Component of sexual health services for vaginismus management: A qualitative study.

BACKGROUND: Provision of sexual health services requires gender-sensitive management, facilities, and staff, as well as planning for gender-sensitive caregivers and education. Couples suffering from vaginismus face many types of barriers to accessing sexual health services. This qualitative study was conducted to explain the needs of sexual health services in women with primary vaginismus in Iran. METHODS: This qualitative study was conducted through the participation of 20 participants including service providers, women with vaginismus and their husbands in 2022, Iran. The samples were selected using purposive sampling method and considering the maximum variation. For data collection, in-depth semi-structured individual interviews were conducted and continued until data saturation was reached. The collected data were analyzed in MAXQDA10 software using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman. RESULTS: Data analysis led to the emergence of three main themes: 1) Comprehensive preventive sex education which included the three categories of sex education in the education system, premarital sex education through the health system, and sex education through the media with scientific content; 2) Efficient sexual health clinics which included three categories of therapist's skills, empowerment of sexual therapist, and structural features of sexual health clinics and cultural considerations in establishing sexual health clinics; and 3) Protocol for management and treatment of sexual problems which consisted of sexual education and counseling content, treatment requirements, and sex education approaches. CONCLUSION: Based on the results of the study, comprehensive preventive sex education through the education system and the Ministry of Health can improve the attitudes of adolescents and young people. Moreover, it can take a fundamental step in solving sexual problems by providing the infrastructure necessary for the establishment of efficient sexual health clinics and protocols required to manage and treat such problems.

Development and psychometric properties of Female Infertility Stigma Instrument (ISI-F): A sequential mixed method study.

BACKGROUND: Infertility stigma is a hidden burden that overshadows the dimensions of reproductive and sexual health in infertile women. The aim of this study was to develop and evaluate the psychometric properties of the Female Infertility Stigma Instrument (ISI-F). METHODS: This mixed method study with sequential exploratory design was conducted in qualitative and quantitative phases. In the first phase, the initial item pool of the Female Infertility Stigma Instrument (ISI-F) was generated using in-depth interviews. In the quantitative phase, psychometric properties of the ISI-f including content, face and construct validity, as well as reliability (internal consistency and stability) were assessed. Exploratory factor analysis was performed on the collected data from 300 infertile women for evaluation of construct validity. Data was analyzed using SPSS version 20. This study has followed the Mixed Methods Article Reporting Standards checklist. RESULTS: The final version of ISI-F had 20 items. Total CVI and CVR were 0.94 and 0.87, respectively. Explanatory factor analysis identified 3 main factors that explained 54.013% of the variance. These factors consisted of stigma profile (7 items), self-stigma (6 items) and escaping from stigma (7 items). Internal consistency and stability of the ISI-F has been approved by Cronbach's alpha, McDonald's Omega (0.909, 0.916) and Intraclass Correlation Coefficient (ICC = 0.878). CONCLUSION: The Female Infertility Stigma Instrument (ISI-F) is a valid and reliable tool for evaluation of the perceived female infertility stigma, that was developed in this study.

Predicting postpartum haemorrhage: A systematic review of prognostic models.

BACKGROUND: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality and morbidity worldwide, and the rate is increasing. Using a reliable predictive model could identify those at risk, support management and treatment, and improve maternal outcomes. AIMS: To systematically identify and appraise existing prognostic models for PPH and ascertain suitability for clinical use. MATERIALS AND METHODS: MEDLINE, CINAHL, Embase, and the Cochrane Library were searched using combinations of terms and synonyms, including 'postpartum haemorrhage', 'prognostic model', and 'risk factors'. Observational or experimental studies describing a prognostic model for risk of PPH, published in English, were included. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist informed data extraction and the Prediction Model Risk of Bias Assessment Tool guided analysis. RESULTS: Sixteen studies met the inclusion criteria after screening 1612 records. All studies were hospital settings from eight different countries. Models were developed for women who experienced vaginal birth (n = 7), caesarean birth (n = 2), any type of birth (n = 2), hypertensive disorders (n = 1) and those with placental abnormalities (n = 4). All studies were at high risk of bias due to use of inappropriate analysis methods or omission of important statistical considerations or suboptimal validation. CONCLUSIONS: No existing prognostic models for PPH are ready for clinical application. Future research is needed to externally validate existing models and potentially develop a new model that is reliable and applicable to clinical practice.

Dietary Fatty Acid Intakes and the Outcomes of Assisted Reproductive Technique in Infertile Women.

BACKGROUND: The purpose of this study was evaluating the relationship between fatty acid (FA) intakes and the Assisted Reproductive Technique (ART) outcomes in infertile women. METHODS: In this descriptive longitudinal study, a validated food frequency questionnaire (FFQ) was used to measure dietary intakes among 217 women with primary infertility seeking ART treatments at Isfahan Fertility and Infertility Center, Isfahan, Iran. The average number of total and metaphase II (MII) oocytes, the fertilization rate, the ratio of good and bad quality embryo and biochemical and clinical pregnancy were assessed. Analyses were performed using mean, standard deviation, Chi-square test, ANOVA, ANCOVA, logistic regression. RESULTS: A total of 140 women were finally included in the study. There was a positive relationship between the average number of total and MII oocytes and the amount of total fatty acids (TFAs), saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), linoleic acids, linolenic acids, and oleic acids intakes, while eicosapentaenoic acids (EPAs) and docosahexaenoic acids (DHAs) intakes had an inverse relationship. Consuming more amounts of TFAs, SFAs, PUFAs, MUFAs, linoleic acids, and oleic acids was associated with the lower fertilization rate, whereas the consumption of linolenic acids and EPAs increased the fertilization rate. The ratio of good quality embryo was directly affected by the amount of PUFAs intakes. Additionally, there was a negative correlation between the amount of SFAs intakes and the number of pregnant women. CONCLUSION: TFAs, SFA, PUFA, and MUFA intakes could have both beneficial and adverse impacts on ART outcomes.

The Effects of Serum and Follicular Fluid Vitamin D Levels on Assisted Reproductive Techniques: A Prospective Cohort Study.

BACKGROUND: Based on studies on animal models, vitamin D plays an essential role in reproduction by controlling Ca and Mg levels. Despite these findings, the effects of vitamin D deficiency and supplementation on the outcome of assisted reproductive techniques (ART) remain controversial. Therefore, the aim of the present study was to assess the relationship between serum and follicular fluid 25-OH vitamin D levels on reproductive outcomes of infertile women. MATERIALS AND METHODS: This prospective cohort study included 150 infertile women who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The participants were allocated to one of the three groups according to their serum and follicular fluid 25-OH vitamin D concentrations (less than 10 ng/ml, between 10 and 30 ng/ ml and more than 30 ng/ml), and fertilization, cleavage and biochemical and clinical pregnancy rates were compared among the groups. Data was analyzed by SPSS software and using Chi-square and Spearman correlation coefficient. RESULTS: Serum and follicular fluid vitamin D levels significantly correlated with biochemical (P=0.008), (P=0.003) and clinical pregnancy (P=0.017), (P=0.001) rates respectively . However, the quality of embryos (P=0.125), (P=0.106) and fertilization rate (P=0.082), (P=0.059) were not associated with the level of serum and follicular fluid vitamin D. CONCLUSION: This study found that women with higher levels of vitamin D in their serum and follicular fluid are significantly more likely to achieve pregnancy but without affecting the quality of embryo and fertility rate.

Dietary Patterns and The Outcomes of Assisted Reproductive Techniques in Women with Primary Infertility: A Prospective Cohort Study.

BACKGROUND: Infertility is one of the most common challenges that women in reproductive age would encounter today. The maternal nutritional status could be a determinant of oocyte quality and embryonic growth. This study was conducted to assess the relationship between dietary patterns and reproductive outcomes in infertile women. MATERIALS AND METHODS: This prospective cohort study was conducted on 140 women with primary infertility who had referred to Isfahan Fertility and Infertility center, Isfahan, Iran. The average number of total oocytes and metaphase II oocytes, the fertilization rate, the ratio of good and bad quality embryo and biochemical and clinical pregnancy were considered as the outcomes of assisted reproductive techniques (ART). A 168-item food frequency questionnaire was used for estimating the dietary intakes during the last year. Factor analysis was used for identifying the dietary patterns and analysis of variance (ANOVA), analysis of covariance (ANCOVA), chi-square, and logistic regression analysis were used for assessing the relation between dietary patterns and ART's outcomes. RESULTS: Three major dietary patterns (the healthy, western and unhealthy diet) were identified. Women with high adherence to the "healthy diet" had a higher educational level and were employed. There was a significant increase in the average number of total oocytes (P-trend=0.009) and metaphase II oocytes (P-trend=0.006) in the third tertile of "healthy diet" compared to the first tertile. Also, women with high adherence to the second tertile of "unhealthy" diet compared to the first tertile, had a significantly lower chance of getting pregnant [odds ratio (OR): 0.14, 95% confidence interval (CI): 0.3-0.7]. CONCLUSION: Nutrition status could affect infertility treatment outcomes. Greater adherence to the healthy diet may enhance oocyte quality and quantity. Unhealthy diet could adversely affect the chance of getting pregnant.

The effect of Cinnamon on primary dysmenorrhea: A randomized, double-blind clinical trial.

BACKGROUND: Primary dysmenorrhea is a cyclic cramp in pelvic which interferes with daily activity. This study determined the effect of Cinnamon on relieving dysmenorrhea. METHODS: This is a randomized, double-blind clinical trial. The intervention group received Cinnamon (capsules contained 1000 mg cinnamon) and the control group received placebo (capsules contained 1000 mg starch) during the first 72 h of menstruation for two cycles continuously. The Visual Analogue Scale was used to determine the severity of pain. The subjects were followed up for two cycles. Descriptive statistics, Independent T test, analysis of variance (ANOVA) with repeated measures were used for continuous quantitative variables. Mann-Whitney and Chi-square tests were used for nominal and ordinal qualitative variables. RESULTS: The results showed the mean intensity of dysmenorrhea significantly decreased over time in both groups (time: P < 0.001) and this reduction was significantly different over time between two groups (time*group: P = 0.02). There is significantly more reduction in the intervention group. Also the pain reduction in the intervention group was significantly lower than the placebo group after the first treatment (P = 0.001) and the second treatment (P = 0.002) compared to before treatment. CONCLUSIONS: Cinnamon can reduce the intensity of primary dysmenorrhea. This aromatic spice for relive of primary dysmenorrhea is recommended.