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1.  Comparison of Sexual Problems in Fertile and Infertile Couples 
Journal of Caring Sciences  2017;6(3):269-279.
Introduction: Infertility is known to have a negative effect on couple's life and in most cases it has a profound impact on sexual relations. Sexual problems may be the cause of infertility or may arise as a result of infertility. The aim of this study was to compare the sexual problems in fertile and infertile couples.
Methods: This cross-sectional study was performed on 110 infertile and 110 fertile couples referring to Montaserieh infertility center and five health centers in Mashhad which were selected as class clustering method and easy method. Data collection tools included demographic questionnaires and Golombok-Rust Inventory. The collected information was analyzed by SPSS software and descriptive and inferential statistics.
Results: No significant difference was found between fertile 26 (17, 37) and infertile 26(18, 37) women in terms of total score of sexual problems and other aspects of sexual problems (except infrequency). The women in the fertile group had higher infrequency than infertile women. Total score of sexual problems in fertile men was 18.5 (13, 27) and in infertile men 25 (19, 31) and the difference was statistically significant. Infertile men reported more problems in no relation, impotency and premature ejaculation compared to fertile men. Men in both fertile and infertile group reported more sexual problems than women.
Conclusion: In view of the more frequent sexual problems in infertile men than infertile women, it seems that it is necessary to pay more attention to sexual aspects of infertility in men and design the training programs for sexual and marital skills in infertility centers.
PMCID: PMC5618951
Sexual dysfunction; Fertile; Infertile; Couples
2.  A survey of the therapeutic effects of Vitamin E suppositories on vaginal atrophy in postmenopausal women 
Menopause is associated with various complications such as depression, sleep disorders, and genitourinary atrophy. Vaginal atrophy occurs due to the loss of steroid hormones, and its major symptoms include vaginal dryness, itching, dyspareunia, and bleeding after intercourse. According to the literature, vitamin E plays a key role in estrogen stability. The aim of this study was to compare the effects of vitamin E suppositories and conjugated estrogen vaginal cream on vaginal atrophy.
Materials and Methods:
In this clinical trial, 52 postmenopausal women, who were referred to a gynecology clinic in 2013, were recruited and randomly divided into two groups (26 cases per group). One group received 100 IU of vitamin E suppositories (n = 26), whereas the other group applied 0.5 g of conjugated estrogen cream for 12 weeks. Vaginal maturation value (VMV) was compared between the two groups before and after the intervention. VMV ≤ 55 was regarded as a cut-off point for vaginal atrophy. Treatment success was defined as a 10-unit increase in VMV, compared to the baseline value. Data were analyzed by Friedman test and Mann-Whitney test. P value less than 0.05 was considered statistically significant.
The mean VMV in the vitamin E group before the treatment and after 4, 8, and 12 weeks of treatment was 43.78 ± 13.75, 69.07 ± 22.75, 77.86 ± 21.79, and 80.59 ± 19.23, respectively. The corresponding values in the estrogen cream group were 42.86 ± 14.40, 86.98 ± 12.58, 92.65 ± 15, and 91.57 ± 14.10, respectively. VMV significantly improved in both the treatment groups after the intervention, compared to the preintervention period (P < 0.001). Treatment success was reported in both groups, although estrogen cream (100%) appeared to be more effective after 4 weeks of treatment, compared to vitamin E suppositories (76.9%) (P = 0.01).
Based on the findings, use of vitamin E suppositories could improve the laboratory criteria for vaginal atrophy and treatment success. Therefore, vitamin E suppositories are suggested for relieving the symptoms of vaginal atrophy, especially in women who are unable to use hormone therapy or cope with the associated side effects.
PMCID: PMC5114791  PMID: 27904630
Conjugated estrogen; vitamin E; vaginal atrophy
3.  Sexual dysfunction in infertile women 
Sexual problems have different effects on the life of people by influencing their interpersonal and marital relationships and satisfaction. Relationship between sexual dysfunctions and infertility can be mutual. Sexual dysfunction may cause difficulty conceiving but also attempts to conceive, may cause sexual dysfunction.
This paper compares sexual dysfunction in fertile and infertile women.
Materials and Methods:
In this cross-sectional study, 110 infertile couples referring to Montasarieh Infertility Clinic and 110 fertile couples referring to five healthcare centers in Mashhad were selected by class cluster sampling method. Data collection tools included demographic questionnaire and Glombok-Rust Inventory of Sexual Satisfaction. Data were analyzed through descriptive and analytical statistical methods by SPSS.
There was no significant difference in total score of sexual problems and other dimensions of sexual problems (except infrequency) in fertile 28.9 (15.5) and infertile 29.0 (15.4) women. Fertile women had more infrequency than infertile women (p=0.002).
There was no significant difference between fertile and infertile women in terms of sexual problems. Paying attention to sexual aspects of infertility and presence of programs for training of sexual skills seems necessary for couples.
PMCID: PMC4869159  PMID: 27200422
Sexual problems; Fertile; Infertile; Couples
4.  Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives 
In developing countries, hemorrhage accounts for 30% of the maternal deaths. Postpartum hemorrhage has been defined as blood loss of around 500 ml or more, after completing the third phase of labor. Most cases of postpartum hemorrhage occur during the first hour after birth. The most common reason for bleeding in the early hours after childbirth is uterine atony. Bleeding during delivery is usually a visual estimate that is measured by the midwife. It has a high error rate. However, studies have shown that the use of a standard can improve the estimation. The aim of the research is to compare the estimation of postpartum hemorrhage using the weighting method and the National Guideline for postpartum hemorrhage estimation.
Materials and Methods:
This descriptive study was conducted on 112 females in the Omolbanin Maternity Department of Mashhad, for a six-month period, from November 2012 to May 2013. The accessible method was used for sampling. The data collection tools were case selection, observation and interview forms. For postpartum hemorrhage estimation, after the third section of labor was complete, the quantity of bleeding was estimated in the first and second hours after delivery, by the midwife in charge, using the National Guideline for vaginal delivery, provided by the Maternal Health Office. Also, after visual estimation by using the National Guideline, the sheets under parturient in first and second hours after delivery were exchanged and weighted. The data were analyzed using descriptive statistics and the t-test.
According to the results, a significant difference was found between the estimated blood loss based on the weighting methods and that using the National Guideline (weighting method 62.68 ± 16.858 cc vs. National Guideline 45.31 ± 13.484 cc in the first hour after delivery) (P = 0.000) and (weighting method 41.26 ± 10.518 vs. National Guideline 30.24 ± 8.439 in second hour after delivery) (P = 0.000).
Natural child birth education by using the National Guideline can increase the accuracy of estimated blood loss. Therefore, training the personnel to use this guideline is recommended. However, It has less accuracy than 'sheet weighing’. Consequently, usage of symptoms and the weighing method is recommended in cases of postpartum bleeding.
PMCID: PMC4525346  PMID: 26257803
Gravimetric method; hemorrhage estimation; midwife; National Guideline; postpartum hemorrhage
5.  The Effect of Virtual Reality on Pain in Primiparity Women during Episiotomy Repair: A Randomize Clinical Trial 
Pain is one of the side effects of episiotomy. The virtual reality (VR) is a non-pharmacological method for pain relief. The purpose of this study was to determine the effect of using video glasses on pain reduction in primiparity women during episiotomy repair.
This clinical trial was conducted on 30 primiparous parturient women having labor at Omolbanin Hospital (Mashhad, Iran) during May-July 2012. Samples during episiotomy repair were randomly divided into two equal groups. The intervention group received the usual treatment with VR (video glasses and local infiltration 5 ml solution of lidocaine 2%) and the control group only received local infiltration (5 ml solution of lidocaine 2%). Pain was measured using the Numeric Pain Rating Scale (0-100 scale) before, during and after the episiotomy repair. Data were analyzed using Fisher’s exact test, Chi-square, Mann-Whitney and repeated measures ANOVA tests by SPSS 11.5 software.
There were statistically significant differences between the pain score during episiotomy repair in both groups (P=0.038).
Virtual reality is an effective complementary non-pharmacological method to reduce pain during episiotomy repair.
Trial Registration Number: IRCT138811063185N1.
PMCID: PMC4430883  PMID: 25999621
Virtual reality; Pain; Parity; Episiotomy
6.  The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery 
Selection and acceptance of appropriate sexual behavior and sexual function are made difficult by low sexual self-efficacy in the postpartum period. The general purpose of this research is to define the effects of an 8-week pelvic floor muscle exercise program on sexual self-efficacy in primiparous women after childbirth.
Materials and Methods:
This clinical trial was performed on 79 primiparous women who referred to health care centers, Mashhad, Iran in 2013, 8 weeks after delivery, to receive health care services. They were selected by easy sampling. The samples were randomly assigned to either intervention or control group. The intervention group was trained in Kegel exercises for 8 weeks. Both groups were evaluated at 4 and 8 weeks. Data collection tools included: Demographic information, sexual self-efficacy, and Brink scale. Data were analyzed using repeated measures, Friedman test, t-test, and Mann–Whitney test.
The results showed significant increase in pelvic floor muscle strength in the intervention group at 4 and 8 weeks after exercises (P < 0.0001), but no significant difference was observed in the control group (P = 0.368). There was a significant increase in sexual self-efficacy in the intervention (P < 0.0001) and control groups (P = 0.001) at 4 and 8 weeks after the start of the study. Comparison of the two groups showed a significant difference in sexual self-efficacy after they performed these exercises (P = 0.001).
The findings showed that 8-week pelvic muscle exercises increase the sexual self-efficacy in women after delivery.
PMCID: PMC4462060  PMID: 26120335
Exercises; Iran; pelvic floor; postpartum; self-efficacy; sexual
7.  The Shape of Uterine Contractions and Labor Progress in the Spontaneous Active Labor 
Dystocia is the most common indication of primary cesarean section. The most common cause of dystocia is uterine dysfunction. In prolonged labor, more attention is usually paid to the fetus and pelvis rather than to the role of uterine contractions in a delivery. Therefore, we decided to determine the relationship between the labor progress and uterine contractions shapes.
In this cross-sectional study, 200 primiparous women participated having a single pregnancy and cephalic presentation. Uterus contractions were recorded using electronic fetal monitoring at the beginning of the active phase of labor (dilatation 3-5 cm) for 30 min. Fall to rise (F:R) ratio was calculated by determining the duration of returning from a contraction peak to its baseline (fall) and the duration of the rise time from baseline to peak (rise) in two groups. The data were analyzed using t-test and Chi-square test.
In this study, 162 women had a normal delivery and 38 women had a cesarean (CS) delivery due to the lack of labor progress. The average F:R ratio was 1.13±0.193 seconds in the vaginal delivery group and 1.64±0.301 seconds in the CS group. This difference was statistically significant (P<0.001). The frequency of contractions in the vaginal delivery group was more than the CS group (P=0.008).
Our findings demonstrated that uterine contractions shapes change; and F:R ratio was higher in the group that lacked labor progress. Therefore, contraction shapes can be used to predict the labor progress.  
PMCID: PMC4359943  PMID: 25821288
Uterine contraction; Dystocia; First stage labor
8.  Relationship between gender role attitude and fertility rate in women referring to health centers in Mashhad in 2013 
Fertility rate apparently is a non-interventional behavior, but in practice, it is influenced by social values and norms in which culture and traditional beliefs play a significant role. In this regard, some studies have shown that gender roles can be associated with reproductive behaviors. With regard to the importance of annual reduction of population growth rate and its outcomes, the present study was performed to determine the relationship between gender role attitude and fertility rate in women referring to Mashhad health centers in 2013.
Materials and Methods:
The present study is an analytical cross-sectional and multistage sampling study performed on 712 women. Data were collected by a questionnaire consisting of two sections: Personal information and gender role attitude questionnaire that contained two dimensions, i.e. gender stereotypes and gender egalitarianism. Its validity was determined by content validity and its reliability by internal consistency (r = 0.77). Data were analyzed by SPSS software version 16.
Initial analysis of the data indicated that there was a significant relationship between acceptance of gender stereotypes (P = 0.008) and gender egalitarianism (P < 0.001), and fertility. There was also a direct association between acceptance of gender stereotypes and fertility rate (r = 0.13) and an indirect association between egalitarianism and fertility rate (r = −0.15).
The results of the present study indicate that there is an association between gender role attitude and fertility. Paying attention to women's attitude is very important for successful planning in the improvement of fertility rate and population policy.
PMCID: PMC4387654  PMID: 25878707
Attitude; fertility rate; gender role; Iran
9.  Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial 
Oman Medical Journal  2014;29(1):32-38.
To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence.
In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King’s Health Questionnaire.
Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King’s Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention.
Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.
PMCID: PMC3910410  PMID: 24498480
Behavioral intervention program; Vaginal cones; Stress urinary incontinence
10.  Evaluating the Relationship between Body Size and Body Shape with the Risk of Breast Cancer 
Oman Medical Journal  2013;28(6):389-394.
This study aims to determine the relationship between body size and body shape with the risk of breast cancer.
In this case control study, 480 women participated (240 women with breast cancer in case group and 240 healthy women in control group). After completing the interview form, the weight, height, waist circumference, hip circumference and breast size, were measured. The data were analyzed using statistical test by SPSS11.5.
The present study showed that the mean of hip circumference were significantly different in both groups (p=0.036). The size of the breast was statistically significant between the two groups. Thyroid type, one of the body shapes, was more seen in the case group than control group (p<0.001).
This study revealed that the risk of breast cancer increases with increased hip circumference. In addition, the results indicate that body shape may be a useful predictor in determining the risk of breast cancer. More studies should be designed to address this subject.
PMCID: PMC3815854  PMID: 24223241
Breast cancer; Body size; Waist circumference; Waist-hip ratio

Results 1-10 (10)