Journal of Midwifery & Reproductive health
Volume:10 Issue: 3, Jul 2022

Inadequate laws to prevent sexual violence against women and to protect victims as well as the factors such as patriarchal culture, and misconceptions of some religious and Islamic teachings can lead to temper divorce and betrayal. This study was performed to review the jurisprudential and legal protections for domestic sexual violence in Iran.

In this review, the published evidence on the supportive aspects of domestic sexual violence between 1990 and 2021 was searched in the English database of Scopus, PubMed, Science Direct, and EBSCO as well as Persian databases of Magiran, SID, and IranMedex. To collect data, searching was done using the key words of Violence, Domestic, Family Violence, Sex Offenses, Partner Abuse, Sexual Violence, Civil Law, legislation, jurisprudence and religion of Islam alone or in combination in English and their Persian equivalents.

Among 69 studies related to the legal and religious aspects of sexual violence, 35 studies were reviewed. In Iranian law, there is legal material only in a number of cases of sexual violence in the section on punishments and the Islamic Penal Code. There is also disagreement among Shiite scholars about some unusual sexual behaviors. Ongoing counseling is emphasized due to the importance of different dimensions such as unconventional sexual request, and sexual violence with reluctance of wife.

Some cases of sexual violence are not properly restricted. Therefore, more attention to these cases by jurists and legislators can reduce the occurrence of many forms of sexual violence against women.

Birth-related perineal injuries, especially its severe degrees, could result in unpleasant childbirth experience and affect maternal and infant morbidities. Since, it is possible to improve the quality of care through understanding patients' expectations and experiences, this study was conducted to explore the perceptions and experiences of women with perineal injuries in postpartum care.

In this qualitative study, 22 women with various degrees of perineal trauma were purposively selected between 10 days to one year after childbirth from hospitals and healthcare centers in Mashhad, Iran in 2016. Data collection was carried out through in-depth, face-to-face semi-structured interviews.  Data were concurrently analyzed through conventional content analysis using inductive approach of Elo and kyngas (2008) following data organization by MAXQDA software (version 10).

Postpartum care of women with severe perineal injuries was explained as "unethical practices in care" with two emerged categories including "lack of professional responsibility" comprising two subcategories of "short term follow-up" and "neglect of comprehensive care " as well as unethical communications" consisting of three subcategories of "dishonesty", "inactive listening", and "lack of compassion".

Postpartum care in women with severe perineal trauma needs to be reviewed so that follow-up care and comprehensive provision of required services should be taken into account with focus on effective communication skills including honesty, active listening and compassion.

Research has demonstrated the negative effects of type-1 diabetes mellitus (T1DM) on the female sexual health and reproductive function. The present study was conducted to develop the concept of sexual and reproductive health (SRH) in women with T1DM.

This concept development was conducted by directed content analysis of relevant literature. A search was carried out for articles published from 2000 to 2019 in English databases including PubMed, Web of Science, Scopus, Embase and Persian databases including Magiran, SID, and IranDoc and search engine such as Google Scholar based on a search strategy developed for each database using Boolean operators. The initial matrix was designed based on the framework proposed by the United Nations Population Fund (UNFPA) and the World Health Organization (WHO) and information resources related to them for the concept of women's sexual and reproductive health (SRH). The selected articles were analyzed using directed content analysis with deductive approach proposed by Hsieh and Shannon. 

The final codes were extracted from the review of 151 articles based on their conceptual differences and similarities, and categories were then defined and a matrix was developed. Four categories were extracted in this study for the concept of SRH in women with T1DM, including reproductive system, safe motherhood, sexual and gender-based violence, and sexual function, along with 20 subcategories.

The findings can be utilized to develop specific tools for assessing SRH in women with T1DM as well as designing programs targeting SRH promotion in this vulnerable group.

Midwives need to have knowledge and skills of human communication to provide their professional services in the most efficient way. The purpose of this study was to investigate the general and professional communication skills of Iranian midwifery students and to explore their viewpoints on the ways of its improvement.

This cross-sectional study using a data triangulation approach was conducted on 343 midwifery students who were selected using convenience sampling from Ahvaz Jundishapur University of Medical Sciences and Semnan Azad University, Iran, in 2020. Data were collected using Queendom Communication Skills Test-Revised (CSTR) and Professional Communication Skills Assessment Questionnaire. There was an open-ended question at the end of the questionnaire that assessed students' views on improving communication skills. The quantitative data were analyzed by SPSS version 22, and qualitative data by qualitative content analysis. 

The mean scores of the students' general and professional communication skills were 64 ± 4.3 (poor) and 92 ± 3.1(moderate), respectively. No significant relationship was found between demographic or academic characteristics of midwifery students and their general and professional communication skills. Analysis of students’ experiences and perceptions resulted in two main categories indicating the need to promote direct training and to control the impact of hidden curriculum.

Most students had poor general communication skills while their professional communication skills were at a moderate level. Communication skills training in the midwifery curriculum needs to be revised. Results reflected the need to empower instructors and students in terms of their communication skills.

Hormonal disorders may be associated with a variety of menstrual disorders that can have different health consequences and are an indicator women’s gynecologic health. The aim of this study was to evaluate the pattern of sexhormones of the menstrual cycle related to the menstrual cycle intervals in girls aged 9-18 years.

In this two-stage cross-sectional study, 2000 girls aged 9-18 years old in first stage were selected conveniently from four districts of Shiraz, Iran in cluster form in 2015, and their pattern of menarche age (early, normal, late) was determined. In the second stage, 50 students with normal menarche and 12 students with late menarche were selected and each completed a questionnaireincluding demographic characteristics, Hygam chart and menstrual bleeding characteristics (using Smith-Di Giulio criterion) questionnaire. Their hormones including TSH, Prolactin, FSH, DHEAS and Testosterone were also measured.

The highest frequency of age was 16 years (40.3%) and the lowest was 17 years old (8.1%). The results of one-way analysis of variance between different hormones and menstrual cycle interval showed that there is a significant relationshipbetween TSH (P=0.03), Prolactin (P=0.002) and menstrual intervals. But no significant relationship was seen between LH (P=0.63), FSH (P=0.08), DHEAS (P=0.82), Testosterone (P=0.703) and menstrual intervals.

TSH and prolactin disorders are the most common hormonal disorders in girls with menstrual disorders. It is recommended to check these hormones in girls with various menstrual disorders after eliminating structural disorders and before starting different treatments for menstrual disorders

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women, which is associated with phenotypic changes, fertility disorders and overweight or obesity. Most of women are concerned about the complications of obesity caused by this disease that can adversely affect their quality of life. Therefore, the present study was conducted to compare the quality of life in normal and overweight women with polycystic ovary syndrome.

This was a cross-sectional study which performed on 95 normal and 100 overweight women with polycystic ovary syndrome, who attended two hospitals in Urmia, Iran in 2019 and were selected through convenience sampling. Demographic and quality of life questionnaires for polycystic ovary syndrome were used to collect data.  Independent sample T test and Chi square test were used to analyze the data.

The mean age of study participants was 26.93 ±5.37 years. The mean score of total quality of life in women with normal weight and overweight was 137.88 ±13.27 and 99.12 ± 22.15, respectively, which was significantly different (P ≤ 0.001).  Also, the mean score of different areas of quality of life questionnaire, except of menstrual disorders, in overweight women were significantly lower than women with normal weight (P ≤ 0.001). In addition, prevalence of hirsutism in obese women was higher than normal weight women, showing a statistically significant difference (P ≤ 0.001).

The results showed that weight gain further reduces the quality of life score in women with polycystic ovary syndrome.

Pregnancy is a unique event that might challenge sexual relationship. The purpose of this study was to explore the meaning of sexuality from pregnant woman’s perspectives.

This was a qualitative study reporting the findings of individual in-depth interviews with 23 pregnant women conducted in Kashan, Iran in 2018. Participants were selected using purposive sampling. All interviews were audio recorded and transcribed verbatim. The data collection continued until data saturation was achieved. Conventional content analysis was used to analyze the data.

The main emerged theme was priority to fulfill husband's sexual need comprising of two categories including: (1) more male-centered sexual relationship in pregnancy consisting of three sub-categories of passive sexual role, give in to sex for fear of infidelity and self-blame for not providing optimal sex to the partner (2) unmet emotional-sexual expectations of pregnant women consisting of two sub-categories of needing to more husband's empathetic behaviors and dissatisfaction from mutual companionship of spouse in sexual relationship.

The findings suggest that pregnancy can have unpleasant effects on pregnant women's life emotionally and lead to a decreased quality of sexual life. Sexual health consultation must be embedded in prenatal care in order to increase marital satisfaction.

Companionship in labor is highly effective in encouraging facility-based delivery and has a positive effect on maternal self-control during childbirth. However, there have been few studies in Ethiopia to examine this issue. Therefore, this study assessed pregnant women’s knowledge and desire towards labor companionship and its associated factors at public hospitals in South Wollo Zone, Northeast Ethiopia.

A facility-based cross-sectional study design was employed from 1st November to 9th December, 2020. Study participants consisted of 416 pregnant women, who were selected by a systematic random sampling technique. Data were collected using structured questioners including socio-demographic characteristics, obstetric history, knowledge and desire towards companionship in labor, through face-to-face interviews.

In this study, 19.5% of respondents have good knowledge while 87.3% of them have desire to have labor companion.  Diploma and higher educational level (AOR=3.23 95% CI: 1.06, 9.86), prior birth at private health-facility AOR=3.95, 95% CI: 1.08, 7.49) and having the experience of previous labor companion (AOR=2.36, 95% CI: 1.27, 4.38) were significantly associated with good knowledge. Rural residence (AOR=6.8, 95% CI: 1.40, 9.99) and history of having labor companion (AOR=5.34, 95% CI: 1.53, 9.64) were associated with desire to have companion.

Small percentage of pregnant women had awareness on labor companionship while a large percentage of women desire companionship during childbirth. Therefore, health care professionals should educate perinatal women about labor companions and allow them to have a support person throughout labor and delivery at a health facility to increase their awareness and desire.

Sexual satisfaction of pregnant women is affected by physiological and psychological conditions of this period. The mindfulness-based stress reduction, as it can increase awareness of sexual responses, may help improve pregnant women's sexual satisfaction. This study was carried out to evaluate the effect of mindfulness-based stress reduction group counseling on sexual satisfaction of pregnant women.

This randomized clinical trial was performed in 2021 on 60 pregnant women aged 18-35 years with gestational age of 20-26 weeks, referring to the health care centers in Mashhad, Iran. In the intervention group, 8 sessions of 60-minute group counseling were conducted through Skyroom in the groups of 10-12 people. The control group received routine care. Sexual Satisfaction for Women (SSSW) and Depression, Anxiety and Stress-21 (DASS-21) were used to collect data. Data were measured before and 4 weeks after the intervention and were analyzed by SPSS software and independent t-test and Mann-Whitney test.

Before the intervention, the mean score of sexual satisfaction of pregnant women was not significantly different in the two groups of intervention (83.80±16.49) and control (85.82±11.46). After the intervention, the mean score of sexual satisfaction of pregnant women significantly increased in the intervention group (110.65±6.53) compared to the control group (95.18±15.12) (P<0.001).

Considering the effect of mindfulness-based stress reduction group counseling on sexual satisfaction improvement of pregnant women, it is suggested to use it to improve sexual satisfaction of pregnant women.

Health literacy is the ability to appraise proper health-related behaviors. Women’s health literacy levels affect not only their own health but also pregnancy, fetus, newborn, and child health. This study aimed to determine the relationship between health literacy and health practices in pregnancy and identify its affecting factors. 

The sample of this cross sectional study consisted of 374 pregnant women who visited the Obstetrics and Gynecology Polyclinic of a University Hospital between the 1st of March and the 1st of October, 2018 in Ankara, Turkey. Data were collected using Demographic Questionnaire, Health Literacy Index, and Health Practices in Pregnancy Scale. The data were evaluated using SPSS 25.0. For analysis, Mann-Whitney U test, Kruskal-Wallis test, Dunn’s test, Spearman Rho correlation analysis, Linear regression analysis were used.

Pregnant women had a good health literacy and an above-average health practice level. A positive and significant relationship was found between health literacy and health practices (p<0.05). Income level, the place where women spent their childhood, perception of pregnancy, and behaviors demonstrated in case of a health problem were found as influencing factors of health literacy level. Health practices in pregnancy were found to be significantly affected by age, educational level, perception of pregnancy, and behaviors demonstrated in case of a health problem (p<0.05).

The study indicates that health literacy and health practices in pregnancy are affected by many important socio-demographic characteristics. In addition, health practices demonstrated during pregnancy increase with the increase in pregnant women’s health literacy levels.

Prevention of high-risk sexual behaviors due to its prevalence among young people is an important health concern. Because of the importance of promoting young people` sexual health, the present study was conducted to investigate the effect of training high-risk sexual behaviors prevention through an educational package on sexual knowledge and attitude of students.

This quasi-experimental study with a two-group pretest-posttest design was performed on 200 eligible female undergraduate students of Mashhad University of Medical Sciences, Mashhad, Iran in 2016. The subjects were randomly divided into two groups of intervention and control group. In the intervention group, the participants received a prevention education program through a training package. Students' sexual knowledge and attitude were assessed using self-structured sexual knowledge and attitude questionnaires before and two weeks after the training. Paired and independent t-test, Mann-Whitney, Wilcoxon and Chi-square tests was used to analyze data by SPSS (version 16).

Sexual knowledge mean score of intervention group was significantly higher compared to the control group (29.29±1.14 vs 14.41±4.21, P=0.005) after training. Mean score of students' sexual attitude although increased after training in intervention group compared to the control group (139.39±13.17 vs 133.01±9.79), but this difference was not significant (P=0.081).

The students` sexual knowledge was increased through using sexual training package as prevention education program. This method is recommended for sexual education and counseling of students to prevent high-risk sexual behaviors and promote community health.

A rectal buttonhole tear during childbirth is an isolated laceration of rectal mucosa and vagina without involvement of anal sphincter that its management is challenging in obstetrics. The aim of this study was to report a case of rectal buttonhole tear following operative vaginal delivery.

Case report: 

A 31-year-old primigravid woman was admitted to the Maternity ward of a teaching hospital of Mashhad University of Medical Sciences for pregnancy termination. The patient underwent an induction of labor. She had a successful assisted vaginal delivery with vacuum. A Rectal buttonhole tear was found in in the rectovaginal septum, which was repaired immediately after delivery in operation room. Six weeks’ follow-up visit showed a completely cured laceration and the patient reported no complaints of fecal incontinence or foul discharge.

Rectal examination before and after suturing perineal tears following vacuum extraction can help the diagnosis of isolated laceration. Accurate evaluation and using the optimal surgical techniques are the main points to achieve the best results.

Infertility has negative effects including sexual dysfunction in infertile women. This study investigated the effect of counseling based on the PLISSIT model on sexual function of infertile women.

This study was performed on 60 infertile women, who were randomly assigned to two intervention (direct and indirect counseling) and control groups (20 in each group). In the direct counseling group, the intervention included four face to face sexual counseling sessions, once a week, based on the PLISSIT model. In the indirect counseling group, the similar content of counselling was given through booklet and the participants received telephone counseling. Sexual function was measured using female sexual function index (FSFI) pre and four weeks after intervention. One-way ANOVA was used to compare the groups before the intervention and ANCOVA with control of the baseline score after the intervention.

There was no significant difference between the sexual function of three groups at baseline. After the intervention, by controlling the baseline score, a significant difference was observed in the overall score of sexual function in the direct counseling group (mean difference: 5.1, 95% CI: 26.3 to 29.7, P=0.001). In the indirect counseling group, after the intervention, only a significant differences was observed in the pain dimension (mean difference: 0.9, 95% CI: 2.5 to 3.9, P=0.044).

It seems that PLISSIT based direct counseling improves more the sexual function of women with infertility. So, it is recommended that such counseling program be integrated into the health care program of infertile women.