Current Women's Health Reviews - Volume 17, Issue 3, 2021

Assisted Reproductive Technologies (ART) have significantly improved the chances of pregnancy. In Vitro Fertilization (IVF) remains the most widely used ART procedure, which involves a series of steps like ovarian hyperstimulation followed by vaginal oocyte retrieval and in vitro fertilization of the oocytes with sperm, the culture of the embryos, and the final transfer of the embryo to the recipient or surrogate recipient. Intracytoplasmic sperm injection (ICSI), another form of ART, is developed to circumvent the problems encountered in IVF. However, the studies have indicated that only about one-third of ART cycles result in live births. This review is designed to provide a comprehensive idea about advances in reproductive medicine in terms of the preparation of gametes and implantation.

Background: Pelvic floor disorders affect many women globally. Objective: To provide a critical appraisal of the literature on the effects of pelvic floor disorders on the quality of life and functioning of pregnant and postnatal women. Methods: Available literature was reviewed and summarized to discuss the definitions, pelvic floor anatomy, dysfunctions, and the mechanism of the condition, and more specifically, on the strengthening exercises for the pelvic floor muscles. Results: Pelvic floor disorder is an important public health concern because of the high prevalence, deleterious effects on pregnancy, and its outcomes as well as impacts on the health care system. They include genuine urinary incontinence, bladder and bowel incontinence, pelvic pain, weakness of the pelvic muscles, weakness of the muscles of the core stability, and the prolapse of pelvic organs. Pregnancy and subsequent vaginal delivery are causes associated with pelvic floor muscle disorders. Approximately 60% and 50% of community settlers and residents of nursing homes respectively are affected by urinary incontinence and the numbers increase with hysterectomy. Multiple birth, obesity, chronic coughs, overweight babies, and heavy lifting are associated with risk factors. Treatment of pelvic floor muscle disorders should involve an increased physical activity prescription among women diagnosed with weaker pelvic floor muscles, engaging the multidisciplinary team, increasing the quality of life and functioning of women during and after pregnancy. Training aimed at strengthening the pelvic floor muscles is beneficial and prevents dysfunctions. Conclusion: Structured and well organised pelvic floor muscle training regimen, also known as Kegel exercises, is important in preventing disorders of the pelvic floor during pregnancy and after delivery.

Background: The prevalence of female sexual dysfunction is high and various interventions are used for the treatment of this disorder. Objective: This systematic review and meta-analysis study aimed to determine the effect of sex education and counseling on the sexual function of Iranian married reproductive age women. Methods: We searched the international databases, including ISI Web of Sciences, Pub- Med/Medline, Scopus and local databases for published randomized clinical trials without time limitation until March 2020. Mean Difference (MD) with 95% Confidence Interval (95% CI) was considered as a summary effect. In order to identify factors related to heterogeneity between studies, we conducted subgroups and Meta-regression analysis. Results: The results showed significant differences in the pooled mean score of female sexual function between intervention and control groups (MD=5.03, CI 95 %; 3.42 to 6.65). The education and counseling were more effective in pregnant women (MD= 6.34, CI 95 %; 4.31 to 8.38), than other married women (MD= 3.87, CI 95 %; 1.25 to 6.49). Counseling interventions (MD= 5.58, CI 95 %; 3.22 to 7.93) were more effective than other sexual education methods (MD= 4.31, CI 95 %; 2.06 to 6.67). Conclusion: Educational and counseling interventions could improve the sexual performance of women, and interventions were more effective in pregnant women. The effectiveness of counseling interventions was better than education.

Background and Objective: Maternal health is one of the main factors influencing pregnancy outcomes. Women at childbearing age with poor health are at higher risks. In this context, preconception planning and receiving care services are of great importance for early identification and diagnosis of risk factors for pregnancy. The present study assessed the theoretical structures of planned behavior for the intention of preconception care. Materials and Methods: This cross-sectional analytical study was performed on 200 women selected using a simple random sampling method in Asadabad, located in the west of Iran, in 2015. The tool used for collecting data was a researcher-made questionnaire containing the theoretical construct of planning behavior. It included the constructs of attitude, subjective norms, perceived behavior control, and behavioral and functional intentions. The validity and reliability of the questionnaire were examined before conducting the research. SPSS 16 using multiple logistic regression and Pearson correlation coefficient test was used to analyze data. Results: The mean and standard deviation of the knowledge were 6.39 ± 3.31, attitude (37.37 ± 4.21), subjective norms (21.12 ± 3.25), perceived behavior control (9.6 ± 2.23), and behavioral intention (26.7 ± 4.06). There was a direct and significant correlation between the construct of subjective norms and intention (p=0.039, r=0.146). The construct of attitude and subjective norms were the most important predictor variables of changes in women's intention of preconception care. Moreover, no statistically significant relationship was observed between intention and the person's age, spouse's education, the person's occupation, and women's education (p>0.05). Conclusion: According to the results, it is suggested to emphasize creating positive attitudes and subjective norms while designing educational interventions in order to increase the coverage of preconception care.

Background: The actual question on the health care system worldwide is a gender inequity in some specialties. In spite of different influencing factors for choosing their specialty by medical students and residents, the recent research studies show that gender is significantly influencing their specialty. Especially gender disparity or inequity is mostly seen in the field of Obstetrics and gynecology. Aim: The purpose of our study is to understand the actual problems faced by male specialists in the field of obstetrics and gynecology in the health care system and to understand how it affects the nation’s health care system, and to analyze the possible solutions. Materials and Methods: The research consists of 815 respondents, which includes medical students, obstetricians and gynecologists and ObsGyn patients. The average age of the respondents was 20 - 50 years. They were divided into three groups. The questionnaire consists of 15 different questions for each group of people in different languages. Results: The significant difference about the future plan towards choosing the specialty of ObsGyn was less among male respondents with 4%, whereas female respondents account for 69% (P<0.001). The main reason for women to choose ObsGyn specialty was to be comfortable in the field (43%). On the other hand, male respondents did not choose ObsGyn specialty because of the limited scope for male specialists in this field (37%) and 51 % of them were not sure about the availability of patients. There is a direct proportion between patients age and wish to visit male consultants, and indirect proportion between patients age and wish to visit the female consultants. Conclusion: Less number of male specialists in the obstetrics and gynecology field does not mean that the male students and residents have no interest in obstetrics and gynecology, but they are concerned about employment, patient’s availability and scope in the field. By including male and female specialists equally in this field, we can improve the quality in the preservation of reproductive health, women’s health and significant changes in crude and specific demographic indices. Making proper awareness and explaining about the current reality could be the best possible solution for this issue. The interpersonal style and communication skills should be the most important traits in physicians rather than gender.

Background: Buprenorphine is a semisynthetic derivative of thebaine, which is 75-100 times more potent than morphine and causes less respiratory depression. Efficacy and safety of transdermal buprenorphine have been well established in chronic pain, but data regarding acute postoperative pain relief are still limited. Aim: In this study, we compared the efficacy of transdermal buprenorphine patch with injectable tramadol for the relief of postoperative pain (POP) following abdominal hysterectomy for benign gynecological conditions. Settings and Design: Three-year prospective observational study. Methods and Material: One hundred patients undergoing abdominal hysterectomy were allocated to one of two groups. Buprenorphine group: we applied 10 mcg/hr transdermal buprenorphine patch on the lateral upper arm after surgery. The onset of relief from a patch is 8 to 16 hours. So, all patients were given diclofenac suppository 100mg before induction of anesthesia as a preemptive analgesic to reduce postoperative pain. Injectable Tramadol Group: Received intramuscular tramadol injections 50mg every 8 hours in the postoperative period. Patients were followed for two days to observe postoperative pain relief and adverse effects. If patients showed a Visual Analog pain (VAS) score >3, intravenous paracetamol was administered as a rescue analgesic. Results: POP was assessed at different time frames: 12, 24, 36 and 48 hours after hysterectomy. Mean pain score at rest in the buprenorphine group was significantly lower than that of the tramadol group. Patients experienced less pain on mobility in the buprenorphine group compared with the tramadol group, which was statistically significant. Conclusion: Transdermal buprenorphine is an effective and safe alternative to injectable tramadol for providing postoperative analgesia. It provides a higher degree of pain relief, faster postoperative mobilization, lower incidence of postoperative nausea and vomiting and higher satisfaction scores starting 12 hours after surgery. However, for the first 12 post-operative hours, there is a need for additional analgesia.

Background: With the global prevalence of COVID-19, general fear has increased along with misinformation and rumors that could affect a pregnant woman's psyche, and her sexual function. Objective: This study was conducted to determine the prevalence of sexual dysfunction and related factors in pregnant women during the COVID-19 pandemic. Methods: This cross-sectional study was performed on 205 pregnant women. Data collection tools included a socio-demographic characteristics questionnaire and the FSFI, both of which were completed online. Results: The mean (SD) of the overall score of sexual function was 21.54 (8.37), and 80% of participants suffered from sexual dysfunction. The results of the adjusted general linear model showed that the variables of spouse's age and occupation, place of residence, and marital satisfaction were significantly statistically correlated with the sexual function score. In women whose husbands were under 30 years of age compared with those over 35 years of age, in women living in their parents' homes compared to those living in private homes, and in women with high or extremely high marital satisfaction compared to moderate satisfaction, the sexual function score was higher. Conversely, women whose husbands were blue-collar workers had lower sexual function scores than those whose husbands were white-collar workers. Conclusion: It is necessary to consider socio-demographic factors in the treatment and prevention of this sexual function disorders. It is recommended that the appropriate solutions be provided and implemented by the relevant authorities, taking into account the effective modifying factors, in order to further improve this dimension of married life.

Background: Some women may consider childbirth an unpleasant event, which can influence their decisions on subsequent pregnancies and type of birth. Objective: The aim of this study was to determine the proportion of negative childbirth experience and its relationship with women’s attitudes towards subsequent pregnancy and vaginal birth. Methods: The study design was cross-sectional. A cluster sampling was used to recruit 800 primiparous women from health centers in Tabriz, Iran. The Persian version of the Childbirth Experience Questionnaire was used to assess women’s childbirth experiences. Univariate and multivariate logistic regression was used to assess the impact of childbirth experiences on women’s attitudes towards subsequent pregnancy and vaginal birth. Results: Thirty-seven percent of women reported a negative childbirth experience. There was a statistically significant relationship between childbirth experience and the attitude of women towards subsequent pregnancy (p<0.001) and vaginal birth (p<0.001). By controlling the effects of potential confounding variables such as socio demographic characteristics, negative childbirth experience was found to be an independent predictive factor for women’s reluctance towards subsequent pregnancies [OR= 0.42 (CI 95%: 0.57 to 0.31), p<0.001] and vaginal birth [OR= 0.08 (CI 95%: 0.14 to 0.04); p<0.001]. Conclusion: Negative childbirth experience is associated with a reduced willingness for women to get pregnant again and have vaginal birth. It is recommended that key stakeholders pay attention to strategies to improve childbirth experiences among primiparous women in Iran.

Background: Lymph node status has a prognostic role in endometrial cancer patients and it determines the adjuvant therapy to be administered postoperatively. Complete lymphadenectomy carries the risk of serious complications. Sentinel Lymph Node mapping (SLN) may be a good option to reduce these complications. Cervical injection of methylene blue may be a suitable technique for SLN mapping, which can be applied in low-resource institutes. Objective: Assessment of the detection rate, sensitivity and false negative rate of SLN mapping using cervical injection of methylene blue. Methods: A total of 76 patients with early stage endometrial cancer were included. Methylene blue was injected into the cervix prior to surgery and open surgical approach was used. SLNs were detected by direct visualization of stained lymph nodes after opening of pelvic spaces. SLNs were excised and pelvic lymphadenectomy was performed. Para-aortic lymphadenectomy was performed when indicated and surgically feasible. Specimens were examined by H&E staining. Results: The SLN detection rate was 47.4% and all detected SLNs were pelvic nodes. All patients with lymph node metastasis had metastatic disease in their SLNs. The technique had 100% sensitivity, 100% negative predictive value and a 0% false-negative rate. An inverse relationship between SLN detection and BMI was detected. Conclusion: Cervical injection of methylene blue dye with an open approach to detect SLNs in patients with early stage endometrial cancer has a low detection rate. The most important factor associated with failed mapping is increased BMI. Further trials are needed to investigate the usefulness of this technique.

Background: To understand the prevalence of postmenopausal symptoms, their order in frequency, as well as the age at onset of menopause in the community is an important step to provide the best quality of care for menopausal women. Objective: The study aims to investigate the prevalence of postmenopausal symptoms, menopausal age of onset and perception of menopause among women in Basra, Southern Iraq. Methods: This cross-sectional study was conducted in two major hospitals in Basra Southern Iraq (Al Mawani Teaching Hospital and Al Shifaa General Hospital), from 1/1/2019 to 1/6/2019. Five hundred participants were interviewed by a questionnaire. Results: The participants` age ranged from 41-65 years. The mean age at menopause was 47.7 ± 2.1 years. The most common complaints were hot flushes (70.8%) followed by back and joint pain (49%), night sweats (32%) and insomnia (25.6%). There was a significant association between age at menopause with body mass index (p=0.00) and the number of menopausal symptoms (p=0.009). While there were no significant relationships between age at menopause and education status (p=0.38), marital status (p=0.133), employment (p=0.86), or income (p=0.12). Conclusion: Despite the fact that the participants were aware of menopause and its natural occurrence, a minority of them sought medical advice or received hormone replacement therapy. Hot flushes are the most common symptom of menopause.

Background: In most cases, ovarian cancer is diagnosed at an advanced stage. The aim of this study was to determine if Primary Debulking Surgery (PDS) for women with advanced epithelial ovarian cancer is an equivalent treatment approach to neoadjuvant chemotherapy (NACT). Methods: A retrospective analysis of 214 women with stage FIGO IIIC and IV ovarian cancer was performed at the Institute of Oncology Ljubljana, Slovenia. Women were divided into two groups based on their primary treatment. The first group was the NACT group (184 women) and the second the PDS group (30 women). The selection of the women for PDS or NACT was based on the expertise of the gynecological-oncological surgeon and the image exam results. We used the Kaplan-Meier method for calculating Overall Survival (OS) and Progression-Free Survival (PFS). The statistical analysis was performed with IBM SPSS. Results: The median OS was lower in the NACT group than in the PDS group, 25 months (95% CI 20.6-29.5) and 46 months (95% CI 32.9-62.1), respectively. The PFS in the NACT group was 8 months (95% CI 6.4-9.5) and 18 months (95% CI 12.5-23.4) in the PDS group. For women treated with PDS the 5-year survival rate was 36.7% and 20.1% in the NACT group. Conclusion: In this study, the best survival results were observed in women treated with PDS, followed by adjuvant chemotherapy. If a woman is not suitable for surgery, NACT doubles the chance of a complete gross resection. Despite higher rates of complete gross resection after NACT, women treated with PDS (complete gross resection or optimal surgery) had higher OS.

Background: Exercise has many physiological and psychosocial benefits for postmenopausal women. Previous research has shown that sedentary postmenopausal women of North Queensland perceive a number of barriers to exercise; however, when they are given the right opportunity, they perceive it as a positive experience. Objective: This study aimed to determine whether an 8-week aerobic and resistance group-based exercise intervention had an effect on the physiological and psychosocial health of postmenopausal women living in North Queensland. A secondary aim was to explore the participatory experiences of women. Methods: A total of thirty-three postmenopausal women volunteered for the intervention, which consisted of group-based circuit style sessions three times per week, incorporating aerobic and resistance exercises. Primary outcome measures included blood pressure, blood lipids, body mass index and waist-to-hip ratio, cardiorespiratory fitness, peripheral bone density, and strength. Secondary measures included exercise self-efficacy and menopausal quality of life using the Menopause- Specific Quality of Life Questionnaire (MENQOL). Focus groups were conducted post-intervention to discuss participants’ exercise experiences. Results: A total of twenty-six women completed the eight-week program. Significant increases were found in cardiorespiratory fitness (p=0.00), upper body strength (p=0.00), lower body strength (p=0.00), exercise self-efficacy (p=0.00), and the MENQOL psychosocial (p=0.01), physical (p=0.00) and sexual (p=0.01) domains. Waist girth (p=0.01) and triglycerides (p=0.02) were significantly decreased. Participants also reported that they had more motivation and confidence, increased strength, and improved functional activities, and also experienced the disappearance of pain and positive feelings from the intervention. Participants mostly enjoyed the social effect, the lack of feeling self-conscious, the friendly competitiveness, and the facilitator. Conclusion: An 8-week group-based exercise intervention can improve the physiological and psychosocial health of postmenopausal women. Sedentary postmenopausal women can have a positive exercise experience, which may increase the likelihood of future exercise participation.

Background: Genetic stability of the chromosome is preserved by telomeres, which act as biological markers of ageing. The Relative Telomere Length (RTL) of a fetus has been found highly variable at birth under the influence of multiple risk factors. Objective: The purpose of this study was to find an association between maternal factors like obesity and low hemoglobin with cord blood RTL. Methods: This study used a Quantitative Real-time Polymerase chain reaction (qPCR) to measure RTL in blood samples of 250 mother-newborn dyads. Participants having the age of 18-35 years and gestational age 37 weeks or above were divided into three BMI groups, normal (18.5-24.5 kg/m²), overweight (25-29.9 kg/m²), and obese (>30kg/m2). Association among maternal parameters and cord RTL was analyzed by spearmen correlation, Kruskal Wallis, and Man Whitney U test. Results: Overall newborn cord blood RTL in base pair (bp) (mean ± SD) was longer (6915±1425, 6469+1077,6485±1015) compared to mother blood (bp) (6471±1144, 6322+838, 6401 ±993) (p<0.05) in all three groups of BMI, whereas shortest cord RTL (6485bp±1015) was observed in the newborns of obese females (p<0.597). A positive correlation (R=0.806) was between the low hemoglobin and cord blood RTL (p=<0.05); however, a significant decrease in cord RTL (7685bp±321) was observed with an increase in BMI (p<0.05). In the newborn gender, boys showed longer RTL (7509bp ±830) and had mothers with overweight, 82(55%), whereas the majority of girls, 20(57%), were born to females with normal BMI (p=0.06). Conclusion: Low hemoglobin was found a significant risk factor for the modification of telomeres in the newborns of Pakistani females. In females having overweight and obesity, shorter cord RTL was observed.