The Association of Breastfeeding with a Reduced Risk of Postpartum Depression: A Systematic Review and Meta-Analysis

Background: Previous research has noted an association between breastfeeding and a reduced risk of postpartum depression (PPD). This article provides a systematic review and meta-analysis on the possible association of the type and degree of breastfeeding and PPD. Methods: A systematic literature search in English was conducted by using PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Library Databases from their start dates until January 2021. Outcome estimates were pooled by odds ratios (ORs) or standardized mean differences. Result: Women who did not exclusively breastfeed had 89% higher odds of PPD (OR = 1.89, 95% confidence interval [CI]: 1.50-2.39). Included studies used different cutoff points for the diagnosis of PPD. Therefore, PPD in nonexclusive breastfeeding mothers was more in studies using the cutoff point 9/10 (OR 1.97, 95% CI 1.46-2.64) as symptoms of depression than those using the cutoff point 12 (OR 1.78, 95% CI 1.21-2.61). Some studies reported PPD based on means and the others reported it based on OR. Accordingly, nonexclusive breastfeeding mothers had higher odds of PPD in studies calculating the effect size based on means (OR 1.62, 95% CI 1.19-2.19) and OR (OR 2.36, 95% CI 1.65-3.39) than in other studies. Conclusion: This review showed that exclusive breastfeeding is associated with a reduced risk for PPD.

The Effects of Pregnancy-Adaptation Training on Maternal-Fetal Attachment and Adaptation in Pregnant Women With a History of Baby Loss

BACKGROUND

Studies have shown that educating mothers can improve their adaptation to pregnancy and motherhood roles. There are also studies that have investigated the effects of certain interventions on maternal-fetal attachment. However, studies on the effects of maternal adaptation training on maternal-fetal attachment in mothers with a history of fetal or baby loss are rare.

OBJECTIVES

The aim of this study was to determine the effects of a pregnancy adaptation training package on maternal-fetal attachment in pregnant women with a history of baby loss.

PATIENTS AND METHODS

This quasi-experimental study was conducted on 60 pregnant women with previous fetal or neonatal death in 2014. The women were randomly divided into an experimental group (n = 30) and a control group (n = 30). The pregnant women in the experimental group received routine prenatal education in addition to four sessions of a pregnancy adaption training package. The control group received only routine prenatal education. The data were collected using a demographic questionnaire, Cranley's maternal-fetal attachment scale, and a prenatal self-evaluation questionnaire at the beginning and at the end of the study. The data analysis was conducted using the Mann-Whitney U, Wilcoxon, chi-square, Fisher's exact, and spearman correlation coefficient tests.

RESULTS

Before the intervention, there were no statistically significant differences between the study and control groups in terms of maternal-fetal attachment (P = 0.280) and adaptation to pregnancy (P = 0.883). However, following the intervention, the mean score of the maternal-fetal attachment was significantly higher in the experimental group, when compared with the control (77.57 ± 7.23 vs. 61.53 ± 2.62; P = 0.001). In addition, the mean post-intervention adaptation to pregnancy score was significantly lower in the experimental group than in the control group (118.89 ± 8.12 vs. 126.38 ± 4.17; P = 0.001).

CONCLUSIONS

The pregnancy adaptation training package increased the adaptation and maternal-fetal attachment scores in pregnant women with a history of baby loss.

Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran

OBJECTIVES

The successful implementation of evidence-based practice (EBP) can lead to appropriate and effective midwifery care during pregnancy, childbirth and in the postnatal period. However, levels of knowledge and confidence in one's ability to apply EBP are related to its effective implementation. This study aimed to investigate levels of knowledge, practice of and self-efficacy towards the use of EBP among midwives in East Iran.

METHODS

This cross-sectional study took place between January and February 2016 and involved 98 midwives employed at two hospitals and all four urban health care centres in Torbat-e Heydariyeh, Iran. Two subscales of the Evidence-Based Practice Questionnaire were used to assess participants' knowledge and practice of EBP, respectively, while a modified version of a previously described scale was used to determine self-efficacy.

RESULTS

A total of 76 midwives participated in the study (response rate: 77.6%). Mean knowledge, practice and self-efficacy scores were 4.48 ± 0.94, 3.53 ± 0.68 and 2.80 ± 0.81, respectively. Significant relationships were found between mean self-efficacy, practice and knowledge scores and proficiency in English language (P = 0.001 each) and statistical methods (P <0.050 each). Additionally, significant relationships were found between knowledge and practice of EBP and proficiency in the use of databases (P <0.050 each). Knowledge and self-efficacy scores were significantly correlated with practice (P = 0.001 each).

CONCLUSION

These findings demonstrate a need for improvement in the self-efficacy, practice and knowledge of EBP among midwives in East Iran. Interventions that promote these factors may help increase the use of EBP in this population.

The Effect of Chamomile Cream on Episiotomy Pain in Primiparous Women: A Randomized Clinical Trial

Introduction: Episiotomy is a surgical incision made in the perineum to enlarge it. Perineal pain is the most common complaint of mothers after episiotomy. Chamomile extract has been proposed as a sedative in traditional medicine. This study was conducted to assess the effect of chamomile cream on the pain after episiotomy.

Methods: This triple blind clinical trial was performed on 114 eligible women at Ommolbanin Hospital in Mashhad, Iran in 2014.They were randomly assigned to two groups using random blocks. After delivery, mothers in the intervention group used 0.5 g of prescribed chamomile while the control group used placebo cream on the stitch twice a day lasting ten days. Episiotomy pain was evaluated before intervention and 12 hours after episiotomy repair and also on the first, seventh, tenth and fourteenth day after delivery by McGill pain questionnaire. Data was analyzed by SPSS ver.13.

Results: There was no significant difference between the two groups before the intervention, 12 hours and the first day after delivery. However, a significant difference was found on the seventh, tenth and fourteenth day after delivery. McGill mean (SD) score on the seventh, tenth and fourteenth in experimental group was 11.36 (5.04), 4.44 (3.43) and 7.16 (4.10) respectively. It was reported 14.88 (7.34), 7.41(4.92) and 9.96 (4.81) in placebo group, respectively.

Conclusion: Chamomile cream can be used to reduce episiotomy pain in Primiparous us women.

The relationship between personality traits and sexual self-esteem and its components

BACKGROUND

Women's sexual self-esteem is one of the most important factors that affect women's sexual satisfaction and their sexual anxiety. Various aspects of sexual life are blended with the entire personality. Determining the relationship between personality traits and self-concept aspects such as sexual self-esteem leads to better understanding of sexual behavior in people with different personality traits and helps in identifying the psychological variables affecting their sexual performance. The aim this study was to determine the relationship between personality traits and sexual self-esteem.

MATERIALS AND METHODS

This correlation study was performed on 127 married women who referred to selected health care centers of Mashhad in 2014-2015. Data collection tools included NEO personality inventory dimensions and Zeanah and Schwarz sexual self-esteem questionnaire. Data were analyzed through Pearson correlation coefficient test and stepwise regression model.

RESULTS

The results of Pearson correlation test showed a significant relationship between neuroticism personality dimension (r = -0.414), extroversion (r = 0.363), agreeableness (r = 0.420), and conscientiousness (r = 0.364) with sexual self-esteem (P < 0.05). The relationship between openness with sexual self-esteem was not significant (P > 0.05). In addition, based on the results of the stepwise regression model, three dimensions of agreeableness, neuroticism, and extraversion could predict 27% of the women's sexual self-esteem variance.

CONCLUSIONS

The results showed a correlation between women's personality characteristics and their sexual self-esteem. Paying attention to personality characteristics may be important to identify at-risk group or the women having low sexual self-esteem in premarital and family counseling.

Assessment of Family Functioning and Its Relationship to Quality of Life in Diabetic and Non-Diabetic Women

Introduction: One of the most important components and health indicators, especially among people with chronic diseases is quality of life. One of the possible factors which may impact on quality of life of diabetic patients is family functioning. This study aimed to determine the relationship between family functioning and quality of life of diabetic and non-diabetic women. Methods: In this correlational cross-sectional study, 180 women (diabetics and non-diabetics) who referred to health centers in Mashhad in 2014-2015 were studied. Data were collected using SF-36 questionnaire and Mc Master Family Assessment Device (FAD). Data were analyzed using descriptive and statistical tests by SPSS ver.13 software. Results: The result showed that diabetic women reported family impairment compared with none diabetic women. There was a significant relationship between the family functioning and quality of life in diabetics and non-diabetic women. Based on the results of the stepwise regression model, among factors of family function only the factor of behavioral control was able to predict the quality of life in diabetic women. Conclusion: Regarding the study findings, good family function associated with better quality of life in diabetics and healthy women. Therefore, due to disturbed family function in diabetic's women implementation of training programs and consulting services could improve their quality of life.

The relationship between body mass index, body image, and sexual function: A survey on Iranian pregnant women

Background

The prevalence of sexual problems is high during pregnancy. Despite this, there are limited data about the impact of physical and psychological factors such as body weight and body image on sexual function in pregnant women.

Objective

To investigate the relationship between body mass index, body image, and sexual function among pregnant women.

Materials and Methods

In this cross-sectional study, a total of 206 Iranian pregnant women (106 with normal weight and 100 overweight women) in their 2nd and 3rd trimesters of pregnancy were surveyed. Survey instruments included the Female Sexual Function Index and Multidimensional Body-Self Relations Questionnaire.

Results

The prevalence of female sexual disorder was 72.3% in this survey. Diminished sexual desire/appetite was the most common problem reported by the participants (37.9%). The mean score of sexual problem and body image were not significantly different among overweight and normal weight women in the 2nd (p = 0.945 and p = 0.800, respectively) and 3rd trimesters of pregnancy (p = 0.310 and p = 0.507, respectively). Further, there were no relationships between the body mass index plus body image and the total female sexual function score (p = 0.44 and p = 0.837, respectively). However, the relationship between the appearance evaluation with lubrication (p = 0.043) and subjective weight with two subscales of sexual satisfaction (p = 0.005) and orgasm (p = 0.019) were significant.

Conclusion

The findings from this study revealed that there were no relationships between body mass index plus body image score and the sexual function in pregnancy. Therefore, a further research is recommended to study other potential factors affecting sexual function during pregnancy.

Marital satisfaction and its associated factors at reproductive age women referred to health centers

BACKGROUND

Marital satisfaction, as one of the elements of family health, is affected by various factors such as social norms, customs, and expectations. Sexual self-efficacy as one of the important aspects of female sexual affairs may be related to the marital relationship. The aim of this study was to evaluate the related factors of marital satisfaction in Torbat Heydariyeh, Iran.

METHODS

This research was a cross-sectional study performed on 350 married women in the reproductive age referred to health centers in Torbat Heydariyeh, Iran, in 2018. The data collection tools were Evaluation and Nurturing Relationship Issues, Communication, and Happiness Marital Satisfaction Questionnaire and a sexual self-efficacy questionnaire derived from Schwarzer general self-efficacy scale. The data were analyzed with Pearson's correlation coefficient and linear regression. A P < 0.05 was considered statistically significant.

RESULTS

The mean age of the participants was 30.85 ± 7.56 years. Most people had high sexual self-efficacy (51%) and relative and intermediate marital satisfaction (68%). There was also a significant relationship between sexual self-efficacy and marital satisfaction (P = 0.001). According to the linear regression test, only three variables of sexual self-efficacy, dyspareunia, and socioeconomic status explain 12% of the variance of marital satisfaction in women (P < 0.05).

CONCLUSION

The results indicated that sexual self-efficacy, dyspareunia, and socioeconomic status have significant relationship with marital satisfaction. Due to the significant relationship between sexual self-efficacy and marital satisfaction, some interventions to improve this aspect of sexual life may increase the satisfaction of individuals from marital life.

Sexual function and quality of life in diabetic women referring to health care centers in Mashhad

CONTEXT

Quality of life (QOL) is one of the important indexes of health and well-being promotion in the diabetic patients. Based on numerous studies, these patients have a lower QOL, compared to nondiabetic individuals. In addition, a higher prevalence of sexual function disorder has been reported in their population that can have a negative effect on their QOL.

AIMS

This study aimed to investigate the association between sexual function and QOL in diabetic women referring to health care centers in Mashhad during 2013-2014.

SETTINGS AND DESIGNS

In this correlational study, the association between sexual function and QOL in 90 diabetic women with type two diabetes referring to health care centers in Mashhad during 2013-2014 was investigated.

SUBJECTS AND METHODS

Data were collected by Rosen female sexual function index and short form-36 questionnaires.

STATISTICAL ANALYSIS USED

Data were analyzed by mean comparison and Spearman correlation coefficient statistical test through SPSS 16.

RESULTS

Subjects' mean sexual function score was 21.7 ± 6.30. Based on the finding, 25.6% of the subjects suffered from sexual function disorder. Subjects' mean score of QOL was 58.75 ± 1616.24. There was a significant association between an overall score of sexual function and its subscales, with their QOL and two dimensions of overall physical and psychological and mental health scores (P < 0.005).

CONCLUSIONS

Sexual function is one of the important and associated aspects of QOL in diabetic patients. Designing and evaluation of the interventions with the goal of an improvement in this variable plays a notable role in the promotion of these patients' QOL. However, with regard to limited research in this field, further studies on this association are suggested.

Midwives' Attitude and Barriers of Evidence Based Practice in Maternity Care

OBJECTIVES

Midwives have a crucial role in providing optimal care for pregnant women. One of the most important policies for quality improvement in maternity care is implementation of evidence-based practice. However, the application of evidence-based practice within the maternity health care setting faces many challenges. The purpose of this study was to describe Iranian midwives' attitude and perceived barriers of evidence based practice in maternity care.

METHODS

In this descriptive, cross-sectional study, a census sample of 76 midwives from two public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran were surveyed. Data collection tools were two reliable and valid questionnaires that measure midwives' attitudes and barriers of implementation of evidence-based practice. Data were analysed using SPSS version 16.

RESULTS

The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years, respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30-60). This study also found time constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literature in one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling of inadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.

CONCLUSION

Survey participants demonstrated a positive attitude toward EBP. Organisational comprehensive strategies such as time efficiency, adequate material and human resources, familiarity with organisations such as the Cochrane Collaboration and managerial support for increasing professional legitimate authority are recommended to promote the use of Evidence-Based Practice in Iran.

Sexual function after childbirth: a meta-analysis based on mode of delivery

Although many women report sexual dysfunction in the postpartum period, controversial research has been reported the relationship between delivery mode and sexual function. This meta-analysis aimed to investigate the sexual function after childbirth and identify the difference of sexual function based on the female sexual function index (FSFI) questionnaire in women with elective cesarean section, vaginal delivery with episiotomy and vaginal delivery without episiotomy. Studies were found by searching in Medline, PubMed, Web of Science, Scopus and considering the references of the related papers from their start dates until September 2021. All observational studies in English that reported the mean and SD of score of sexual function and its domains based on the mode of delivery were included in this meta-analysis. Random effect model was used to combine the results of included studies on female sexual function and its subdomains. Finally, 17 articles with a total population of 3410 were included in the meta-analysis. Total mean (95 percent CI) of sexual function was 24.27 (22.82, 25.72) with substantial heterogeneity among studies (χ2 = 7487.63, P < .001; I² = 99.45). In subgroup analyses, the mean score of sexual function was significantly differed in terms of time elapsed since delivery (P = .04) and studied country (P < .001). But, the mode of delivery has no significant effect on postpartum sexual function and subdomains. The result indicated that elective cesarean section, vaginal delivery with episiotomy, vaginal delivery without episiotomy are not associated with the female sexual function.

Effects of progestin contraceptive methods on sexual function in reproductive age women: a meta-analysis

AIM

The aim of this study was to investigate the effects of progestin contraceptive methods on sexual function in reproductive-age women.

METHODS

The published literature was identified via a systematic search in medical databases of PubMed, SCOPUS, ISI Web of Sciences, Embase, Cochrane library and Google Scholar up to December 2019 using relevant search terms. All randomized controlled trials or before-after studies which assessed the effects of progestin contraceptive method on sexual function in human were included in the analysis. Data extraction was done separately by two independent reviewers. A random-effects meta-analysis was performed to calculate the overall mean effect sizes. Heterogeneity was assessed using Q test and I² index. Publication bias was performed by visual inspection of funnel plots and Egger bias test.

RESULTS

A total of 5244 articles were found in primary search, of which 19 studies (N  =  710 participants) met the inclusion criteria for the meta-analysis. The results of the random effects meta-analysis suggested no effect of implant on sexual function three months after insertion (WMD: 1.85; 95% CI: -0.34 to 4.04; p = .098). In contrast, this method has a positive effect on sexual function six months after insertion (WMD: 3.48; 95% CI: 2.78 to 4.19; p = .001). Furthermore, the results of random effects models indicated that there was no significant effect of LNG-IUS on female sexual function until 12 months after insertion (WMD: 3.20; 95% CI: -1.56 to 7.98; p = .188). Any evidence of publication bias was found.

CONCLUSIONS

The findings showed a positive or neutral effect of implant and LNG-IUS on female sexual function. Given the importance of examining sexuality in contraceptive users, this study provides new evidence, which can be offered to women during contraceptive counseling.

The Relationship of Socio-Demographic Factors, Fertility Behavior and Child's Perceived Value with Fertility

BACKGROUND

Fertility intention is one of the strongest predictors of couple's fertility behavior that is affected by many variables. This study aimed to identify the relationship of socio-demographic factors, fertility behavior, and child's perceived value with fertility intention of women in a region in the east Iran.

METHODS

In this descriptive cross-sectional study, 241 married women aged between 15 and 49 years of Torbat Heydariyeh City in 2015, were studied. The data collection scales included a demographic information form, fertility information questionnaire and Trommsdorff's child value questionnaire. Data were analyzed using SPSS 16 by Chi-square, Kruskal-Wallis, t-independent test and logistic regression. The significance level of P<0.05 was considered.

RESULTS

Most of the subjects (52.7%) had no fertility intention. Independent-samples test and Kruskal-Wallis revealed significant differences in fertility intention with the subject's age, mate's age, number of children and costs of children (P=0.001). In addition, in subjects with children of both sexes, intention for childbearing was significantly lower when compared to subjects with only one sex in children (P=0.001). However, when the logistic regression test was performed, being housewife, number of children, having children of both sexes, benefit and costs of children showed statistical significance (P<0.05).

CONCLUSION

The results indicate that being housewife, number of current children, having children of both sexes, and perceived childbearing costs are important in determining the odds that a woman will intend to have a child. These findings can contribute to the realization of new population programs towards higher fertility rate in the country.

Comparison of the Effect of Cumin Cyminum and Nettle Oral Drops on the Breast Milk Sufficiency Indicators in New Mothers

Objectives

This study aimed to compare the effects of green cumin (Cuminum cyminum) and nettle (Urtica dioica L.) oral drops on the indicators of breast milk adequacy in lactating mothers. Due to the presence of phytoestrogens in the combinations of cumin and nettle, it is stipulated that they may have milk-increasing properties.

Methods

A triple-blind, randomised, controlled clinical trial was conducted on 117 lactating mothers who had given birth to healthy infants aged 10-15 days and who received cumin oral drops (n = 39), nettle oral drops (n = 39) or placebo (n = 39) from August 2020 to March 2021. The participants were recruited from a regional public health care centre affiliated with Iran University of Medical Sciences of Tehran, Tehran, Iran. The 3 study groups received 15 drops thrice a day for 4 weeks. Infant weight, breastfeeding frequency, number of wet diapers, diaper weight and frequency of infant defecation were evaluated before and after the intervention.

Results

At the beginning of the trial, no statistically significant differences were observed between the 3 groups for infant weight (P = 0.891), breastfeeding frequency (P = 0.921), number of wet diapers (P = 0.783), diaper weight (P = 0.841) and frequency of infant defecation (P = 0.898). However, following the intervention, the mean scores of all indicators were significantly higher in the experimental groups than in the placebo group (P <0.001). In addition, all the indicators in the cumin group increased significantly compared to those in the nettle group (P <0.001).

Conclusion

Considering the effectiveness of cumin and nettle drops in increasing milk and the availability of these native plants in Iran, it is suggested that they, especially cumin, be used postpartum to increase breast milk production.

Exploring the decision-making process of female genital cosmetic procedures in Iranian women and constructing and validating a results-based logic model for a healthy public policy: a study protocol

BACKGROUND

Female genital cosmetic procedures have grown rapidly in most parts of the world. Professional organizations have issued warnings about the complications and long-term consequences of these practices. To be able to adopt the right health policies, it is necessary to know why women decide to perform these procedures. Therefore, the present study will be aim to discover the decision-making process involved in performing female genital cosmetic procedures for Iranian women and construct and validate a results-based logic model for healthy public policy.

METHODS

The present study was conducted in three phases. In the initial phase, a qualitative study will be conducted with the Corbin and Strauss ground theory approach. The participants in the study will be healthy women who desire or have undergone female genital cosmetic procedures without medical indications. In this phase, purposive and theoretical sampling will guide recruitment and data collection. The data will be collected via semi-structured interviews, field notes and observations of individual interactions. The data will be analysed using the approach of Corbin and Strauss (2015). MAXQDA 2007 software was used for managing the process of data analysis. In the second phase, the development of a results-based logic model for a healthy public policy is performed based on the findings of the first phase of the study, interviews with key informants and a review of the results of the literature in this field. Finally, validation of the designed program will be performed by the nominal group technique with the presence of a group of experts in the third phase.

DISCUSSION

The findings of this study, by identifying women's main concerns related to the studied phenomenon, the existing context, participants' reactions and the consequences of the adopted reactions, can be very important in designing a program that fits Iran's cultural characteristics. In this research, a program using a logical model will be presented that is suitable for policymakers, planners and healthcare service providers to be implemented in the social-cultural context of the study.

Female genital cosmetic procedures from the perspective of health practitioners: a systematic review of knowledge, attitude and practice studies

BACKGROUND

Currently, the popularity of female genital cosmetic procedures is on the rise worldwide. Despite the multiple roles of healthcare practitioners at different stages of women's decision-making for these procedures, limited studies have been conducted in this area. This systematic review aimed to summarize the available qualitative and quantitative data from observational studies that investigated healthcare practitioners' knowledge, attitudes and practices regarding female genital cosmetic procedures.

METHOD

The present systematic review was performed based on PRISMA guidelines. All published studies that examined the knowledge, attitudes and practices of healthcare practitioners regarding female genital cosmetic procedures were included. PubMed/Medline, Scopus, Web-of-science, ScienceDirect and Google Scholar were searched using related keywords until 30 November 2023. Quality assessment was performed using the Appraisal Tool for Cross-Sectional Studies and Checklist for Qualitative Research from the Joanna Briggs Institute.

RESULTS

Eight studies comprising 2063 healthcare practitioners met the inclusion criteria and were analysed. Based on the results, some healthcare practitioners in the included studies acknowledged the naturalness of the variety of female genitalia, but others considered very small labia as attractive. There was little agreement on the positive effects of female genital cosmetic procedures on improving women's quality of life and sexual function in the included studies. Nearly all healthcare practitioners have seen women who had concerns about being natural of their genitalia. Meanwhile, approximately two-thirds of them had encountered women requesting female genital cosmetic procedures. Only three-quarters of healthcare practitioners felt confident in assessing the normality of genital appearance. The willingness to perform female genital cosmetic procedures was higher among male healthcare practitioners and plastic surgeons than among females and gynecologists.

CONCLUSION

The results indicated that although a large number of healthcare practitioners had encountered women who were concerned about genitalia or requested genital cosmetic procedures, they did not have sufficient knowledge or favorable attitudes and practices in most related fields. Therefore, it is recommended to design educational interventions, formulate guidelines and make policies.

Relationship between Gender Roles and Sexual Assertiveness in Married Women

BACKGROUND

Evidence indicates that sexual assertiveness is one of the important factors affecting sexual satisfaction. According to some studies, traditional gender norms conflict with women's capability in expressing sexual desires. This study examined the relationship between gender roles and sexual assertiveness in married women in Mashhad, Iran.

METHODS

This cross-sectional study was conducted on 120 women who referred to Mashhad health centers through convenient sampling in 2014-15. Data were collected using Bem Sex Role Inventory (BSRI) and Hulbert index of sexual assertiveness. Data were analyzed using SPSS 16 by Pearson and Spearman's correlation tests and linear Regression Analysis.

RESULTS

The mean scores of sexual assertiveness was 54.93±13.20. According to the findings, there was non-significant correlation between Femininity and masculinity score with sexual assertiveness (P=0.069 and P=0.080 respectively). Linear regression analysis indicated that among the predictor variables, only Sexual function satisfaction was identified as the sexual assertiveness summary predictor variables (P=0.001).

CONCLUSION

Based on the results, sexual assertiveness in married women does not comply with gender role, but it is related to Sexual function satisfaction. So, counseling psychologists need to consider this variable when designing intervention programs for modifying sexual assertiveness and find other variables that affect sexual assertiveness.

The relationship between gender role and attitude toward menstruation with female sexual function: A cross-sectional study

Background

Although female sexual function can be affected by many psychological, interpersonal, and sociocultural factors, limited studies have focused on the relationships between this construct with some concepts such as women's attitudes toward menstruation and perception from their gender role.

Objective

To investigate the association between gender roles and attitude toward menstruation with sexual function among Iranian reproductive women.

Materials and Methods

An observational cross-sectional study was carried out on a group of 164 Iranian women referred to the health centers of Torbat Heydariyeh, between August and December 2018. All eligible women filled the female sexual function index (FSFI), Bem Sex Role Inventory, and Menstrual Attitude Questionnaire.

Results

The result showed that the total FSFI score was significantly higher in masculine and androgynous gender role groups than women with undifferentiated gender role (p = 0.014, and p = 0.012, respectively). Nevertheless, androgynous women had better sexual arousal than undifferentiated women (p = 0.013). Significant reverse correlations were observed between the perception of menstruation as a debilitating, bothersome, and predictable event with a total score of FSFI and all subscales except lubrication (p = 0.001). In contrast, there was a positive relationship between denial of any effects of menstruation with total FSFI and all its sub-scores except lubrication (p = 0.001).

Conclusion

This study highlighted the role of masculinity and androgyny gender role stereotypes and menstrual attitude in the sexual function of heterosexual women. Future studies are needed to explain how these psychological contexts contribute to different aspects of women's sexuality.

Effects of the Combined Contraceptive Vaginal Ring on Female Sexual Function: A Systematic Review and Meta-analysis

There are controversial debates regarding the effects of contraceptive vaginal ring devices on females' sexual function. Therefore, the meta-analysis of before-after was conducted on the intervention studies published in the past years to clarify these contradictions. The existing literature on the subject was reviewed by searching through such databases as PubMed, Scopus, ISI Web of Sciences, Embase, Cochrane Library and Google Scholar up to July 2021. Before-after intervention studies that had examined the effect of vaginal rings on females' sexual function were collected as well. In total, five studies with 369 participants were included in quantitative syntheses. Pooled results from the random-effect model showed that NuvaRing had a positive effect on females' sexual function three months after insertion (WMD: 2.48; 95% CI: 0.30, 4.67; P = 0.026); however, this effect was not significant after 6 months (WMD: 4.38; 95% CI: -4.95, 13.72; P = 0.357). Meta-regression analysis suggested that the effect of this device is associated with users' age and body mass index 3 months after insertion. No publication bias was found by Egger's test or funnel plots. Overall, the results of this meta-analysis support the view that vaginal ring use is associated with a positive effect on the sexual function of women 3 months after insertion, while the effect of this device on the sexual function of women was insignificant after 6 months. However, given the dearth of available data, it is not possible to reach a definite conclusion on the effect of vaginal rings on females' sexual function.

Unbridled Advertising of Female Cosmetic Genitoplasty Procedures in the Absence of Health Policymaking in the World: An argumentation

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The Effectiveness of Virtual Reality Application for Women Undergoing Episiotomy Repair: A Systematic Review and Meta-analysis

Introduction

Virtual reality (VR) is effective in several healthcare domains. As of date, there have been no systematic reviews investigating the efficacy of VR technology in episiotomy repair in women. This systematic review and meta-analysis examined the effects of using VR on pain, anxiety and satisfaction in women under episiotomy repair.

Methods

For the original articles, six databases were searched using relevant keywords without restriction on time or languages until June 6, 2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess the risk of bias in randomized and non-randomized studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) also determined the quality of our evidence. All analyses employed Comprehensive Meta-Analysis (CMA) V.2.

Results

Five randomized clinical trial and two quasi-experimental studies with poor-to high-quality met the inclusion criteria. The VR significantly decreased perineal pain during [MD (95% CI)=-1.622 (-2.598, -0.645), P=0.001], immediately after [MD (95% CI)=-1.931 (-2.785, -1.076), P<0.001], and one hour after [MD (95% CI)=-1.596 (-2.436, -0.765), P<0.001]. It also significantly decreased anxiety [SMD (95% CI)=-1.48 (-2.451, -0.509), P=0.003] after repair. VR group participants were significantly more satisfied than the control group. The quality of was moderate for perineal pain intensity one hour after episiotomy repair and anxiety after episiotomy repair.

Conclusion

Given the efficacy of VR on pain, anxiety, and satisfaction, it is suggested that it be utilized as a novel modality to enhance the quality of maternity hospital care.

The Relationship between Menstrual Pattern and Menstrual Attitude Dimensions in Reproductive-age Women

Objective: Women's attitudes towards menstruation play a critical role in shaping their body and psychosocial integrity. Menstruation is affected by some bio-psychosocial factors; therefore, more in-depth understanding is needed to cope better with the consequent difficulties. This study aimed to investigate the relationship between menstrual patterns and menstrual attitude dimensions in reproductive-age women. Methods: An observational cross-sectional study was conducted on 170 women referred to the urban health centers of Torbat Heydariyeh, Iran, from January 2019 to December 2019.  The Menstrual Attitudes Questionnaire (MAQ) and Verbal Multidimensional Scoring (VMS) systems were used to collect the required data. The features of the menstrual cycle were also recorded. Results: The overall response rate was 96.74%. Women with dysmenorrhea perceived menstruation as a more debilitating, bothersome, and predictable event and less denied any menstrual effect (p=0.001). The results also revealed that the subjective menstrual blood loss was associated with higher levels of perceiving menstruation as a natural (p=0.008), bothersome (p=0.026), and anticipatory event (p=0.021) and reporting less denial of any menstrual effect (p=0.001). Moreover, women rated menstruation as a more bothersome event by increasing the menstrual bleeding length (p=0.014). There was no significant relationship between the other features of the menstrual cycle with menstrual dimensions (p>0.05). Conclusion: The findings of this study suggest that women's attitudes towards menstruation was associated with menstrual pain, length, and subjective volume of menstrual flow.  These factors could be used to modify women's attitudes towards the natural phenomenon of menstruation. Keywords: Attitude; Menstruation; Dysmenorrhea; Menarche; Menorrhagia.

Determinants of Maternal Near Miss among Women in Northeast Iran: A Facility-Based Case-Control Study

Background

The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran.

Materials and Methods

A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported.

Results

A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant.

Conclusions

Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.

Comparison of the efficacy of nifedipine with ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor: a systematic review and meta-analysis

BACKGROUND

Some studies have compared the efficacy of nifedipine with that of other tocolytic drugs in the treatment of preterm labor, but the reported results are conflicting.

OBJECTIVE

To compare the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor.

METHODS

In this systematic review and meta-analysis, PubMed/MEDLINE, Scopus, Clarivate Analytics Web of Science, and Google Scholar were searched until April 3,2024 using predefined keywords. Randomized controlled trials (RCTs) and clinical trials that compared the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor were included. Two authors independently reviewed the articles, assessed their quality and extracted the data. The quality of the included RCTs based on the Cochrane Risk of Bias Tool 1 for clinical trial studies. The risk difference (RD) with the associated 95% confidence interval (CI) was calculated. A forest plot diagram was used to show the comparative point estimates of nifedipine and other tocolytic drugs on the prevention of preterm labor and their associated 95% confidence intervals based on the duration of pregnancy prolongation. Study heterogeneity was evaluated by the I2 index, and publication bias was evaluated by Egger's test.

RESULTS

Forty studies enrolling 4336 women were included. According to our meta-analysis, there was a significant difference in the prolongation of preterm labor within the first 48 h between the nifedipine group and the nitroglycerine group (RD, -0.04; 95% CI, -0.08 to -0.00; I2: 32.3%). Additionally, there were significant differences between nifedipine and ritodrine (RD, 0.11; 95% CI, 0.02 to 0.21; I2, 51.2%) for more than one week RD, 0.10; 95% CI, 0.03 to 0.19; I2, 33.2%) and for 34 weeks and more. The difference between nifedipine and magnesium sulfate was not significant in any of the four time points.

CONCLUSIONS

Considering the superiority of nifedipine over ritodrine and nitroglycerine and its similar efficacy to magnesium sulfate for tocolysis, it seems that the side effects of these options determine the first drug line.