A Review of Pharmacological Treatments for Vaginal Atrophy in Postmenopausal Women in Iran

Vaginal atrophy is one of the most common menopausal complications and is often overlooked. There are various pharmacological and non-pharmacological treatment approaches to reduce vaginal atrophy; however, no comprehensive study on a convenient, affordable, inexpensive, and noninvasive treatment with fewer complications has been conducted so far. Thus, the current study aimed to provide a systematic review of pharmacological treatment for vaginal atrophy in postmenopausal women in Iran. In this systematic review, all Iranian articles published in Persian or English during 2009 to 2019 were collected and analyzed by searching the Scopus, PubMed, Web of Science, Magiran, Iranian Registry of Clinical Trials (IRCT), and Cochrane Library databases. The inclusion criteria were clinical trials for vaginal atrophy and menopause. Based on the selection criteria, articles with a Jadad scale score of 3 and above were included in the study and qualitatively analyzed. Overall, 15 clinical trials met the inclusion criteria. In total, 12 articles examined the efficacy of pharmacological treatments (including three herbal medicines, three vitamins and dietary supplements, and two chemical drugs) in treating vaginal atrophy in postmenopausal women. Various types of medication have been used to improve vaginal atrophy, and effective treatments include licorice, chamomile, royal jelly, vitamin E, vitamin D, hyaluronic acid, and Vagifem; however, the results of studies on fennel have been inconsistent. However, considering the small number of studies reviewed, further studies with a stronger methodology are needed to confirm the efficacy of these medications.

Effects of aromatherapy with Rosa damascena on nulliparous women's pain and anxiety of labor during first stage of labor / 中西医结合学报

<p><b>BACKGROUND</b>Reducing labor pain and anxiety is one of the most important goals of maternity care.</p><p><b>OBJECTIVE</b>This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08 mL of Rosa damascena essence in the aromatherapy group and 0.08 mL of normal saline in the control group, every 30 min. Pain was measured 3 times, once each at three stages of cervical dilation (4-5, 6-7, and 8-10 cm). Anxiety was measured twice, once each at two stages of cervical dilation (4-7 and 8-10 cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann-Whitney U test and Chi-square test.</p><p><b>MAIN OUTCOME MEASURES</b>Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures.</p><p><b>RESULTS</b>Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4-5, 6-7, and 8-10 cm; P < 0.05). Anxiety levels were also significantly lower in the treatment group than in the control group after treatment at each time of measurement (cervical dilation of 4-7 and 8-10 cm; P < 0.05).</p><p><b>CONCLUSION</b>Aromatherapy with R. damascena reduced the severity of pain and anxiety in the first stage of labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor.</p><p><b>TRIAL REGISTRATION</b>Iranian Registry of Clinical Trial: IRCT201306258801N3.</p>

Women's perceptions and feelings about loss of their sexual desire: a qualitative study in Iran

Background: Reduced sexual desire leaves serious impacts on women's life. The current study aims to investigate the perceptions and concerns of Iranian women of reproductive age with female sexual interest and arousal disorder [FSIAD]

Methods: This qualitative research was conducted using content analysis approach. Data were collected through seventeen in-depth interviews from October 2015 to June 2016. Purposive sampling was carried out from among reproductive-aged women suffering from FSIAD who responded to female sexual function index [FSFI] with mean scores of

Results: The three main themes that emerged in this study included: 1] "Spoiled feminine identity" with two categories of "deteriorated sexual self-esteem" and "deteriorated feminine position", 2] "Struggle in sexual issues" with two categories of concern about losing the relationship and spouse, and surrendering to sexual relationship, and 3] "Deterioration of the couple's relationship" with two categories of deteriorated marital interaction and sexual disharmony between the couple

Conclusion: Feeling inability to play gender role as a woman and fear of losing the spouse are the most important concerns of women with lack of interest in sex. Training communication skills for sexual talks with the spouse and expression of feelings are the first steps to help such women

Comparison of social, economic and familial empowerment in married women in three cities of Iran

Background: Women's empowerment was defined as their ability to achieve awareness and control their personal, social, economic and political forces aiming at taking measures in order to improve their lives. This study aimed to compare the empowerment of the married women in medical sciences university in social, economic and familial domains in three cities, IRAN

Methods: This was a descriptive-analytical study conducted in 2016 on 399 married and employed women. Data collection instrument was a four-part questionnaire consisting of demographic, social, economic and familial domains and made by researchers. Collected data were analyzed using SPSS, version 16. Using paired t-test for intra-group and Chi-square and t-test for between groups comparisons. The significance level was set at<0.0

Results: The total score of empowerment in Rasht [126.34 +/- 17.51] was more than the two cities of Shiraz [123.46 +/- 15.62] and Bandar Abbas [123.42 +/- 12.34]. There was a significant relationship between the mean score of the total empowerment and monthly income of the participants in Bandar Abbas [P=0.04], and job of their husbands in Rasht [P=0.004]. The mean score of family empowerment of the women was significantly interrelated with the number of their children in Rasht [P=0.001], and with the education of the participants' husbands in Shiraz [P=0.002]

Conclusion: The score of social empowerment in Rasht was more than two other cities. In economic domain, the scores of Rasht and Bandar Abbas were more than those of Shiraz. Scores of Rasht and Shiraz were more than Bandar Abbas in the familial domain. It is useful to carry out qualitative studies aiming at determining the effects of various factors on women's empowerment and strategies for improving it

Women's orgasm obstacles: a qualitative study

Background: woman's orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors

Objective: the aim of this study is exploring obstacles to orgasm in Iranian married women

Materials and Methods: this qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran

Results: orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was "Multidimensionality of women's orgasm obstacles". Subcategories and some codes included: Physical obstacles [wife's or husband's boredom, vaginal infection, insufficient vaginal lubrication], psychological obstacles [lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems], relational obstacles [husband's hurry, having a dispute and annoyance with spouse] and contextual obstacles [Irregular sleep hours, lack of privacy and inability to separate children's bedroom from their parents, lack of peace at home]

Conclusion: for prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman's life is necessary

Contributing factors to high-risk sexual behaviors among Iranian adolescent girls: a systematic review

Background: Adolescence is a period of overwhelming changes and challenges, which expose the adolescents to high-risk behaviors. Risky sexual relationship is one of these behaviors that entails physical risks and psychosocial harms. Various factors have been recognized to shape sexual behaviors in adolescents. This paper is an attempt to investigate the factors contributing to high-risk sexual behaviors in Iranian adolescent girls

Methods: A literature review of the research published by Iranian authors, in Farsi or English language in local and foreign journals, was conducted using PubMed, Science Direct, Scopus, Scientific Information Database [SID], IranMedex, IranDoc, and Google Scholar. The search in each database included all the years covered at that time using keywords such as "sexual, adolescents, and Iran", and continued using other keywords such as "sexual behavior, high-risk behavior, sexual risk and reproductive behavior" individually and in combination

Results: Sixteen published articles were identified. Factors contributing to high-risk sexual behaviors in girls can be divided into four general groups including personal, family, peer, school and community

Conclusion: Regarding the identified risk and protective factors, appropriate individual, family and school-based interventions can be designed and implemented to strengthen protective factors. While individual and family factors are considered more in research, factors related to peers, school and community have received less attention. Since social values, beliefs and norms are important factors in formation of sexual behaviors, further research regarding these factors is suggested

Association between electromagnetic field exposure and abortion in pregnant women living in Tehran

Background: Health-related quality of life is affected by electromagnetic field exposure in each person everyday life. However, this is extremely controversial issue

Objective: Investigation of the associations between electromagnetic field exposure and miscarriage among women of Tehran

Materials and Methods: In this longitudinal study, 462 pregnant women with gestational age <12 wks from seven main regions of Tehran city in Iran with similar social and cultural status were participated. Women were interviewed face-to face to collect data. Reproductive information was collected using medical file recorded in those hospitals the subjects had delivery. The measuring device measured electromagnetic waves, Narda safety test solutions with valid calibration date at the entrance door of their houses

Results:A significant likelihood of miscarriage in women who exposed to significant level of electromagnetic wave. However, this association was not confirmed by Wald test

Conclusion: This study may not provide strong or consistent evidence that electromagnetic field exposure is associated or cause miscarriage. This issue may be due to small sample size in this study

Design and psychometric properties of male adolescent health needs-assessment scale

Background: given the importance of adolescents' health in establishing health in the newly thriving generation of every society, the first step for adolescents' health promotion is health needs assessment. The present study was, therefore, conducted to design a valid and reliable scale for health needs assessment of male adolescents

Methods: this is an exploratory sequential mixed method study [2014 2015]. The qualitative part was performed using content analysis approach and aimed to generate items pool. Data collection was performed by 7 focus group discussions with 51 male adolescents, and 10 semi-structured in-depth interviews with 10 other adolescents. Nine further in-depth interviews were also performed with 9 key informants. Purposive sampling was used and continued until data saturation. In the quantitative part, the designed scale was psychometrically assessed through the examination of the face and content validities using qualitative and quantitative methods and also the construct validity using the exploratory factor analysis along with the tool's internal consistency and stability

Results: the content analysis of the data from the qualitative part led to the extraction of 4 main themes and 103 items, which moved to the quantitative stage. The mean content validity index of the scale was estimated 0.91 and content validity ratio was 0.89. The exploratory factor analysis showed 4 factors for the designed scale [49 items], including physical, psychological, social and sexual health needs. The internal consistency and the stability assessment of the scale showed 0.79 and 0.89, respectively. [P<0.001]

Conclusion: according to the psychometric assessment, MAHNAS is a valid and reliable scale compatible with the Iranian culture that can be used in the health needs assessment of male adolescents

Sexual behavior of infertile women: a qualitative study

Infertility makes an essential challenge to the sexual life of couples, especially infertile women. When pregnancy does not happen, infertile women think that sexual intercourse is not fruitful and sexual desire became reduce gradually. Infertile women progressively forget that their sexual relationship is also a response to their natural need. This qualitative study was conducted to explore the infertility consequences in the sexual behavior of infertile women. This was a qualitative content analysis study; and it was part of a widespread study, used a sequential mixed-method and conducted from August 2014 until February 2015. A purposeful sampling was used to recruit infertile women who had referred to Yazd Research and Clinical Center for Infertility. Data gathering techniques employed in this research included in-depth semi structured open face-to-face interviews and field notes. Credibility, transferability, confirm ability, and dependability were assessed for the rigor of the data collection. Totally, 15 infertile women and 8 key informants were interviewed. Data analysis showed four themes about impact of infertility on female sexual behavior: I/ Impact of infertility drugs on couple sexual behavior, 21 Impact of assisted reproductive technologies on female sexual behavior, 3/ Timed intercourse during infertility and 4/ The psychological impact of infertility on sexual behavior. Some of Iranian infertile women could cope with their problems, but some of them were very affected by infertility drugs and assisted reproductive technologies procedures. Psychosexual counseling before medical treatment could help them to have a better sexual life

social consequences of infertility among Iranian women: a qualitative study

Infertility may prevent couples to achieve the desired social roles and lead to some social and psychological problems. This study aimed to explain the social consequences of infertility in Iranian women seeking treatment. A qualitative content analysis was conducted based on 32 semi-structured interviews with 25 women affected by primary and secondary infertility with no surviving children. The participants were purposefully selected with maximum variability from a fertility health research center in Tehran, Iran, from January to October 2012. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method. Our findings indicate that the consequences of infertility are divided into five main categories: 1. violence including psychological violence and domestic physical violence, 2. marital instability or uncertainty, 3. social isolation including avoiding certain people or certain social events and self-imposed isolation from family and friends, 4. social exclusion and partial deprivation including being disregarded by family members and relatives and reducing social interactions with the infertile woman and 5. social alienation. This study reveals that Iranian women with fertility issues seeking treatment face several social problems that could have devastating effects on the quality of their lives. It is, therefore, recommended that, in Iran, infertility is only considered as a biomedical issue of a couple and pay further attention to its sociocultural dimensions and consequences

Thyroid dysfunction and pregnancy outcomes

Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes. In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort [prospective and retrospective], case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded. Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterrn delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects. While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly identified and its long term impact on childhood development is well known, data on the early and late complications of subclinical thyroid dysfunction during pregnancy or thyroid autoimmunity are controversial. Further studies on maternal and neonatal outcomes of subclinical thyroid dysfunction maternal are needed

Comparison of sexual dysfunction in women using depo-Medroxyprogesteron Acetate [DMPA] and cyclofem

Sexual affairs are one of the physiological needs affecting human health. Sexual functioning disorders can reduce individual's capabilities and creativities. Sexual relations are in the center of women's quality of life. The most important family planning is to prevent unintended pregnancies. Injectable contraceptives protect women exposed to many complications and mortality due to unintended pregnancies, with tolerable effects on other aspects of women's life. An important aspect of women's life is sexual health. This study aimed to compare sexual function of women using DMPA with women using Cyclofem presented to health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran in 2013. This descriptive-comparative study was conducted on 240 women in health centers in Tehran, Iran. They were selected by multistage sampling. The data was collected using a questionnaire completed by interviewing. The questionnaire had 2I parts, demographic characteristic section and Female Sexual Function Index [FSFI]. Data was analyzed by descriptive statistics, independent T-test, U-test, Chi-square, Fisher exact test. The p-value less than 0.05 were applied for all statistical tests as significance level. The difference in sexual function between Cyclofem and DMPA groups was insignificant, but in terms of sexual desire in DMPA users better than and sexual pain them less than in Cyclofem users, the difference between the groups was significant [p<0.05]. In introducing hormonal contraceptive methods, health workers should emphasize their adverse effects on sexual function. Women who use Cyclofem and DMPA should be aware that they may experience some changes in libido and sexual pain

[Psychological impact of infertility among infertile women seeking treatment: a qualitative study]

Infertility is a important life event which it and its treatment can affect lives of couples. Infertility can cause various psychological-emotional disorders or consequences. The aim of this study was to explore psychological experiences of infertility and its treatment in infertile women attending to Vali-e-Asr Fertility Health Research Center Tehran, Iran. This qualitative study was carried out on 15 women with primary and secondary infertility. The study was conducted in VaIi-e-Asr Fertility Health Research Center in Tehran. A judgemental method was used to recruit participants in the study. Data were collected using semi -structured interviews and continued until data saturation. Simultaneously in process of data collection, the data analysis phase was performed with conventional content analysis method main concepts emerged from the data were categorized into four main themes and their sub-categories include: 1. Cognitive reactions of infertility 2. Cognitive reactions to therapy process 3. Emotional-affective reactions of infertility 4. Emotional-affective reactions to therapy process. This study showed that the infertility and its treatment process for Iranian infertile women is a source of psychological suffering with devastating effects on psychological well-being of infertile couples. The results also showed that one of the major causes of psychological distress is the social pressure by community members, while is less attention is paid to the sociocultural dimensions and consequences of infertility

emotional-psychological consequences of infertility among infertile women seeking treatment: results of a qualitative study

Infertility is a major life event that brings about social and psychological problems. The type and rate these problems in the context of socio-cultural of different geographical areas and sex of people is different. The aim of this qualitative study was to explain the psychological consequences of infertility in Iranian infertile women seeking treatment. This qualitative study was done using qualitative content analysis on 25 women affected by primary and secondary infertility with no surviving children in 2012. They were purposefully selected with maximum sample variation from a large Fertility Health Research Center in Tehran, Iran. Data were collected using 32 semi-structured interviews and analyzed by the conventional content analysis method. The findings of this study include four main themes: 1. Cognitive reactions of infertility [mental engagement; psychological turmoil]. 2. Cognitive reactions to therapy process [psychological turmoil; being difficult to control in some situations; reduced self-esteem; feelings of failure]. 3. Emotional-affective reactions of infertility [fear, anxiety and worry; loneliness and guilt; grief and depression; regret]. 4. Emotional-affective reactions to therapy process [fear, anxiety and worry; fatigue and helplessness; grief and depression; hopelessness]. This study revealed that Iranian infertile women seeking treatment face several psychological-emotional problems with devastating effects on the mental health and well-being of the infertile individuals and couples, while the infertility is often treated as a biomedical issue in Iranian context with less attention on the mental-emotional, social and cultural aspects

Women's experience regarding the role of health centers in empowering them for family planning

Nowadays, the concept of family planning has been detached from the population control and it is expressed as an essential element in women's reproductive rights, empowering them and promoting their status in society. Family planning services have an important role in fertility decisions using contraception methods in women. This study was carried out to explore the experience of women from the role of health centers in empowering them for family planning. This qualitative study was performed on 37 married women who were volunteer and eligible for contraception as well as 8 staffs and directors of family planning services. They were selected useing purposeful sampling method in Isfahan, Iran. Data were collected by recording discussions of focused group in 7 sessions and 5 individual interviews. Conventional content analysis was used for coding and classification of data. Participants descriptions about the role of health centers in empowering the family planning was classified into 4 main categories including: encouraging male's participation in family planning, providing comprehensive reproductive health services, expanding free services for family planning and appropriate technology for public awareness. Accessibility to health centers and offering free services for family planning are not sufficient for empowering women in terms of their fertility desires. The health centers should offer comprehensive reproductive health services and provide family planning services with a new approach for helping women and men to consciously and freely make a responsible decision in order to have more control over their fertility.

study on the effects of pimpinella anisum on relief and recurrence of menopausal hot flashes

With respect to the high incidence of hot flash in postmenopausal women and the controversies regarding its treatment, this double-blind clinical trial was conducted to determine the effects of Pimpinella anisum on hot flashes in these women referring to rural and urban health centers of Qazvin Province in 2009.Seventy-two women with hot flashes were randomly selected according to the predetermined criteria and divided into two experimental and control groups. Their medical records at health centers were used for sampling. Each woman in the experimental group took a capsule containing 330 mg Pimpinella anisum 3 times a day while in the control group, women took 3 capsules, each containing 330 mg potato starch, over 4 weeks and after that, they were following up for 4 weeks. Before taking the capsules, they were assessed for 2 weeks about the frequency and severity of hot flashes. Data were collected through a questionnaire and an information form. Content validity method was used for validity of the tools. ANOVA and Student›s t-test were applied for statistical analysis. In the experimental group, the frequency and severity of hot flashes before the treatment were 4.21% and 56.21% and, after that, were 1.06% and 14.44% at the end of the fourth week respectively. No change was found in the frequency and severity of hot flashes in the control group. The frequency and severity of hot flashes was decreased during 4 weeks of follow up period. P. anisum is effective on the frequency and severity of hot flashes in postmenopausal women