Sexual motivations during the menopausal transition among Iranian women: a qualitative inquiry

Adopting strategies with menopausal experiences: A systematic review

Background and Aims

Menopause is one of the most significant stages in women's life. It is accompanied by many complications and a serious challenge. This study aimed to assess the menopause experiences of Iranian women and compatibility strategies.

Methods

We searched PubMed, Web of Science (ISI), Scopus, Ovid, and the Iranian Clinical Trial Registry and Magiran, SID, from January 1990 to January 2021.

Results

Psychological effects, sexual disorders, physical problems, bone pain, insomnia, fatigue, and hot flashes are all menopause experiences. Cultural factors, lifestyle, social factors, education level, employment and economic status, marital status, and the number of pregnancies and births can influence this experience. It is important that menopausal women are aware how menopausal compatibility and prepare for this period. Many factors have affected menopausal adopting strategies. Negative emotions, negative attitudes, worry, and anxiety, and their psychological effects exacerbate the annoying experiences of menopause and decelerate menopausal adoption.

Conclusions

Social support and educational intervention were the practical menopausal adopting strategies. It will guarantee the health of menopausal women in the last third of their lives.

Comparison of predictive effect of the dietary inflammatory index and empirically derived food-based dietary inflammatory index on the menopause-specific quality of life and its complications

INTRODUCTION

Menopause, defined as the cessation of menstruation for at least 12 months, is one of the important stages of a woman's life cycle. Some hormonal variations occur during the transition to menopause, which affects women's quality of life. Recently, the role of dietary factors in alleviating symptoms has been investigated.

AIM OF THIS STUDY

We tried to investigate the relationship between dietary inflammatory index (DII), food-based dietary inflammatory index (FDII) and quality of life, and menopausal symptoms, comparing their predictive power and suggesting the best cut-off point.

METHODOLOGY

One hundred forty-nine postmenopausal women were included in the cross-sectional study. After collecting data by interview, the desired variables were calculated. Logistic regression and ROC curves were used to investigate the relationship and predictive power of DII and FDII with menopausal symptoms.

FINDINGS

We observed that both DII and FDII were significantly associated with the severity of sexual symptoms. The first tertile of DII (OR = 0.252, P-value = 0.002) and FDII (OR = 0.316, P-value = 0.014) had a significantly lower odds ratio for severe to moderate symptoms compared to the third tertile. Both inflammatory indices had significant predictive power in predicting the probability of having severe to moderate poor quality of life (FDII (p-value = 0.004) > DII (p-value = 0.006)) and sexual symptoms (DII (p-value = 0.002) > FDII (p-value = 0.003)). Also, regarding the physical subtype, only FDII (p-value = 0.002) results were significant.

CONCLUSION

Both dietary inflammatory indices appear to be suitable for predicting quality of life, but FDII had slightly more predictive power. It seems that the quality of life and severity of menopausal symptoms may be improved, particularly with regard to sexual symptoms, by following an anti-inflammatory diet.

Comparison of predictive effect of the dietary inflammatory index and empirically derived food-based dietary inflammatory index on the menopause-specific quality of life and its complications

INTRODUCTION

Menopause, defined as the cessation of menstruation for at least 12 months, is one of the important stages of a woman's life cycle. Some hormonal variations occur during the transition to menopause, which affects women's quality of life. Recently, the role of dietary factors in alleviating symptoms has been investigated.

AIM OF THIS STUDY

We tried to investigate the relationship between dietary inflammatory index (DII), food-based dietary inflammatory index (FDII) and quality of life, and menopausal symptoms, comparing their predictive power and suggesting the best cut-off point.

METHODOLOGY

One hundred forty-nine postmenopausal women were included in the cross-sectional study. After collecting data by interview, the desired variables were calculated. Logistic regression and ROC curves were used to investigate the relationship and predictive power of DII and FDII with menopausal symptoms.

FINDINGS

We observed that both DII and FDII were significantly associated with the severity of sexual symptoms. The first tertile of DII (OR = 0.252, P-value = 0.002) and FDII (OR = 0.316, P-value = 0.014) had a significantly lower odds ratio for severe to moderate symptoms compared to the third tertile. Both inflammatory indices had significant predictive power in predicting the probability of having severe to moderate poor quality of life (FDII (p-value = 0.004) > DII (p-value = 0.006)) and sexual symptoms (DII (p-value = 0.002) > FDII (p-value = 0.003)). Also, regarding the physical subtype, only FDII (p-value = 0.002) results were significant.

CONCLUSION

Both dietary inflammatory indices appear to be suitable for predicting quality of life, but FDII had slightly more predictive power. It seems that the quality of life and severity of menopausal symptoms may be improved, particularly with regard to sexual symptoms, by following an anti-inflammatory diet.

The spousal role of middle-aged Iranian women: A qualitative content-analysis study

This study aimed to explain the spousal role in the lives of Iranian middle-aged women. This qualitative study was conducted in Iran from July 2018 to November 2019. The participants included 25 middle-aged women selected through purposive sampling. The data were collected using semi-structured interviews and analyzed through conventional content analysis. The theme of reviving the spousal role was explained by three main categories of paying more attention to the spouse's needs, enhancing feminine charms, and maintaining married life. A deeper understanding of the middle-aged women's spousal role may help health-care personnel to develop indigenous marriage-enrichment programs for middle-aged individuals.

He hurts her womb: Physical-sexual violence and pregnancy complications among women in Afghanistan

Background: Though some studies show the association between intimate partner violence and pregnancy complications in developed countries, the association remains understudied in less developed and low-income settings. This study examines the association of physical and sexual violence with pregnancy complications among women in Afghanistan.

Methods: This study used the data from the 2015 Afghanistan Demographic and Health Survey (AfDHS). The analysis included 7229 women aged between 15 and 49 and used logistic regression to show the association of physical and sexual violence with pregnancy compilations. The analysis controlled for some potential variables and followed complex survey design factors such as strata, clusters, and survey weights.

Results: Fully adjusted regression model shows that the women who experienced physical violence were 21% (adjusted odds ratio [OR]=1.21; confidence interval [CI]=0.98, 1.50; P <0.1) more likely to endure pregnancy complications compared to those who did not face the violence. Likewise, the women experiencing sexual violence were 89% (adjusted OR=1.89; CI=1.37, 2.62; P <0.01) higher to face pregnancy complications than those who did not face any of sexual violence. More specifically, physically and sexually violated women were highly prey to the complications that increased with the increment of the violence.

Conclusion: This study adds that policymakers may formulate policies for ensuring 3C (caring couple counselling) by readdressing couple relationships, raising gender rights and awareness, providing reproductive health literacy, and increasing mental health awareness during pregnancy.

The association between sexual function and body image among postmenopausal women: a cross-sectional study

BACKGROUND

Postmenopause physiological changes may alter body image (BI) during the postmenopausal period of life. Body image dissatisfaction may have negative effects on the sexual function of women. The present study aims to assess the relationship between body image and sexual function during the postmenopausal period.

METHODS

This cross-sectional study was performed on 231 postmenopausal women who were menopausal during the recent 5 years, aged > 40 years old, and referring to health centers in Tehran-Iran. The participants were recruited using a multi-stage sampling method. Data were collected using 3 questionnaires including socio-demographic, Fisher's Body Image, and female sexual function index (FSFI). Data were analyzed using SPSS 24 and multiple regression, Mann-Whitey, Pearson, and Spearman correlation tests.

RESULTS

Two hundred thirty-one postmenopausal women aged 52.53 ± 5.32 (mean ± SD) years old participated in the study. The mean and standard deviation of FSFI and BI of the women were respectively 19.59 ± 11.11(ranges 1.2-36) and 155.43 ± 37.09 (ranges from 46 to 230). According to FSFI, 62.8% of female sexual dysfunction (FSD) was reported. There were significant correlations between scores of total and all domains of FSFI with scores of total and all dimensions of BI. There was also a positive correlation between education and family income of the women and a negative correlation between age of husband and duration of menopause with their sexual function. Significant relationships were also shown between the women's and the husbands' jobs with the total score of women's sexual function. According to the multiple linear regression model, BI was a significant predictor of sexual function in postmenopausal women.

CONCLUSION

Body image is effective on the sexual function of postmenopausal women. Therefore, body image is necessary to be considered in future postmenopausal health promotion programs.

Effects of Group and Individual Culturally Adapted Cognitive Behavioral Therapy on Depression and Sexual Satisfaction among Perimenopausal Women

Aims: Previous research has shown the efficacy of culturally adapted Cognitive Behavioral Therapy (CA-CBT) in reducing depression, yet its effect on increasing sexual satisfaction is not well documented. In this study, an embedded randomized controlled trial design was used to examine the effect of group and individual CA-CBT on depression and sexual satisfaction among perimenopausal women. Method: A total of 64 depressed Iranian perimenopausal women were randomly assigned to two formats of treatments; sixteen sessions of group CA-CBT and eight sessions of individual CA-CBT, as well as a waitlist control group. Depression and sexual satisfaction were measured using BDI-II and ENRICH, respectively, at T1 (pre-treatment), T2 (post-treatment) and T3 (follow-up). Results: Repeated measures ANOVA indicated that the women who underwent both group and individual CA-CBT had effectively reduced depression and increased sexual satisfaction between pre-treatment and post-treatment, and it was sustained after six months of follow-ups with large effect sizes of significant differences (p < 0.001), but the control group did not. Conclusion: The results showed promising evidence for the efficacy of both treatment groups of CA-CBT for depression and sexual satisfaction among perimenopausal women. The population mental health burden among perimenopausal women may likely be reduced by propagating this effective treatment.

The Impact of Couple Therapy Based on Relationship Enrichment Approach on Couples’ Intimacy and Sexual Function

Background: Intimacy is one of the basic and psychological needs of couples and is a motivating factor in their sexual participation. Objectives: To determine the impact of couple therapy based on the relationship enrichment approach on the intimacy and sexual function of the couples consulting healthcare centers. Methods: This research was a quasi-experimental study and was performed on 60 couples referring to Comprehensive Health Centers in the southeast of Iran in 2020. The research instruments included a demographic information questionnaire, three standard questionnaires of intimacy and sexual function of men and women. The educational content was implemented only for the intervention group. Data were collected at baseline, 8th week, and 12th week after the intervention. Data were analyzed using descriptive statistics and two-factor repeated measures ANOVA using SPSS (ver. 21) software. Results: The results showed that the intervention had a significant effect on sexual function and intimacy in the intervention group in three time periods (P < 0.001), whereas in the control group, no significant difference was observed in the three time periods (P > 0.05). Conclusions: The results showed that relationship enrichment counseling can increase intimacy and sexual function of couples.

The Persian Version of Menopause Rating Scale (MRS): A Psychometric Study

Objective

Menopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS).

Study Design

The study was conducted on a random sample of 270 middle-aged women (age range 40-60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects.

Results

Content validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.91) indicated good internal consistency.

Conclusion

The Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.

Psychological well-being and happiness among Middle-aged women: A cross-sectional study

Biological, physical, and psychosocial changes that occur during the aging process can negatively impact women's mental health and happiness at midlife. In this cross-sectional study, we aimed to determine the level of psychological well-being and happiness among middle-aged women in Tabriz. Data were collected from December 2017 to February 2018 by face-to-face interviews, using structured questionnaires of happiness and psychological well-being. The participants were 40-60-year-old middle-aged women (n = 300) selected by clustered random sampling allocation. A total of 167 (55.7%) out of all the women had decreased levels of psychological well-being. Psychological well-being was found to be significantly lower among the women with low levels of happiness (B: 24.43, CI (18.57 to 30.29), p < 0.001). Health care centers should implement more comprehensive mental health promotion programs for middle-aged women, including free of charge recreational opportunities (e.g., walking, swimming, dancing) to improve psychological health and well-being.

Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation

OBJECTIVE

Menopause triggers changes in sexual function and many women develop sexual problems. Insomnia is common in postmenopausal women, and disturbed sleep has been linked to poor sexual health. Thus, postmenopausal women with insomnia may be especially vulnerable to developing sexual difficulties. This study estimated rates of sexual distress in postmenopausal women with chronic insomnia and explored associations between various facets of sexual health, insomnia symptoms, and insomnia-related stress dysregulation.

DESIGN

Cross-sectional.

SETTING

Large multi-site health system in the US.

PARTICIPANTS

150 postmenopausal women diagnosed with DSM-5 chronic insomnia disorder (56.44±5.64 years) completed measures of sexual distress, sexual function, hot flashes, insomnia symptoms, depression, and stress dysregulation in the forms of cognitive-emotional arousal (worry, rumination), sleep reactivity, and somatic hyperarousal.

RESULTS

Nearly half of the sample endorsed clinically significant sexual distress (46.9%). Insomnia symptoms were largely associated with poor sexual arousal, orgasmic dysfunction, sexual distress, and sexual dissatisfaction. Insomnia-related stress dysregulation was similarly associated with these facets of sexual health but was also linked to problems with low desire and greater vaginal pain during sex. Hot flashes and depression were negatively associated with sexual health.

CONCLUSION

Postmenopausal women with chronic insomnia endorse high rates of sexual distress. Although compromised sexual function appears directly related to poor sleep itself, our data suggest that stress dysregulation may play vital role in sexual problems endorsed by postmenopausal insomniacs, particularly regarding low desire and vaginal pain. Prospective research is needed to characterize the evolution of these co-occurring symptoms.

Women's sexual health in later life: Gaps and opportunities in research and practice

This article complements emerging reviews and summaries of the recent expansion of sexuality studies within and beyond geriatrics and associated fields. To this end, we synthesize important insights and discussions taking place throughout geriatrics and other fields at present, and situate these conversations in broader discussions concerning sexualities, health, and aging. In so doing, we outline some gaps in existing work as well as opportunities for not only filling these gaps in our understandings of women's sexual health in later life but also in order to demonstrate the usefulness of expanding prior approaches to analyses concerning womanhood, aging, sexualities, and health over the life course. In conclusion, we outline some specific pathways for future research concerning women's sexual health in later life.