisms involved.

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.

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.

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.

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.

Predictor Factors of Female Sexual Distress in a Population-Based Sample of Iranian Women: a Path Analysis.

PURPOSE: To investigate the direct and indirect effects of demographic characteristics, relationship satisfaction, and psychological factors on female sexual distress (FSD) using path analysis. MATERIALS AND METHODS: This study was conducted in two stages. Initially we obtained the FSD predictor factor's conceptual model through a literature review and expert panel. In the Second stage, a population-based cross-sectional study on 207 non-pregnant and married women (without any age restriction) in Zanjan, Iran was conducted. FSDs-R, FSFI-6, DASS-21, and GEMREL Standard questionnaires and the demographic researcher-made questionnaire were used in this study. The data undergone path analysis based on the initial conceptual model. RESULTS: Sexual function (SF) had the strongest relationship with FSD from the direct path (ß = -.49) and overall effect (ß = -.58). The highest indirect effect belonged to depression-anxiety-stress level (ß = .284) mediated by SF (ß = -.42) and relationships satisfaction with spouse (ß = -.20). Age difference (ß = -.13) and relationships satisfaction with spouse (ß = -.19) had only a direct effect on FSD. Marriage Duration had only indirect effect on FSD through mediating role on SF (ß = -.26) and depression-anxiety-stress level (ß = -.15). CONCLUSION:  Among the predictor factors investigated in this study, sexual dysfunction is the most important predictor of FSD. In addition; men older than their spouses, longer marriage duration, relationship dissatisfaction with the spouse and higher rate of depression-anxiety-stress have positive correlation with SD. Therefore, we should offer a combination of the mentioned factors in providing care for women with SD.

Development of an educational guide for postpartum sexual health promotion: The Delphi method.

BACKGROUND: The Promotion of sexual health has been emphasized in Sustainable Development Goals (SDGs). As a primary prevention strategy, the promotion of sexual knowledge can reduce the incidence of postnatal sexual disorders. This study aimed to develop an educational guide for postpartum sexual health promotion. MATERIALS AND METHODS: This qualitative study was conducted in 2021 in Tehran. The steps of developing the educational guide were based on the model of the National Institute for Health and Clinical Excellence (NICE). First, the related guidelines, books, booklets, and original articles were comprehensively reviewed. Based on the scientific evidence, the educational content was compiled. Then, the quality of this content was evaluated using the Delphi method; It was performed using expert opinions with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. RESULTS: The educational content was developed in three chapters as follows: basic sexual education, postpartum changes and prevalent sexual problems of this period, and strategies for solving or adapting to postpartum sexual problems. This guide was developed in two separate sections for healthcare providers and mothers. The content was of excellent quality in all 6 domains of the AGREE tool (>90%); and evaluated to be optimal in terms of scientificity, significance, and feasibility with the consensus of experts (>95%). CONCLUSIONS: In this research, the steps of developing a comprehensive evidence-based educational guide for sexual health services in postpartum care were described, and its content was presented. The validity of the compiled content was also confirmed.

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.

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 Properties of the Sexual Health Scale for Middle-Aged Married Women (SHIMA): a Mixed Methods Study.

PURPOSE: This study aimed to develop and psychometrically validate the Sexual Health Scale for Middle-Aged sexually active women (SHIMA). METHODS: This study was a sequential exploratory study consisting of two phases. In phase one, we interviewed 19 middle-aged women and reviewed the existing instruments to generate an item pool. Then, a panel of experts (n = 16) examined the items. In the second phase, the psychometric properties of the scale were assessed. For content and face validity, a panel of experts (n = 8) and a group of middle-aged women (n = 10) reviewed the items. For construct validity, a cross-sectional study was carried out on a sample of 427 married women. Finally, SHIMA's reliability was assessed. RESULTS: In the first phase, the sexual health concept was explored, and a provisional scale including 60 items was generated. Next, 21 items were removed based on content and face validity. Accordingly, the results obtained from the exploratory factor analysis (EFA) indicated acceptable loading for 34 items tapping into six factors that jointly explained 48.67% of the total variance observed. The internal consistency evaluation revealed that Cronbach's alpha and McDonald's omega were greater than 0.7, and the average inter-item correlation was greater than 0.4, except for one factor that showed borderline results. Test-retest reliability over a 2-weeks interval was 0.90, indicating its high stability. CONCLUSION: The SHIMA is a reliable and valid scale for measuring sexual health in middle-aged married women. It can be used as a sexual health screening scale by healthcare professionals and for research purposes.

The translation and psychometric assessment of the SCOFF eating disorder screening questionnaire: the Persian version.

BACKGROUND: Eating Disorders (EDs) are defined by abnormal eating habits. The SCOFF (Sick-Control-One stone-Fat-Food) is a simple screening questionnaire for EDs. This study was conducted to translate and evaluate the psychometric properties of the SCOFF questionnaire in Iranian university students. METHODS: A total of 310 Iranian students of the Shahid Beheshti University of Medical Sciences completed a test battery of questionnaires including the well-known screener of eating disorder symptoms, the SCOFF. All measures were presented to the participants in Persian. The 5-item SCOFF questionnaire was translated to Persian using the forward-backward method. The face, content, criterion, and construct validity of the Persian version of the SCOFF were assessed. The validity and reliability of the Persian version of the SCOFF was assessed and factor analysis was conducted. RESULTS: All five items of the translated questionnaire were approved after face validity. Content validity ratio was 0.73 (range 0.66-0.83) and content validity index was 0.96 (range 0.91-1), so all items were approved. Exploratory factor analysis revealed a 2-factor structure, which explained 52.47% of the variance. Confirmatory factor analysis showed a very good goodness-of-fit for the 2-factor model. 2-factor and 1-factor models indicate a very good goodness-of-fit in females and adequate goodness-of-fit in males. Criterion validity showed an acceptable correlation between the SCOFF and the EDE-Q. Reliability was acceptable based on the stability [ICC = 0.905(95% CI .760-.962 p < 0.001)] and the internal consistency (KR20 = 0.4). CONCLUSION: Appropriate psychometric properties of the 5-item Persian version of the SCOFF (both models) were confirmed, suggesting its use as a valid questionnaire in EDs screening.

Eating Disorders (EDs) are defined by abnormal eating habits that affect a person's health. Eating disorders are common in Iranian young people. Early recognition of EDs can reduce its physical, psychiatric, psychosocial outcomes, improve the prognosis, and minimize the impact on patients and their families. However, timely recognition of EDs is difficult because of the variety of signs and presentations. The SCOFF (Sick-Control-One stone-Fat-Food) is a valuable screening questionnaire for rapid identification of people at risk for EDs. This study was conducted to translate and evaluate the psychometric properties of the SCOFF questionnaire in Iranian university students. The results of our study suggest that the 5-item Persian version of the SCOFF is a valid questionnaire in EDs screening.

Development of sexual health promotion package in pregnancy: The Delphi method.

BACKGROUND: The World Health Organization recommendation requires the development and use of effective, brief, clear, and evidence-based education packages to improve health-care outcomes. No comprehensive sexual health improvement package exists for the pregnancy period in the Iranian health system. This study aimed to develop a package to promote sexual health in pregnancy. MATERIALS AND METHODS: The present study is a qualitative study, which was conducted in 2019 in Tehran, Iran. Sexual health package during pregnancy was developed based on the National Institute for Health and Clinical Excellence (NICE) steps. The first step included reviewing of international guidelines, strategies, handbooks, education packages, and articles in this regard. The package was developed in the second step. In the third step, quality assessment was performed using expert opinion with the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) tool, and validation was performed using Delphi method. RESULTS: Package content was designed in two sections: for midwives and health-care providers and for pregnant mothers in three sessions (in each trimester of pregnancy). The quality assessment using the AGREE II guidelines revealed excellent quality (>89%). The package was validated based on expert opinion (>95%). CONCLUSION: The sexual health promotion package during pregnancy was designed with high quality and validity based on NICE steps. It is recommended, midwives be performed this designed and validated package in routine pregnancy care to promote the couple's sexual health.

Prevalence of female sexual dysfunction during pregnancy in Eastern Mediterranean Regional Office Countries (EMRO): a systematic review and meta-analysis.

BACKGROUND: Sexual dysfunction is potential abnormality in the ability of a person to sexual respond or enjoy sexual experience. During pregnancy, sexual function is at risk and disorder due to physical, hormonal and psychological changes. The prevalence of female sexual dysfunction is very variable during pregnancy. OBJECTIVE: The aim of this study was to determine the prevalence of sexual dysfunction in pregnant women in the Eastern Mediterranean Regional Office Countries (EMRO) by meta-analysis and systematic methods. MATERIALS AND METHODS: This study was reported based on the PRISMA checklist for systematic review and meta-analysis. This study investigated all articles with full English text in the EMRO region, from the international databases from 2000 to January 2019, which examined the prevalence of the sexual dysfunction in pregnant women. Statistical analysis was performed by using STATA12.1software. RESULTS: The results reveal that the prevalence of the sexual dysfunction in pregnant women is65% (95% CI: 54-75%). The mean of total sexual dysfunction in women was 22.71 (95% CI: 18.52-28.51%) and for the first, second and third trimester of pregnancy were obtained as 23.77 (95% CI: 28.56-28.96%), 23.80 (95% CI: 23.78-23.82%) and 22.60 (95% CI: 22.58-22.62%), respectively. CONCLUSION: The prevalence rate of sexual dysfunction is high in pregnant women in the EMRO region. The high rate of sexual dysfunction can be due to the difference in sexual performance scoring using the female sexual function questionnaire and on the other hand, pregnant women may be due to incorrect beliefs about sexual activity and cultural, religious and social restrictions and taboos, they have been avoiding to express their sexual function correctly.

Psychometric properties of vaginal penetration cognition questionnaire (VPCQ) in Iranian women with sexual pain disorders.

AIM: The aim of this study was to investigate the psychometric properties of the Persian version of the Vaginal Penetration Cognition Questionnaire (VPCQ). DESIGN: Cross-sectional study. METHODS: This research was conducted in two phases from June 2019 to February 2020. PHASE I: The World Health Organization Protocol of forward-backward translation and an expert panel in order to determine face and content validity. PHASE II: Survey development with 352 eligible women with sexual pain disorders, construct validity, internal consistency and construct reliability were evaluated. RESULTS: The exploratory factor analysis showed that the Persian version of VPCQ has three factors that explained 53.94% of the total variance. Confirmatory factor analysis also confirmed the fit of the three-factor model. Convergent and divergent validity were confirmed for all factors. The average measure ICC was 0.99 (95% CI 0.98 to 0.99). The absolute reliability with estimated SEM of 2.67 and MDC% of 28% approved the reliability of the questionnaire.

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.

The 4-month effect of Vitex agnus-castus plant on sexual function of women of reproductive age: A clinical trial.

BACKGROUND: Sexual dysfunction in women is a common disorder. Yet, there is no consensus on its treatment. Few studies have shown that Vitex agnus-castus improves sexual dysfunction in postmenopausal women; the present study was conducted to evaluate the effect of V. agnus-castus on the female sexual function in the reproductive age. MATERIALS AND METHODS: This was a double-blinded randomized control clinical trial on the women of reproductive age referred to the gynecology clinic of Al-Zahra Medical Center in Rasht, Iran, from February 2018 to December 2019. The intervention group received Agnugol tablet containing 3.2-4.8 mg dried extract V. agnus-castus (51 participants) and the control group received a placebo tablet (51 participants). All participants received one tablet daily for 16 weeks. The participants were asked to complete the Female Sexual Function Index questionnaire at the beginning of the study and after 4, 8, 12, and 16 weeks. Data were analyzed in SPSS statistics (version 21) using Chi-square test, t-test, Mann-Whitney U-test, analysis of variance, and mixed model to examine the differences between the groups. RESULTS: The results showed that the difference between the two groups was not significant in each domain, but there was a significant difference in the overall sexual function mean score so that the intervention group had a higher score than the placebo group after 16 weeks (P < 0.05). CONCLUSION: In the present study, it was observed that the consumption of V. agnus-castus during 16 weeks was more effective than the placebo in improving sexual dysfunction. Further studies with larger sample sizes are needed to be able to decide on the prescription of this drug in the clinics.

Child-Free Lifestyle and the Need for Parenthood and Relationship with Marital Satisfaction among Infertile Couples.

Objective: Marital satisfaction is considered as satisfaction with a marital relationship on which the presence of a child has different effects. Concerns about a childfree life and its effect on marital satisfaction in infertile couples are very critical. Therefore, this study was intended to characterize and compare concerns about a childfree lifestyle and the need for parenthood and their relationship with marital satisfaction in infertile couples. Method : A total of 200 men and 200 women who referred to fertility centers in Tehran participated in this cross-sectional study. Convenience sampling method was used for sampling. Demographic survey, ENRICH Marital Satisfaction Scale, and Fertility Problem Inventory were used for data collection. The resulting data were analyzed using descriptive and analytical statistical tests (Pearson Correlation Coefficient and Stepwise Regression). Results: The mean scores for concern about a childfree lifestyle and the need for parenthood in women were significantly higher than in men. The variables rejection of a childfree lifestyle and the need for parenthood were respectively predictors of marital satisfaction in women and men. Conclusion: Since marital satisfaction in infertile couples is affected by their feelings about having a child and becoming a parent, it is therefore suggested that appropriate counseling be provided in supportive healthcare programs for infertile couples to promote their marital satisfaction.

The relationship between depression, stress, anxiety, and postpartum weight retention: A systematic review.

Postpartum weight retention (PPWR) is a factor that causes permanent obesity and subsequent chronic and noncommunicable diseases. The relationship between depression/stress/anxiety and PPWR has been studied in some articles, but there is no definitive conclusion in this regard. The present systematic review was conducted to investigate the relationship between depression/stress/anxiety and PPWR. An extensive search was performed in the PubMed, Scopus, Embase, Web of Science, Google Scholar, SID, and Magiran, Irandoc databases using Medical Subject Headings terms (or their Persian synonyms) from 2000 to 2020. Inclusion and exclusion criteria were used for articles selection. The quality of the selected articles was assessed using the Newcastle-Ottawa Scale. Out of 371 reviewed articles, 24 articles were selected. The total sample size was 51,613 (range: 49-37,127). The mean of PPWR ranged from 0.5 kg (standard deviation [SD] = 6.49) to 6.4 kg (SD = 8.5). There was a statistically significant relationship between depression/stress/anxiety and PPWR in 12 of 23, 4 of 6, and 3 of 8 studies. This review demonstrates the relationship between depression/stress/anxiety and PPWR. Time of depression/stress/anxiety assessment is an important issue, as well as different measurement tools. Prevention of the mothers' psychological problems through educational and supportive programs may help to limit PPWR.