The self-care situation analysis of reproductive-aged women in Tehran: a survey study.

BACKGROUND: Along with a global increase in the prevalence of infectious and non-communicable diseases, self-care with an emphasis on reproductive health Self-care has received special attention. Given the importance of women's health, assessment of their self-care status using a valid and reliable tool seems to be necessary to determine the needs for future women's reproductive health promotion interventions. The present study aimed to assess the women's self-care at reproductive age in Tehran, to determine women's health needs based on global guidelines for women's health. METHODS: This was a descriptive cross-sectional study on 1051 women of reproductive age, living in Tehran. The Subjects were recruited using a multi-stage sampling method. The women completed a socio-demographic and valid and reliable questionnaire to assess their self-care status. The data were analyzed using SPSS 24 and by Pearson, Spearman, ANOVA, and regression tests. RESULTS: The mean score of self-care was 49.57 ± 23.50% in the reproductive-aged women. The lowest scores were related to psychosocial health (32.12 ± 29.93%) and reproductive-sexual health (49.74 ± 27.99%) respectively. There were significant positive correlations between the self-care and women's education level (r = 0.180; p < 0.01), and husband's education level (r = 0.272; p < 0.01), while there was a negative significant correlation between the self-care and the family size (r = - 0.135; p < 0.01). CONCLUSION: The findings showed inadequate self-care among reproductive-aged women in Tehran. The most important challenge in their self-care behaviors was related to psychosocial and reproductive-sexual health. It seems to provide a package for promoting women's self-care in four areas of physical, psychosocial, reproductive-sexual health, and screening tests, with an emphasis on the first two priorities, namely psychosocial and reproductive health necessary in Tehran.

The framework for integrated, people-centered health services was introduced in 2016 by the World Health Organization (WHO) (World Health Organization, Interim report: placing people and communities at the Centre of health services: WHO global strategy on integrated peoplecentred health services 2016-2026: executive summary, 2015). A people-centered approach supports health literacy so that people can take responsibility for their health with evidence-based self-care interventions. When people have agency and autonomy, they can make and enact decisions in all aspects of their lives, including health (World Health Organization, WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights: executive summary, 2019). The WHO defines self-care as "the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider". Self-care allows people to become agents of their health, leading to improved outcomes, especially in the area of sexual and reproductive health where stigma may prevent them from seeking care. Women and girls can identify their own health needs, and effectively manage their health conditions through self-care approaches. The WHO places great emphasis on promoting self-care, especially in women's reproductive-sexual health, and encourages countries to design and implement their programs. Given the diversity of women's self-care needs, this study designed women's self-care assessment tools in two reproductive age groups in 4 dimensions including physical, psychosocial, sexual-reproductive health, and screening tests, based on a review of the valid international guidelines. The results showed that women are practicing only half of self-care and the main challenges were in psychosocial health and sexual-reproductive-health self-care in Tehran. It seems that evidence-based planning is necessary to promote self-care among reproductive-aged women.

Women's self-care for Coronavirus prevention and the related factors in Iran: A cross-sectional study.

Promoting self-care can be an effective way to decrease the rate of transmission and expansion of the infection. However, there seem to be different related factors to self-care by gender. This study aims to assess women's self-care for COVID-19 prevention and some related factors in Tehran-Iran in 2021. This was a descriptive cross-sectional study that was performed on 403 women living in Tehran in 2021. Subjects of the study were recruited using a multi-stage sampling method. Data was collected using a socio-demographic questionnaire as well as a valid and reliable questionnaire to assess women's self-care for COVID-19 prevention (SCVP-38). The questionnaires were sent on the Google platform to the eligible participants. After completion of the forms, the created data in the Excel software in Google Drive were converted to SPSS 24 and then analyzed by using t-test, ANOVA, Pearson correlation, and multiple linear regression tests. The overall mean score of self-care was 71.84±17.81 percent. The highest and lowest scores were respectively related to using masks in public vehicles and not touching the face. Significant negative correlations were shown between the women's self-care on Corona prevention with stress, anxiety, concerns, and fear (P<0.001). Linear multiple regression showed two factors including women's age (p = 0.033) and their number of children (p = 0.042) predict the self-care, so that, for increasing each year to women's age, SCVP increases by 0.463 units, and with increasing each child, SCVP decreases by 3.608 units. We concluded that in the COVID-19 pandemic, women in Tehran are performing more than 70% of measures of self-care. Also, education about self-care is recommended for younger women with more children. Moreover, promoting the self-care program can improve women's mental health during the COVID-19 pandemic.

Development and validation of the code of ethics for midwives in Iran.

BACKGROUND: Considering ethical issues in midwifery care is essential for improving the quality of health services and the client's satisfaction. This study aimed to develop and validate the code of ethics for Midwives in Iran (ICEM). MATERIALS AND METHODS: This was a mixed sequential study that was performed in three phases including a qualitative study, a review, and the content validity assessment. The first phase was a qualitative study with a content analysis approach. The data were collected by conducting in-depth semi-structured individual interviews with 14 midwifery and ethics experts. The purposive sampling method was used to recruit the participants and sampling continued until data saturation. The data were analyzed using the conventional content analysis described by Graneheim and Lundman. Lincoln and Guba's criteria were used to confirm the trustworthiness of the data. Then, a narrative review of the selected national and international codes of ethics for Midwives was performed to complete the items of the ICEM. For validity assessment, the face and content validity of the items of ICEM was assessed by 15 experts to calculate the content validity ratio (CVR) and index (CVI). RESULTS: Fourteen experts were interviewed in the qualitative phase, and 207 codes were extracted from a content analysis which were categorized into 23 sub-categories and 6 main categories. The extracted codes were considered as the items for ICEM that were completed by a review of the selected national and international code of ethics for Midwives. The content validity and ratio assessment of the items demonstrated an average CVI = 0.92 and CVR = 0.85. Then, the final version of ICEM was developed with 92 items in 6 domains about; 1) "professional Commitments" with 30 items; 2) "providing midwifery services to the client and her companions" with 26 items; 3) "relationship with colleagues" with 11 items; 4) "herself" with 6 items; 5) "education and research" with 8 items; and, 6) "management" with 11 items. CONCLUSION: ICEM was prepared with 92 items in six sections that facilitate its use for midwives who are working in the different fields of care, counseling, education, research, and management. In this new version of the ICEM, the items related to recent social-, scientific, and technical improvements were considered for providing ethical midwifery care.

A situation analysis on postmenopausal women's self-care needs and priorities in Tehran: a population-based study.

BACKGROUND: Women need special care during and after menopause. Due to the emphasis of the World Health Organization on promoting self-care in postmenopausal women, this study aims to analyze the situation and prioritize the self-care needs of postmenopausal women in the Tehran-Iran. METHODS: This was a descriptive-analytical study on 486 postmenopausal women aged 46-85 years living in Tehran in 2021. The Subjects were recruited using a multi-stage sampling method. Data were collected using a socio-demographic and a valid and reliable questionnaire to assess postmenopausal women's self-care status with four domains including physical health, psychosocial health, reproductive-sexual health, and screening tests. The data were analyzed by SPSS-24. RESULTS: The mean age of the participants was 62.58 ± 7.75 years. The mean score of self-care was 44.63 ± 21.64% in the postmenopausal women. The lowest score and highest scores were related to psychosocial health (25.12 ± 28.21%) and periodic tests (50.62 ± 24.40%) respectively. There were significant positive correlations between self-care with women's education level (r = 0.277; p < 0.001), husband's education level (r = 0.258; p < 0.001), as well as monthly income (r = 0.153; p = 0.001). There was a negative correlation between self-care with the number of children (r = - 0.215; p < 0.001). The level of self-care was higher in employed women (p = 0.001) and also, in women whose husbands were employed (p = 0.012). Multiple linear regression test showed the level of education of the husband (B = 2.72, p = 0.038) and the family size (B = -1.54, p = 0.023) are predictors of the self-care of postmenopausal women. CONCLUSION: The findings showed more than 55% of challenges in the self-care behaviors of postmenopausal women in Tehran. The most and least challenging self-care behaviors were related to psychosocial health and performing periodic tests. The priorities were in psychosocial health and reproductive-sexual health dimensions. Self-care promotion is necessary, especially in postmenopausal women, who need special care due to various physical, psychological, and social changes.

The relationship between body image and quality of life in postmenopausal women: A correlational cross-sectional study.

The relationship between body image (BI) and quality of life (QoL) among postmenopausal women was assessed in this study. This correlational cross-sectional study was conducted on 320 postmenopausal women in Tehran-Iran. The participants were selected using a multistage sampling method. Data was collected using the WHOQOL-BREF questionnaire, the Fisher's body image questionnaire, and a socio-demographic questionnaire. Total score and score of all domains of QoL had a significant positive correlation with total score and score of all dimensions of BI and BI was a predictor of QoL (p < 0.001). Therefore, women health policies should concentrate on BI improvement for promoting QoL during menopause.

A Comparative Study on the Effects of "Honey and Fenugreek" with "Fenugreek" on the Breastfeeding Success: A Randomized Trial.

Objective: Herbal galactagogues are usually recommended to be sweetened with honey. Despite the high nutritious value of honey for lactating women and extensive studies on the effects of herbal galactagogues, no investigation was made to compare galactagogue effects of using herbal galactagogues with and without honey so far. The present study aimed to compare the effect of a combination of "honey and fenugreek" with "fenugreek" on breastfeeding success (BFS). Methods: This study is a triple-blind randomized clinical trial on 75 breastfeeding mothers referred to a Tehran-Iran health center. The participants were randomly divided into two intervention (fenugreek and honey users) and control (fenugreek users) groups. These women had infants of 1-5 months and had exclusive breastfeeding practice. Tools for data collection were (1) the personal and maternal-infant information, (2) the breastfeeding success, and (3) the complications questionnaires. Participants received 30 liquid drops, three times daily for four weeks. The BFS questionnaire was completed twice, before and 4 weeks after the intervention. The CONSORT checklist was followed. Results: Before and after comparison showed no significant difference in the BFS score in the "fenugreek" group, while there was a significant increase in the BFS score in the "honey and fenugreek" group (P=0.035). Between groups, comparison demonstrated a significantly higher score of BFS in the intervention group than in the control group (P=0.023). There were no significant differences between the two groups regarding the possible complications. Conclusion: The combination of honey with fenugreek showed a significant effect on BFS, while there was no improvement in BFS after fenugreek only uses. Trial registration: the study was approved in the Iranian registry of clinical trials with IRCT ID: IRCT20120122008801N23 on 2019-12-30 (https://www.irct.ir/).

Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial.

BACKGROUND: Fathers' involvement is crucial for promoting breastfeeding. There are a few studies on the effectiveness of fathers' educational programs to promote exclusive breastfeeding. This study aims to assess the effectiveness of a fathers' educational program on their support for breastfeeding, mothers' breastfeeding practice, and exclusive breastfeeding status. METHODS: This was a randomized controlled trial on 76 fathers who were randomly assigned to two groups of intervention and control, in a selected health center in Iran, 2018. The tools for data collection were: 1) a questionnaire for "Demographic and Maternal-Infant Information"; 2) a questionnaire to assess "Fathers' support for Breastfeeding", and 3) an observational checklist to assess "Mothers' Breastfeeding Practice"; and 4) a questionnaire to assess "Exclusive Breastfeeding Status". The questionnaires were filled up through an interview. The checklist was completed through observation by the researcher. The fathers (with the mothers) of the intervention group were educated using individual face-to-face education and counseling, in two sessions, with the duration of about 40 min and one-week interval, whereas, the fathers of the control group did not receive any education and only mothers were educated with the same instruction. The content of the education was: fathers' education about "benefits of breast milk" and "the supporting ways for breastfeeding including the women encouragement". Then, the scores of "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" were compared before and after 4 months of intervention in each group, and also between groups. Data were analyzed using SPPS-23, and t- and paired-tests, Chi-square, and Generalized-Estimating-Equations (GEE) tests. RESULTS: The results showed two groups were not significantly different regarding the demographic and any other possible confounding variables before the intervention (P < 0.05). The before and after comparisons also demonstrated significant improvements in the two variables including "father's support for breastfeeding", and "mothers' breastfeeding practice after 4 months, in the intervention group (Paired t-test: P<0.001 and P<0.0001, respectively) however, there was a significant decrease in "father's support for breastfeeding" and no improvement in "mothers' breastfeeding practice" after 4 months in the control group (Paired t-test: P < 0.001 and P = 0.07, respectively). Between groups comparison showed also significant higher scores for "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" in the intervention group comparing to the control group, after 4 months (T-test: P < 0.001 and P < 0.0001; Chi2: P < 0.001, respectively). The interaction effects of time and group were significant in the GEE test for the fathers' support for breastfeeding (B-group = 31.93, B-time = 22.15, p < 0.001) and mothers' breastfeeding practice (B-group = 26.32, B-time = 12.86, p < 0.0). CONCLUSION: The results showed that the father's education improves mothers' breastfeeding practice and increases the rate and continuity of exclusive breastfeeding. TRIAL REGISTRATION: IRCT201508248801N10. "31/08/2016".

Priorities for a gender-sensitive sexually transmitted infections and human immunodeficiency virus (STIs/HIV) services: An exploratory mixed methods study.

Background and Aim: Providing gender-sensitive health services is emphasized by the World Health Organization. This study aimed to assess and prioritize the needs for the gender-sensitive sexually transmitted infections/human immunodeficiency viruses (STIs/HIV) prevention services by a valid and reliable questionnaire. Methods: This was an exploratory mixed methods sequential study in Shiraz Iran 2019. The first phase was a qualitative study on 37 providers and managers of the services who were recruited using the purposive and then snowball sampling method. In the second phase, following the content analysis of the qualitative data and a review of related literature, a questionnaire was developed and its psychometric properties were evaluated. Then, in the third phase, the questionnaire was used to assess and prioritize the needs through a quantitative descriptive cross-sectional study on all 290 providers of STI/HIV prevention services affiliated with Shiraz University of Medical Sciences. Results: The finding of the qualitative phase showed gender-sensitive STI/HIV prevention services should provide gender-sensitive care and education by the trained personnel and manages with appropriate facilities and equipment. Providing these services also requires supportive policies, intersectoral cooperation, and community capacitation. In the second phase, a questionnaire was developed with 63 items. Assessment of psychometric properties of the questionnaire demonstrated the scale content validity index and ratio (S-CVI = 0.98 and S-CVR = 0.87, respectively), as well as the reliability of the questionnaire (internal consistency = 0.972 and intracluster correlation coefficient = 0.910). Results of the third descriptive phase of the study demonstrated the highest priorities for gender-sensitive education (92.01 ± 11.76%) and care services (92.11 ± 12.04%), respectively. Conclusions: To improve the quality of the services, a gender-based education and care process, as well as a gender-sensitive structure, including gender-sensitive personnel, facilities, and management are necessary. Recognizing and meeting the needs for gender-sensitive services will improve the quality of the services.

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

BACKGROUND: Postmenopause physiological changes may alter body image (BI) during the postmenopausal period of life. Body image dissatisfaction may have negative effects on the sexual function of women. The present study aims to assess the relationship between body image and sexual function during the postmenopausal period. METHODS: This cross-sectional study was performed on 231 postmenopausal women who were menopausal during the recent 5 years, aged > 40 years old, and referring to health centers in Tehran-Iran. The participants were recruited using a multi-stage sampling method. Data were collected using 3 questionnaires including socio-demographic, Fisher's Body Image, and female sexual function index (FSFI). Data were analyzed using SPSS 24 and multiple regression, Mann-Whitey, Pearson, and Spearman correlation tests. RESULTS: Two hundred thirty-one postmenopausal women aged 52.53 ± 5.32 (mean ± SD) years old participated in the study. The mean and standard deviation of FSFI and BI of the women were respectively 19.59 ± 11.11(ranges 1.2-36) and 155.43 ± 37.09 (ranges from 46 to 230). According to FSFI, 62.8% of female sexual dysfunction (FSD) was reported. There were significant correlations between scores of total and all domains of FSFI with scores of total and all dimensions of BI. There was also a positive correlation between education and family income of the women and a negative correlation between age of husband and duration of menopause with their sexual function. Significant relationships were also shown between the women's and the husbands' jobs with the total score of women's sexual function. According to the multiple linear regression model, BI was a significant predictor of sexual function in postmenopausal women. CONCLUSION: Body image is effective on the sexual function of postmenopausal women. Therefore, body image is necessary to be considered in future postmenopausal health promotion programs.

The relationship between postmenopausal women's body image and the severity of menopausal symptoms.

BACKGROUND: Body image is the main element of an individual's personality that may be influenced by many factors during menopause. We aimed to assess the relationship between postmenopausal women's body image with the severity of menopausal symptoms. METHODS: This was a cross-sectional study on 300 postmenopausal women, aged 45 to 65 years old, in Tehran, Iran. We recruited the samples using the multi-stage sampling method. Tools for data collection were: 1) the Menopausal Rating Scale (MRS), 2) the Fisher's Body Image questionnaire and 3) a socio-demographic questionnaire. We analyzed data using the independent samples t-test, Pearson correlation coefficient, Spearman's correlation coefficient, and multiple linear regression tests. RESULTS: Three hundred women aged 55.11 ± 3.99 years old, participated in the study. Mean scores for body image and MRS were 163.07 ± 21.17 (Range: 46-230) and 16.45 ± 8.38 (Range: 0-44), respectively. About 50% of women had severe symptoms of menopause (MRS score ≥ 17). There was a negative correlation between the total score and the score of all dimensions of body image with the total score and all dimensions of MRS (P < 0.001). There were also significant relationships between women's body image with: their education (P < 0.001, r = 0.20) the spouse's education (P < 0.001, r = 0.26), adequacy of monthly household income (P < 0.001, r = 0.32), marital status (P = 0.36), their occupation (P = 0.007) and housing status (P = 0.012). There was also a significant negative correlation between women's lower body organs image with the number of children (P = 0.017, r = - 0.14). According to the multiple linear regressions model, severity of menopausal symptoms (Beta = - 0.45, P < 0.001) and adequacy of monthly household income (Beta = 0.15, P = 0.005) are the significant related factors with postmenopausal women's body image. CONCLUSIONS: Body image is correlated with menopausal symptoms of women during menopause. Therefore, it seems that interventions aimed at relieving the annoying symptoms of menopause can help to improve their body image. Also, body image could be influenced by some socio-demographic factors which should be considered in menopause health promotion programs.

Needs for a gender-based perimarital couples' counselling services in Iran.

AIM: To assess needs for a gender-sensitive perimarital counselling services in Iran. DESIGN: A descriptive cross-sectional study. METHODS: This was a study on all 236 premarital counselling providers in 37 health centres in Shiraz-Iran. The tools for data collection included the following: (a) a demographic information questionnaire and; (b) a valid and reliable Needs Assessment questionnaire for Gender-Sensitive Perimarital Counseling Services (GSPCS) in 3 sections of needs for process, structure and policy making of the perimarital counselling services. Data were analysed using SPSS 21. RESULTS: All health providers with average working experience of 8.63 (SD 5.35) years participated in the study. Results demonstrated highest scores for needs related to facilities as the structure of the services (90.09 SD 13.70 per cent) and community empowerment (89.50 SD 16.67 per cent) as the necessary policy for the gender-sensitive services. We concluded that providing gender-sensitive perimarital counselling healthcare services needs to reform the process, structure and policies of the services.

Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study.

BACKGROUND: Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services. METHODS: This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation. RESULTS: The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach's α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance. CONCLUSION: GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.

Correction to: Is body image a predictor of women's depression and anxiety in postmenopausal women?

An amendment to this paper has been published and can be accessed via the original article.

Is body image a predictor of women's depression and anxiety in postmenopausal women?

BACKGROUND: Women in perimenopausal and postmenopausal period are at increased risk of depression and anxiety. Physiologic changes in menopause can change body's appearance and function that may disturb body and then lead to anxiety and depression. This study aims to assess the relationship between body image with anxiety and depression among postmenopausal women. METHODS: This descriptive study was performed on 307 women attending to the health centers in Tehran- Iran. Sampling was performed by a multi-staged randomized method. Data were collected by using Beck Depression questionnaire, Spielberger Anxiety Questionnaire, Fisher Body Image Questionnaire and Socio-demographic questionnaires. Data were analyzed by SPSS 21 and using t-test, Pearson and Spearman correlation tests and multiple linear regression methods. RESULTS: The average age of the participants was 55.19 ± 4.034 years. Mean scores for body image, anxiety and depression were 163.26 ± 20.38, 12.00 ± 7.71 and 42.70 ± 8.40 respectively. Fifty five percent of women had mild to severe depression and 83.7% of them had mild to severe anxiety. Total score and all domains of body image had a negative correlation with depression and anxiety scores (P < 0.001). Multiple linear correlation showed that body image is a predictor for depression and anxiety (P < 0.001). CONCLUSIONS: Body image of women can be effective on occurrence of depression and anxiety in menopause. Therefore, women's health policies should consider body image to control cognitive problems including depression and anxiety in menopause.

Factors associated with quality of life of postmenopausal women living in Iran.

BACKGROUND: Quality of life (QoL) after menopause could be influenced by a host of personal and social factors. This study aimed to determine the factors associated with quality of life among postmenopausal women. METHODS: This cross-sectional study was conducted among 405 postmenopausal women selected using a multi-stage randomized sampling. The data-collection tools were the WHO Quality of Life-BREF (WHOQOL-BREF), the Menopause Rating Scale (MRS), and a researcher-designed questionnaire. The relationship between QoL and its potentially correlated factors was examined using t-test, ANOVA, Pearson's correlation, Spearman's correlation coefficient, and multiple linear regression. RESULTS: A negative correlation was found between the scores of QoL (total and all subscales) and the MRS total scores. The total scores of QoL were negatively correlated with duration of menopause (r = - 0.127, P = 0.010), gravida (r = - 0.177, P < 0.001), parity (r = - 0.165, P = 0.001), frequency of stillbirth (r = - 0.104, P = 0.037), vaginal delivery (r = - 0.161, P = 0.001), and waist-to-hip ratio (r = - 0.195, P < 0.001). The QoL total scores were positively correlated with the educational level of the participants (r = 0.207, P < 0.001) and that of their spouses (r = 0.160, P = 0.001) along with their level of monthly family income (r = 0.218, P < 0.001). Multiple-linear-regression analysis showed that the total score of QoL decreased with inadequate income, waist-to-hip ratio, and the total score of MRS. CONCLUSIONS: Personal and social factors along with the severity of menopausal symptoms affect QoL post-menopause. These factors need to have a bearing on any effort to improve QoL among postmenopausal women.

Needs assessment for gender sensitive reproductive health services for adolescents.

Background A dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents. Objective This study aims to assess needs for gender sensitive reproductive health care services for adolescents. Methods This was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21. Results Three hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services. Conclusions Providing gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.

Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women: a randomised clinical trial.

Background The adverse effects of menopause on sexual function could be mitigated by pelvic floor muscle (PFM) training. This study aimed to investigate the effects of PFM exercises on sexual function in postmenopausal women. METHODS: A randomised clinical trial was conducted among 97 Iranian postmenopausal women, aged 40 to 60 years. The participants' baseline sexual functions were assessed using the Female Sexual Function Index (FSFI) questionnaire. They were then randomly designated to two groups: (1) the intervention group, which received specific instructions on PFM exercises and was followed up on a weekly basis; and (2) the control group, which received general information on menopause. After 12 weeks, the sexual functions of the participants were reassessed. RESULTS: No significant difference was initially observed between the two groups in terms of demographic and socioeconomic characteristics and total scores of FSFI. After the intervention, however, the scores of arousal, orgasm and satisfaction were significantly higher in the intervention group (3.10, 4.36, and 4.84 vs 2.75, 3.89, and 4.36 respectively; P<0.05). CONCLUSION: PFM exercises have the potential to improve the sexual function of postmenopausal women and are thus suggested to be included in healthcare packages designed for postmenopausal women.

Effects of aromatherapy with Rosa damascena on nulliparous women's pain and anxiety of labor during first stage of labor.

BACKGROUND: Reducing labor pain and anxiety is one of the most important goals of maternity care. OBJECTIVE: 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. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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). CONCLUSION: 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. TRIAL REGISTRATION: Iranian Registry of Clinical Trial: IRCT201306258801N3.

Quality of Life and Body Image of Individuals with Gender Dysphoria.

This study aimed to assess the body image and quality of life of individuals suffering from gender dysphoria (GD) who were undergoing different types of treatment or no treatment at all. This was a descriptive-comparative study of 90 patients with GD sorted into three groups: untreated (no hormone therapy or surgery) (n = 30), hormone therapy (n = 30), and gender-reassignment surgery (n = 30). They were recruited using convenience sampling from a hospital in Tehran, Iran. The tools for data collection were three questionnaires to assess quality of life, body image, and demographic characteristics. The results showed that scores of quality of life and body image were significantly higher in the surgery group compared to the untreated singular (p < 0.001). A significant correlation was found between the quality of life and body image of the patients (r = 0.49; p < 0.001). We concluded that gender-reassignment surgery is the most effective treatment in improving body image and quality of life among individuals with GD.