Current Women's Health Reviews - Volume 17, Issue 2, 2021

Infertility is defined as the inability to conceive a pregnancy after one year or more of unprotected sexual intercourse, among the women at the risk of conceiving a pregnancy. In addition to the age factor, it is known to be associated with pathological and genetic conditions that contribute to its early onset. Polycystic ovarian syndrome (PCOS), endometriosis, fibroids, and blockade in fallopian tubes are certain common pathological causes of female infertility. Researches are focused to eradicate the primary cause of infertility to achieve healthy fertile ground for fertilization. Depending on the cause, therapeutic options include medicines (chemical, herbal and Chinese), hormonal stimulation, surgery, assistive reproductive technology, and tissue engineering. To the extent of research, biotechnology has played a significant role to answer the problem. This review discusses advancements in these therapeutic fields to treat women-associated infertility.

Objective: To study the outcomes of membrane sweep done during induction of labor with sublingual misoprostol at term pregnancy such as the mode of delivery and the induction delivery interval. Methods: This prospective descriptive study was conducted on 305 term women (237 primigravidas and 68 multigravidas) who received sublingual misoprostol followed by membrane sweep (single or double sweep based on the progress of labor). Main outcome measures included mode of delivery, induction to delivery interval, duration of labor, neonatal outcomes and maternal complications. Results: Among 237 primigravidas, 108 (45.5%) women delivered after a single sweep and 129 (54.4%) women needed a second sweep. Among 68 multigravidas, 47 (69.1%) delivered after a single sweep and only 21 (30.8%) required a second sweep. The maximum number (75.5%) of primigravidas had a pre-induction Bishop score of 2, while the maximum number (67.6%) of multigravidas had a pre-induction Bishop score of 3. Vaginal deliveries (including instrumental delivery) were more in both primigravidas (55.6%) and multigravidas (88.2%), who received membrane sweep in conjunction with induction of labor. The mean time from the first dose of sublingual misoprostol to the onset of contraction was 6.9 hours in primigravidas and 4.2 hours in multigravidas, while the meantime from the onset of contractions till vaginal delivery (duration of labor) was 11.2 hours in primigravidas and 5.8 hours in multigravidas. The mean interval from induction to the vaginal delivery was 18.8 hours in primigravidas and 14.4 hours in multigravidas. Conclusion: Sublingual misoprostol, along with membrane sweep at the initiation of labor induction, is an effective intervention despite its association with an increased rate of cesarian section among primigravidas as compared to the literature.

Background: Evaluation and screening of breast cancer demand significant primary care practice. Breast pain and nipple discharge are the frequent complaints owing to the benign conditions. Objective: In this study, we have investigated the prevalence of breast complaints among women referred to our clinic in Khorramabad, Iran. Methods: This is a cross-sectional study about the prevalence of breast-related complaints in women with breast problems referred to surgery clinic over a period of 6 months. Results: Among 151 patients, following outcomes were seen; breast pain (60.3%), lump (27.8%), nipple discharge (4%), lump with pain (4.6%) and other (0.7%). 11 patients were presented with lump malignancy (23.9%) including; fibrocystic change (56.5%) and fibro-adenoma (19.6%). Conclusion: This study showed that breast pain was the most common of all complaints and fibrocystic change was the most detected lump-type. Lumps were frequent in single women whereas, mastalgia was common in married women.

Background: Lack of sexual knowledge or incorrect sexual information can lead to anxiety and fear of sexual communication and subsequent sexual dysfunction in marrying women. Objective: The purpose of this study was to investigate the impact of sexual cognition counseling on the sexual communication anxiety of women upon marriage. Methods: In this randomized quasi-experimental study, 124 women upon marriage with poor sexual knowledge and attitudes, were randomly assigned into two groups of intervention and control group (62 in each group), using four randomized blocking. Data was collected by Sexual Knowledge and Attitude (SKAS) and Sexual Communication Anxiety questionnaires. In the experimental group, five counseling sessions were held with the aim of promoting women's sexual knowledge and attitude. Control group women did not receive any intervention. Results: The mean scores of sexual knowledge and sexual attitude of women in the experimental group were significantly increased from 30.02 ± 9.09 and 32.34 ± 6.09 to 34.35 ± 10.23 and 34.53 ± 6.92 after the intervention, respectively (p <0.05). The mean scores of sexual communication anxiety in the intervention group showed a significant decrease from 42.23 ± 10.63 to 40.47 ± 10.94 after the intervention (p <0.05). Conclusion: This study showed that an increase in knowledge and improvement of sexual attitude can reduce the sexual communication anxiety of women upon marriage. Designing and implementing effective interventions with the purpose of promoting sexual knowledge in women and amending the false attitudes and beliefs may take some effective steps to protect and promote sexual health in women, then the couples.

Background: Sexual function is affected by various physiological and psychological factors. Individual differences and various personality types are effective in response to sexual function. Objective: The present study aimed to investigate the correlation between sexual function and personality types among the women referred to healthcare centers in Shiraz in 2014 till 2015. Methods: This cross-sectional, descriptive-analytical study was conducted on 514 women referred to healthcare centers in Shiraz. The study data were collected using a demographic information form, the Female Sexual Function Index (FSFI), and a NEO Personality Inventory. Written informed consent forms were also obtained from the participants. Afterward, the data were analysed through the SPSS software, version 19, using t-test, chi-square test, and Fisher’s exact test. Results: The results showed sexual desire disorder in 39% of the participants, sexual arousal disorder in 38.6%, orgasm disorder in 25.5%, and sexual pain in 33%. The results also indicated that sexual desire, arousal, and pain were significantly associated with extroversion and reversely related to neuroticism. Conclusions: The score of extroversion was higher in individuals without sexual dysfunction, while the score of neuroticism was higher among individuals with sexual dysfunction. Therefore, it is necessary to evaluate women’s personality types as a technique for the assessment of sexual dysfunction.

Background: Despite the global importance of work-family issues and the many calls for studies within distinct cultural contexts; work-family research has mainly been conducted in Anglo societies, and Western countries. Objective: The present study was designed to explore the factors which determine the work-family conflict through personal information, including, but not limited to the lived experiences and perspectives of Iranian women who are both employed and married. Methods: A qualitative approach was chosen, which would allow for an in-depth and rich exploration of the experiences, perceptions, and feelings of participants. Data were obtained from 29 participants , in-depth individual interviews with 17 participants and two focus groups. Each focus group discussion included 6 participants. Results: Six main categories emerged from the data analysis: the value of work and family, hegemonic masculinity, non-supportive environment, job stress, overloading family, and inadequacy of individual ability and skills. Conclusion: Based on the data obtained from participants, sociocultural factors play an important role in the creation of work-family conflict.

Background: The relationship between gestational diabetes and postpartum depression (PPD) is poorly understood and seldom studied. Objective: In an effort to explore this issue, the present study investigated the relationship between gestational diabetes and PPD. Methods: The present cross-sectional study was performed on 342 women who were referred to four urban health centers of Hamadan city, west of Iran. We used convenience sampling as a method to recruit women in each health center. We used a researcher-made checklist for gathering data on socio-demographic characteristics and potential risk factors of PPD. The Persian validated version of the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Univariate and multivariable binary logistic regression was applied to estimate the odds ratio (OR) (95% confidence interval [CI]). Results: Gestational diabetes was identified as the most important risk factor for PPD with OR (95% CI) of 2.19 (1.11, 4.31); P-value=0.02 after adjusting for other variables. Moreover, the adjusted odds ratio showed that PPD among less-educated women (primary school) was 3.5 times higher compared to women with a university education (OR=3.54, 95% CI: 1.27, 9.84; P-value=0.01). Conclusion: Our findings suggested that PPD is more likely among women with gestational diabetes and those who are less educated. Interventional and educational activities can be employed to reduce the risk of PPD in this population.

Background and Objective: Certain liver diseases are uniquely associated with pregnancy, whereas others are unrelated. Highly Active Antiretroviral Therapy (HAART)-associated hepatic toxicity is of increasing concern in the management of patients with HIV/AIDS. There is no available data on whether the pregnancy is associated with an increased risk of liver damage and chronic liver damage in HIV-positive women on HAART. We evaluated the effects of antiretroviral drugs on the liver biochemical parameters in HIV-infected pregnant women. Methods: Using a cross-sectional survey design, 171 women were exclusively screened for hepatitis B and hepatitis C infections; grouped as 50 HIV seronegative pregnant women, 20 newly diagnosed HIV-infected pregnant women (treatment-naïve), 51 HIV-infected pregnant women already on HAART, 12 non-pregnant infected females (treatment-naive) and 38 non-pregnant HIV-infected women on HAART. Liver biomarkers were determined using standard methods. Student’s t-test and one-way analysis of variance (ANOVA) followed by Tukey’s Post-HOC multiple comparison tests were used to analyse the results. Results: The Aspartate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP) and Total Bilirubin (TB) levels in HIV-infected pregnant women on HAART were elevated. The AST (29.40±4.35 U/L) of naïve HIV-infected pregnant women was significantly low (p<0.05) compared to non-pregnant naive HIV-infected women with AST (53.36±5.92 U/L). Also, the ALP (272.5±22.79 U/L) and TP (80.9±4.40 g/L) of naïve HIV-infected pregnant women were highly significant (p<0.05) compared to non-pregnant naive HIV-infected women with ALP and TP levels of (200.30±12.74 U/L) and (63.70±6.50) g/L respectively. On the basis of the trimester, HIVpositive pregnant women on HAART had significantly higher levels of liver markers when compared with that of HIVsero-negative pregnant women. Interpretation and Conclusion: Pregnancy is associated with an increased risk of liver damage and chronic liver damage in HIV-positive women on HAART.

Background: Low measured bone mineral density (BMD) in clinical settings is known as an indirect indicator of osteoporosis and fracture risk. Objective: To evaluate the mean BMD at lumbar spine and femoral neck and study the correlation between BMD and some associated factors in women aged over 40 years. Methods: A prospective cross-sectional research was performed. The study group included 168 healthy women aged over 40 years having annual health surveillance at Can Tho University of Medicine and Pharmacy Hospital. BMD at lumbar spine and femoral neck was measured by dualenergy X-ray absorptiometry (DEXA) method from June 2017 to May2018. Results: The results recorded that the mean BMD at lumbar spine and femoral neck was 0.92±0.2g/cm2 and 0.84±0.15g/cm2, respectively. BMD at lumbar spine and femoral neck had a significant positive correlation with height (r=0.353, p<0.001; r=0.394, p<0.001), weight (r=0.435, p<0.001; r=0.414, p<0.001), and BMI (r=0.33, p<0.001; r=0.284, p<0.001), while had a significant negative correlation with age (r=-0.609, p<0.00; r=-0.561; p<0.001), time elapsed since menopause- TESM (r=-0.495, p<0.001; r=-0.523; p<0.001), and number of births given (r=-0.381, p<0.001; r=- 0.268, p<0.001). Conclusion: The mean BMD at the lumbar spine and femoral neck which had a significant correlation with age, TESM, number of births given, height, weight and BMI were rather high. A targeted future research is suggested to point out a strategy that directly impacts osteoporosis and fracture risks outcomes in healthy Vietnamese women over 40 years of age.

Background: A lot of research has been done to improve the treatment of infertility and increase the quality and effectiveness of performance. Objective: In this randomized clinical trial study (IRCT2014031116911N2), we compared the effect of Fluoxetine and midwifery consultation on infertile women suffering from depression and the focus of the study was on the results of In-Vitro Fertilization (IVF) treatment. Methods: 90 infertile women who suffered from mild to moderate depression according to the Beck Inventory and had undergone IVF treatment were selected and randomly divided into 3 groups. The control group, the second group, were treated with Fluoxetine 20 mg, and the third group received 6 sessions of midwifery consultation and then the outcomes were reviewed. The amount of cortisol in the women’s sera was measured in three stages and the level of depression and anxiety was measured in two stages. Results: The pregnancy rate in the midwifery consultation group (n=13) was about two times as high as that in the fluoxetine group (n=7) and three times as high as that in the control group (n=4); there was a statistically significant difference among the groups (P=0.016); as to the abortions occurring in each group (P>0.05). Conclusion: Providing the people undergoing IVF treatment with emotional and mental support will increase their chances of pregnancy and this kind of support will be helpful for the patients if it is given in the form of midwifery consultation.

Background: Cesarean scar pregnancy (CSP) is the implantation of the gestational sac in the hysterotomy scar. The optimal treatment for a cesarean scar pregnancy is unclear and therapy should be selected according to the patients' clinical presentation. The aim of this study was to report a successful medical treatment of a cesarean scar pregnancy with fetal heart activity and a very high level of beta-human chorionic gonadotropin (β-hCG). Case Presentation: A 38-year-old woman referred for a routine prenatal visit after 2 months of menstrual retard and a positive pregnancy test. She had a history of 3 cesarean sections and a uterine curettage. Ultrasonography revealed cesarean scar ectopic pregnancy. The serum level of β-hCG was 109063 mIU/ml. Two doses of systemic methotrexate therapy and intragestational sac injection of methotrexate and potassium chloride were administered. Eight weeks after the initial treatment, the β-hCG level became undetectable. Conclusion: Combined medical treatment with local and systemic MTX administration may be a successful treatment with low complications even in the presence of high serum β-hCG level.

Introduction: Bladder leiomyoma, commonly found in middle-aged females, is a rare, benign, and mesenchymal tumor of the bladder. Its incidence rate is lower than 0.5% of all types of bladder tumors. There are fewer than 250 reports on bladder leiomyoma. Herein, we report a case of bladder leiomyoma in 37 years’ female. Case Presentation: A 37-year-old multiparous woman has been presented with complaints of occasional hematuria and dysuria and irritative symptoms. In the examination and imaging, a mass with a size of 8 cm was reported in the anterior border of the uterus with a firm consistency. Surgery was performed, and the mass was resected. Postoperative histopathology review confirmed bladder leiomyoma. Conclusion: Leiomyoma should be considered as a differential diagnosis in women presenting with dysuria, frequency or hematuria and a firm consistency mass even in the unusual site as the bladder. Complete resection leads to a very good outcome with almost no recurrence.