Cultural Barriers Influencing Midwives' Sexual Conversation with Menopausal Women

OBJECTIVES: The present study aimed to determine the barriers influencing the sexual conversation. METHODS: In this descriptive cross-sectional study, 200 midwives were selected through convenience sampling method from private and public clinics in Mashhad, North East of Iran. A self-structured questionnaire was used to collect the study data. RESULTS: The mean age of subjects was 39.58 ± 8.12 years with 13.49 ± 7.59 years of work experience. A number of cultural conditions act as an inhibitory force for the midwives to address sexual issues with menopausal women. Menopausal women visit a doctor at the acute stage when emotional and physical problems make sexual discussion difficult for the midwives (86.5%). Other related causes for not having proper sexual conversation were insufficient knowledge (51.4%), inadequate education provided via public media through health providers (83.5%), midwives or their patient's shame (51.5%), and attempt to get help from traditional healers, friends, relatives and supplicants instead of midwifery staff (78.5%). Also, we found that sexual workshops, communication workshops, and work experiences had a significant influence in changing the views of midwives. CONCLUSIONS: Cultural barriers prevent the patients and providers from communicating effectively with each other, thus highlighting the need for sexual and communication workshops for the health care providers.

Erratum to: Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications

Title and Abstract correction. The title and abstract should be corrected as ‘Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons and Strategies’.

Sexual Disharmony in Menopausal Women and Their Husband: A Qualitative Study of Reasons, Strategies, and Ramifications

OBJECTIVES: The goal of this study was to explore perceptions and experiences of general practitioners and midwives during sexual dialogue with menopausal women. METHODS: In a descriptive exploratory qualitative study, 13 midwives and 12 general practitioners were selected using a semi-structured interview and purposive sampling method. Data analysis was conducted using qualitative content analysis adopted by Graneheim and Lundman. RESULTS: Through data analysis “sexual disharmony” emerged as a central theme, which included three categories of reasons, strategies, and ramifications of sexual disharmony. Reasons for sexual disharmony included subcategories of aging and health related-problems, marital problems, and stereotypical perceptions regarding menopause and sexuality and daily concerns. Strategies used by couples to address sexual disharmony consisted of changing roles and values, pretending to reach orgasm, suppressing sexual desire, meeting sexual needs of husbands in accordance with religious rules, seeking help of peers, seeking friends or traditional medicine and health providers, seeking a help charmer, engaging in sex with other women to fulfill sexual needs, pretending to be moody to alleviate sexual tension. Sexual disharmony may lead to spending money on a prostitute instead of engaging in sex out of wedlock or a surge in social pathologies such as sexually transmitted disease. CONCLUSIONS: Healthcare providers must be aware of various sexual behavior of menopausal women and their husbands when they detect sexual disharmony in their patients. Results of this study can facilitate development of restricted guidelines for sexual discussion with menopausal women.

Development and psychometric properties of the decision making on the type of delivery questionnaire in Iranian women

Background: A tool which can help to decide on the determinants in selecting the delivery type is an effective step towards the goals of the World Health. This study aimed to develop and evaluate the psychometric properties of a scale based on Iranian culture to make decision on the type of delivery

Methods: This is a methodological study using a questionnaire proposed by Schneider. The following steps were used to design the project. In the first step, perceptions and experiences of 45 pregnant women, postpartum women, midwives, gynecologists and non-pregnant women were determined based on interviews and observations using focused ethnography. In the second stage, the terms in the questionnaire based on qualitative study was assessed. Then, in the third stage, psychometric testing of the decision making on the type of delivery scale [DMTDS] based on the cultural concepts of decision making towards the type of delivery and its influencing factors based on focused ethnography using face validity, content validity, construct validity, internal consistency and reliability was done on400 pregnant and postpartum women

Results: The initially developed scale consisted of 60 items on a 5-point Likert scale, which reduced to 43 items following measurement of the face and content validity. The results of the exploratory factor analysis elicited 36 items and a seven-factor structure including motivational beliefs on vaginal delivery, social beliefs towards childbirth, motivational beliefs on cesarean delivery, personal beliefs, sources of information, catastrophic thinking and child birth experiences. Cronbach's alpha coefficient [0.80] confirmed the high internal consistency of the scale

Conclusion: The developed questionnaire appears to be a valid and reliable tool for health care providers to measure the women's decision making towards type of delivery. Therefore, this tool can be used in the Iranian community. The scale may help the midwives and obstetricians to be aware of the women's decision regarding their choice of delivery and as a result to plan appropriately in order to reduce unnecessary cesarean sections

Effectiveness of infertility counseling on pregnancy rate in infertile patients undergoing assisted reproductive technologies: a systematic review and meta-analysis

Background: Psychological interventions such as counseling for infertile patients seem to increase pregnancy rate

Objective: The aim of this systematic review and meta-analysis was to examine if counseling improves pregnancy rate among infertile patients. Thus, randomized controlled trials investigating the effect of counseling on pregnancy rate in infertile patients undergoing ART were pooled in a meta-analysis

Materials and Methods: The databases of PubMed, Scopus, Cochrane, Google Scholar, and Persian databases including SID, Iran Medex, and Magiran were searched from 1997 to July 2016 to identify relevant articles. Included studies were trials on infertile patients [women or couples] receiving counseling independent of actual medical treatment. The outcome measure was pregnancy rate. Out of 620 relevant published trials, a total of nine RCTs were ultimately reviewed systematically and included in a meta-analysis to measure the efficacy of counseling on pregnancy rate. Odds ratio and Risk difference were calculated for pregnancy rate. All statistical analyses were done by Comprehensive Meta-analysis Version 2

Results: Nine RCTs involving 1079 infertile women/couples were included in the study. The findings from RCTs indicated significant effect of counseling on pregnancy rate so that there was a positive impact of counseling on pregnancy rate [OR= 3.852; 95% CI: 2.492-5.956; p=0.00] and [RD= 0.282; 95%; CI: 0.208-0.355; p=0.00]

Conclusion: Counseling was found to improve patients' chances of becoming pregnant. So counseling represents an attractive treatment option, in particular, for infertile patients who are not receiving medical treatments

efficacy of Iranian herbal medicines in alleviating hot flashes: a systematic review

Background: Hot flashes are the most common symptoms experienced by women around the time of menopause. Many women are interested in herbal medicines because of fear of side effects of hormone therapy

Objective: The aim of this systematic review was to assess the effectiveness of Iranian herbal medicines in alleviating hot flashes

Materials and Methods: MEDLINE [1966 to January 2015], Scopus [1996 to January 2015], and Cochrane Central Register of Controlled Trials [The Cochrane Library, issue 1, 2015] were searched along with, SID, Iran Medex, Magiran, Medlib and Irandoc. Nineteen randomized controlled trials met the inclusion criteria

Results: Overall, studies showed that Anise [Pimpinella anisum], 60Tlicorice [Glycyrrhizaglabra]60T, Soy, Black cohosh, Red clover, Evening primrose, Flaxseed, Salvia officinalis, Passiflora ¡itex Agnus Castus, Piascledine [Avacado plus soybean oil], 60TSt. John's wort [Hypericum perforatum]60T, and valerian can alleviate the side effects of hot flashes

Conclusion: This research demonstrated the efficacy of herbal medicines in alleviating hot flashes, which are embraced both with people and health providers of Iran Therefore, herbal medicine can be seen as an alternative treatment for women experiencing hot flashes

Psychological empowerment model in Iranian pregnant women

Background: women's empowerment programs during pregnancy focus primarily on increasing women's health goals and psychological empowerment has been considered important in most issues related to pregnant mothers' mental health. Using path analysis, this study aims to examine the direct and indirect components of psychological empowerment of pregnant mothers

Methods: this model-testing study was conducted in Gorgan, northwest of Iran during three months in spring of 2015. Through random cluster sampling, a total number of 160 pregnant women were selected from 10 urban medical centers and clinics as primary centers. We used Spritzer's Psychological empowerment scale. Suitable sampling based on Nunally and Bernstein was followed in the model. The relationships between the dependent variables were then examined by means of path analysis using Amos 18

Results: the psychological empowerment of pregnant mothers [PEPW] model is impacted by individual factors, such as marriage age and employment, including some subjectively rated factors such as marital satisfaction and experience of violence. The PEPW model was deemed appropriate as optimum conditions indicators of goodness of fit; low index of CHI[2]/df shows little difference between the conceptual model and observed data, while RMSEA value indicated the goodness of fit. Other indicators such as CMIN=0.957, CMIN/DF=0.957, P-CLOSE=0.418, CHI[2]=0.957 and probability level=0.328 the fact that the model is ideal. The mothers' employment had the highest coefficient in the PEPW path model .731 [0.443, 0.965] bootstrap confidence intervals by 95%, and with a p-value of less than 0.05

Conclusions: the mothers' employment is the most important factor in psychological empowerment, but it cannot be addressed quickly. Programming to increase marital satisfaction followed by a decrease in family violence and prevention of early marriage are necessary for promotion of psychological empowerment during pregnancy

Socio-cultural beliefs, values and traditions regarding women's preferred mode of birth in the north of Iran

Pregnant women rely heavily on informal information while making a decision about the mode of delivery they would rather have, either as normal vaginal delivery [NVD] or cesarean section [CS]. Through recognition of social attitudes towards different modes of delivery, societies can be directed towards a positive understanding of vaginal delivery, which can ultimately lead to maternal health promotion. Thus, this study aimed to explore the common beliefs, values and traditions surrounding women's preferred mode of birth in the North of Iran. Using a focused ethnographic approach, twelve pregnant women, 10 women with previous experience of childbirth, seven midwives, seven obstetricians, and nine non-pregnant women were included in this study through a purposeful sampling in health clinics of Tonekabon in the North of Iran. Semi-structured interviews and participant observations were used for data collection. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using Braun and Clarke thematic analysis [2006] and MAXqda software. Through analysis, three major themes and 10 subthemes emerged. They included: 1] sociocultural childbirth beliefs with five subthemes: a] CS as protector of genital tract integrity, b] blind imitation in choosing mode of birth, c] NVD as a low cost type of delivery, d] CS as a prestigious mode of birth and, e] NVD as a symbol of woman's power and ability; 2] traditional health beliefs with two subthemes: a] NVD as a guarantee for woman's health, b] traditional childbirth facilitators; 3] religious beliefs and values with three subthemes: a] NVD as a symbol of God's power, b] call for help from the Mighty God, and c] NVD as a sacred phenomenon. The results of this study indicated that cultural beliefs, values and traditions can significantly affect individuals' attitudes towards modes of delivery, their definitions of different modes, and the decisions they make in this regard. In order to develop a positive cultural and religious attitude towards vaginal delivery, women's awareness has to be raised through various ways and the existing misconceptions need to be corrected

Impact of an educational program on knowledge and attitude of female sex workers in preventing high risk sexual behaviours

The most important risk factor for one's sexual health is high-risk sexual behavior. Implementation of educational programs has been considered as one of the most crucial interventions in the prevention and treatment of these behaviors. Therefore, this study aimed to determine the effect of an educational program on the knowledge and attitude of female sex workers toward preventing high-risk sexual behaviors. This pretest-posttest, one-group study was conducted on 40 female sex workers, imprisoned in Mashhad Vakil Abad prison in 2013. Data were collected using a questionnaire including demographic characteristics, as well as knowledge- and attitude-related data. An educational program was designed after the pretest and conducted in four 70-minute sessions. Immediately and four weeks after the educational program, post-test was performed. Data were analyzed by Friedman and Wilcoxon tests, using SPSS version 16. A positive significant increase was found in the mean scores of knowledge and attitude of female sex workers immediately and four weeks after the program [P<0.001]. Considering the increased knowledge and improved attitude of female sex workers in this study, it is necessary to design and implement educational programs in prisons

Effects of telephone support on stress and perceived social support in primiparous women experiencing nausea and vomiting in the first half of pregnancy

Gestational nausea and vomiting are positively correlated with stress and stress is negatively associated with social support. Due to advances in technology, telephone has become the most accessible device for home-based support. This study aimed to determine the effects of telephone support on stress and perceived social support in primiparous women experiencing nausea and vomiting during the first half of pregnancy. This clinical trial was conducted on 60 healthy pregnant women suffering from mild nausea and vomiting in the first half of pregnancy. They were randomly assigned to intervention [n=30] and control [n=30] groups. The intervention group received social support twice a week for a period of four weeks. Each phone conversation lasted around 15-20 minutes. During these conversations, dietary and lifestyle changes during pregnancy, as well as ways to reduce fatigue and improve psycho-emotional status, were discussed. The control group received routine care. Data were collected using a demographic questionnaire, Multidimensional Scale of Perceived Social Support, and Visual Analogue Scale for stress. Independent t-test and paired test were performed, using SPSS version 16. No significant difference was found in the mean scores of stress in two groups at the beginning and end of the study [P=0.052]. However, social support score at the beginning of the study was significantly different from that at the end of the study in both groups [P=0.036]. It is recommended that telephone support be integrated into the routine care of women with nausea and vomiting in order to improve their perceived social support and decrease their stress

Vaginal delivery vs. cesarean section: a focused ethnographic study of women's perceptions in the north of Iran

Cesarean section [C-section] in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women's perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women's perceptions towards modes of delivery in the North of Iran. Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software. Two major themes emerged from the data including: "vaginal delivery, a facilitator of women's physical and mental health promotion", and "C-section, a surgical intervention associated with decreased labor pain". Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery. In the North of Iran, women's justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section

Iron supplementation protocols for Iron deficiency Anemia: a comparative review of Iron regimens in three countries of India, Iran and England

Iron deficiency anemia is the most common micronutrient deficiency in the world today. It affects the lives of millions of women and children through contributing to poor cognitive development, increased maternal mortality and decreased work capacity. Because of the important role of Iron in the physical and cognitive health, and for the universal consideration of eradication of this problem, this review aimed to compare iron supplementary programs in three countries if India, Iran and England. The design was a comparative review of iron supplementary programs in three countries of India, Iran and England. These countries were selected for review, as they represent the spread of iron deficiency anemia in three different level of low, medium and high. Relevant data were retrieved from databases including PubMed as well as WHO, World Bank Ranking and BMJ Center reports and then were included in comparative tables to provide the basis for detecting similarities and differences. The included countries in this review were different in terms of preventive and treatment strategies to overcome iron deficiency. The reason for this difference was due to health conditions, and availability of healthy drinking water, and also prevalence of various diseases like anemia, parasitic diseases, and malaria. In Iran and India the preventive programs are confined to all groups at risk, however, in England it just encompasses the immigrants and the people who are supported by the government. This review showed that in low income countries, the most economic and cost-effective practice is enriching the nutritionals. Additionally, the treatment and preventive programs and policies for anemia in different countries are related to health conditions and health indicators of that country

Horseshoe-shaped placenta and preterm labour: a case report

Horseshoe placenta is a variant of ring-shaped placenta. Ring-shaped placenta is a rare anomaly seen in fewer than 1 in 6000 deliveries, which could be seen as horseshoe shape due to atrophy in a portion of the ring. This report refers to a possible relationship between the horseshoe shape placenta and preterm labor; although it has not been yet validated in the literature. In this case report we present the placenta of a 35 years-old G2L1 woman who was referred to delivery unit of Shohada Hospital in Ghouch, Iran with starting of labor pain at 34 weeks of gestation who gave birth to a live-born female baby with 6/8 APGAR score. The amniotic fluid was meconium-stained. The patient had no evidence of fever, bleeding, infection. It is concluded that due to the risks to the fetus and mother caused by horseshoe placenta, its timely diagnosis during pregnancy using ultrasound is important and leads to early detection and better management of pregnancies complicated with placental abnormalities

Influence of gender role and women's empowerment on couples' fertility experiences in Urban society of Mashhad, Iran

Iran has experienced a great variation in women's status in recent years. There is a little knowledge on how and why advancing gender equality and equity and the empowerment of women play a role in recent fertility reduction in the country. This study was conducted to gain insight into the role of gender beliefs and women's empowerment in the couples 'experiences of fertility in Mashhad, Iran in 2011-2012. In this exploratory qualitative study in-depth interviews were conducted with 54 purposefully selected eligible male and female participants and some key informants who lived in urban society of Mashhad. Data was collected until saturation was happened and analyzed adopting conventional content analysis approach through giving analytical codes and identification of categories using MAXqda software. Study rigor verified via prolonged engagement, thick description and validation of anlysis through member check. Findings from data analysis demonstrated three major categories about the influence of women's empowerment and gender role on fertility experiences including: 1] The couple's understanding of gender roles 2] Women's empowerment and changing gender roles 3] Couple's interactions in complementary or parallel roles and 4] Fulfillment of fertility goals based on role division. Some aspects of couples' interaction including equal roles in fertility decisions, choosing and using best fit family planning method and participative child care influenced couples' fertility behavior. Women's empowerment together with balanced gender role in the family resulted in success in attaining couple's fertility desire. Managing fertility behaviors needs to understand the roles of spouses in their mutual interaction in fertility decision making and related behaviors. Imbalanced gender role in family acts as an obstacle to reach the fertility goals and leads to lower than desired fertility. Reproductive health policy makers and family planning counselors could apply the findings of this study in order to publicize proper fertility behaviors through making the couples aware of the risks of gender role imbalance

Qualitative inquiry into the mediating role of religion and spirituality in adjusting marital relationships of infertile women

Despite growing body of literature regarding marital adjustment of infertile women, to our knowledge, there is no study to address the role of religious and spiritual beliefs in adjusting marital relationships in infertile women. Considering the significance of marital cohesiveness and commitment in the long and stressful journey of infertile women, this study was designed to explore how marital relationships are experienced by infertile women who affiliated to different religious faiths. A group of 30 infertile women affiliated to different denominations of Christianity [Protestantism, Catholicism, Orthodoxies] and Islam [Shiite and Sunni] were interviewed. The design was a grounded theory study including semi structured in-depth interviews. Data were collected in one Iranian and two UK fertility clinics through theoretical sampling and analyzed using Strauss and Corbin's mode of grounded theory. Religious infertile women using a religious/spiritual meaning-making framework tried adjust their marital relationships through going the following phases: being optimistic and positive, having supportive relationships, being grateful and appreciated for their marital life, offering spiritual sympathy and adopting religious role models. These strategies aided infertile women to be more understanding, sympathetic and gentle towards maintaining the family cohesion. I argue that awareness of health professionals of the potential ways in which religion and spirituality assist infertile women to deal with their marital issues could be important. This knowledge will help them to support emotional wholeness and integrity of infertile women, offering religious and spiritual coping strategies which can help adjusting their marital relationships

influence of social network on couples' intention to have the first child

Recently, the relevance of social interactions as determinants of behavioral intentions has been increasingly perceived, but there is a lack of knowledge on how and why it interacts with couples' fertility intentions. This qualitative study was conducted to explore the influence of social network on couples' intention to have their first child in urban society of Mashhad, Iran in 2011. In this exploratory qualitative study in-depth interviews were conducted with 24 participants including 14 fertile women, two parents, three husbands and five midwives and health care providers. The sample was selected purposively in urban health centers, homes and workplaces until data saturation was achieved. Data analysis was carried out adopting conventional content analysis approach through giving analytical codes and identification of categories using MAXqda software. Study rigor verified via prolonged engagement, validation of codes through member check and peer debriefing. Findings from data analysis demonstrated four major categories about social network's influence on couples' intention to have their first child including 1] perception of fertility relevant social network, 2] occurrence of various types of social influence 3] subjective judgment to the benefits of social network and its fitness to personal life, and 4] couples' interaction with social network. Managing the fertility behaviors need to include the consideration of personal social networks surrounding the couples. It is important to apply the study findings in providing family planning services and dissemination of appropriate fertility behaviors through community-based reproductive health care delivery system

Female adolescents' experiences and perceptions regarding sexual health education in Iranian schools: a qualitative content analysis

Despite so many unmet sexual health education [SHE] needs of adolescents, socio cultural challenges have caused this issue to be ignored in different scoieties. This study investigated Iranian female adolescents' experiences and perceptions with respect to SHE that they received at schools, and what they really needed, expected, and preferred. In this qualitative study, seven focus group discussions [44 adolescents] and 13 individual in depth interviews were conducted among female adolescents aged 14-18 in Mashhad and Ahvaz, Iran, to explore adolescents' experiences and perceptions towards SHE in Iranian schools. Data were analyzed using qualitative content analysis. Analyzing adolescents' perspectives and experiences revealed their great dissatisfaction with SHE in schools. Emerged categories included: lack of obligation and priority for SHE, sexual reticence and evading, making adolescents frightened of sexual issues, inconsistency of SHE with adolescents' needs, unqualified educators, and lack of appropriate educational materials. This study found some similarities between expectations of Iranian adolescents and those of adolescents from other cultures about an SHE program. Adolescents showed great abilities to appraise health services delivered for them, and so any program for sexual health promotion in adolescents ought to address adolescents' needs, demands, and aspirations. Their contribution can provide insights for tailoring SHE programs for adolescents.

Women's experiences and preferences in relation to infertility counselling: a multifaith dialogue

Religion and spirituality are a fundamental part of culture and influence how individuals experience and interpret infertility counselling. Thus far, little research has examined the influence of religiosity on the experience of infertility, and to our knowledge no study exists investigating the responses of religious infertile women to counselling. In this study we explored Muslim and Christian women's experiences and preferences with regard to infertility counselling. Using a grounded theory approach, 30 infertile women affiliated to different denominations of Islam [Shiite and Sunni] and Christianity [Protestantism, Catholicism, Orthodoxies] were interviewed. Data were collected through semi-structured in-depth interviews at fertility clinics in the UK and Iran, and analyzed using the Straussian mode of grounded theory. Emerging categories included: Appraising the meaning of infertility religiously, applying religious coping strategies, and gaining a faith-based strength. These were encompassed in the core category of 'relying on a higher being'. Religious infertile women experienced infertility as an enriching experience for spiritual growth. This perspective helped them to acquire a feeling of self-confidence and strength to manage their emotions. Hence, they relied more on their own religious coping strategies and less on formal support resources like counselling services. However, they expected counsellors to be open to taking time to discuss their spiritual concerns in counselling sessions. In addition to focusing on clients' psychosocial needs, infertility counsellors should also consider religious and spiritual issues. Establishing a sympathetic and accepting relationship with infertile women will allow them to discuss their religious perspectives, which consequently may enhance their usage of counselling services