فهرست مطالب دکتر میترا ملایی نژاد

Vaginismus is one of the most common GenitoPelvic Pain/Penetration Disorders, which is classified as either lifelong (primary) or acquired (secondary). The present study aimed to investigate the efficacy of Cognitive Behavioral Therapy on women with lifelong vaginismus. During a single-case experimental trial of multiple-baseline type, four women were included and diagnosed with lifelong vaginismus by a psychiatrist in a psychosexual clinic in Ahvaz. Full intercourse was evaluated daily based on the self-reports of participants. Secondary outcome measures (i.e.catastrophic cognitions, tightening, helplessness, sexual adjustment, avoidance, and penetration motivation were assessed in participants by a multidimensional vaginal penetration disorder questionnaire at baseline and after intervention. The subjects were entered into an eightweek Cognitive Behavioral Therapy program. The decreasing curve is compared with the baseline for each variable and considered the recovery index. After the treatment, all participants reported successful intercourse without pain and fear. The findings investigated that catastrophic cognitions, tightening, helplessness, sexual adjustment, avoidance, penetration motivation, sexual information, hypervigilance, optimism, and thoughts about genital incompatibility significantly improved by Cognitive Behavioral Therapy in all participants(P < 0.05). Based on the results, Cognitive Behavioral Therapy can be considered an effective treatment for LLV. In addition, this study can enhance our knowledge about the fear-avoidance essence of vaginismus and develop treatment options for women with lifelong vaginismus. Future studies are recommended with larger sample sizes and control groups.

Sexual dysfunctions related to the long-term of methadone and buprenorphine are common. In order to investigate the effects of Methadone maintenance therapy (MMT) and buprenorphine maintenance treatment(BMT) on women sexual function with opioid abuse dependence, the present study was performed with aim to evaluate the effect ofmaintenance treatment with methadone and buprenorphine on sexual function of females with opioid abuse dependence .In order to the effective measures regarding choosing the best practice , consultation and decision making will be taken.

This cross-sectional descriptive-analytic study was performed in 2015-2017 on 89 women with opioid abuse. Demographic information, sexual function and satisfaction of women who were previously treated with MMT and BMT were completed and collected using the Female sexual function index(FSFI) and Larson Sexual satisfaction questionnaire (LSSQ) in two stages with an interval of 3 months. Data were analyzed by SPSS software (version 20) and Independent T, Mann-Whitney U and Chi-Square tests.

The total scores of FSFI (Female Sexual Function Index) were significantly higher in the BMT group (p < 0.05). The scores of sexual desire and arousal subscales were significantly improved in the BMT group compared with the MMT group (p < 0.05). No significant difference was observed between the two groups in terms of the level of sexual satisfaction in two studied stages (p=0.25).

The use of BMT in women with opioid abuse can have a more positive effect on sexual desire and arousal than those in the MMT group. This issue likely leads to more adhesion to the use of maintenance treatment. In other cases, these two drugs are similar in terms of efficacy and causing satisfaction from sexual function.

Sexual dysfunctions are relatively prevalent in female patients with multiple sclerosis (MS) and affect their quality of life. This study was performed with aim to evaluate the effect of Bupropion on sexual function in women with multiple sclerosis.

This randomized controlled clinical trial study was performed in 2019 on 60 women with relapsing and remitting MS, receiving routine MS treatment and had sexual dysfunction. The subjects were divided to two groups of 30 persons receiving Bupropion and placebo. Multiple sclerosis intimacy and sexuality questionnaire, female sexual function index, fatigue severity scale and Beck depression questionnaire were filled out for all the patients before, 4 and 8 weeks after the interventions initiation. Data were analyzed by SPSS software (version 20) and Analysis of variance (AOVA) and repeated measure tests. P<0.05 was considered statistically significant.

Multiple sclerosis intimacy and sexuality scores 8 weeks after the intervention were significantly lower in bupropion group (9.96±45.85) compared to placebo group (53.56±11.46) (P= 0.007). Also, the score of depression in the two stages after the intervention in the bupropion group (11.26 ± 23.03) was lower than the placebo group (37.86 ± 13.43) and decreased during the intervention (p <0.0001). FSFI score and its subscales showed an improvement in bupropion group (2.67±25.88) compared with placebo group (17.44±2.8) which indicated continuity of effectiveness of Bupropion independently from depression and fatigue scores alteration during treatment (p<0.001).

The results of the present study showed the effectiveness of bupropion on improvement of sexual function in female patients with MS.

Women's orgasm is a biopsychosocial experience that causes a woman to experience sincere communication and pleasure, and possibly pregnancy. To date, limited studies conducted for evaluation of the efficacy of drugs on sexual function in women with anorgasmia. Therefore, the purpose of this study was to evaluate the efficacy of bupropion on the sexual function of a group of Iranian women with orgasmic disorders. This was a pilot randomized clinical trial study on 32 women with orgasm disorders, who referred to the psychosexual clinic of Khorshid hospital, Isfahan, Iran. Patients were selected by simple sampling method, and randomly divided into equal intervention and control groups. In intervention group, bupropion was started at a dose of 75 mg, and increased weekly to 300 mg; the control group received a placebo. Scores of sexual satisfaction and sexual function of participants were evaluated using the Persian version of the Larsson Sexual Satisfaction Questionnaire and the Female Sexual Function Index (FSFI) before the intervention and 2, 4, 6, and 8 weeks after the onset of intervention. The data were analyzed using Mann-Whitney U and Friedman tests. There was a significant difference in desire subscale between the two experimental and control groups from the second week, and in mental arousal and vaginal lubrication from the fourth week of the trial. This significant difference was observed in orgasm, sexual satisfaction, and pain only at the sixth and eighth weeks, and between experimental and control groups in the total scores of sexual satisfaction from the second week (P < 0.010 for all). Bupropion caused improvement in sexual satisfaction of women with orgasmic disorders and these changes occurred in all subscales of sexual performance. Further studies are warranted with greater sample sizes and more extended periods.

Sexual and marital dissatisfaction seems to be one the most common complications among
patients on methadone maintenance therapy (MMT), which may decrease adherence to continue treatment in
patients. Efficacy of adding bupropion to MMT protocols has been investigated in previous studies; but evidence
for implication of permission, limited information, specific suggestions, intensive therapy (PLISSIT) method for
these patients is limited. So, this study was designed to investigate the efficacy of adding PLISSIT as an adjuvant
therapy to MMT protocol on sexual dysfunction and marital satisfaction among men patients.
During a clinical trial study conducted in the addiction quitting clinics of Isfahan University of
Medical Sciences, Isfahan, Iran, 50 men patients with sexual dysfunction receiving MMT were randomized into
two equal treatment group of 6-week PLISSIT program and control. Both groups received slow-release
bupropion with a usual dosage (150 to 300 mg/day) for improving sexual function. Sexual function and marital
satisfaction for both groups were assessed accordingly using Arizona sexual experience scale (ASEX), and
revised dyadic adjustment scale (RDAS).
Findings: During the intervention, the mean changes in the overall scores of sexual dysfunction and marital
satisfaction were significantly different between the two groups (P Adding PLISSIT to bupropion could improve sexual function and marital satisfaction among men
under MMT. Further studies can support these findings for implication of PLISSIT by counselors in addiction
treatment clinics

Aim and Obesity is the cause of many physical and psychological problems. The present study aimed to compare the effect of three methods of aerobic exercise, Kegel, and combinatorial (aerobic and Kegel), on body image, and sexual and marital satisfaction in obese women.
Methods and Materials: This was a quasi-experimental study with a pretest-posttest design. 60 obese women with an age range of 35 to 40 years, and body mass index of higher than 30 kg/m2, were selected through convenience sampling method. They were randomly divided into three experimental groups of aerobic, Kegel, and combinatorial, and one control group. Experimental groups participated in their sports activities for eight weeks. The research tools consisted of Fisher Body Image, Yavari Sexual Satisfaction, and ENRICH Marital Satisfaction Scale. The validity and reliability of all four questionnaires had been examined and confirmed in Iran before.
Findings: The positive effects of all three exercises on sexual and marital satisfaction were approved using the covariance analysis. In addition, the effects of combined training on sexual and marital satisfaction were more than the other two method of practice. Aerobic and combined exercises improved body image, but the Kegel exercise did not have a significant effect on body image.
Physical activity is recommended to increase sexual and marital satisfaction in obese women.

Sexual health is a critical component of couples’ health and general health. Body mass index (BMI) is known to influence sexual function, self-efficacy, and sexual performance. This study aimed to assess the relationship of sexual function and sexual self-esteem among the women of reproductive age based on body mass index.
In a cross-sectional study in Isfahan City, Iran, 192 married women aged between 18 and 50 years were enrolled as a convenient sample. Data were gathered using meter, digital scale, Female Sexual Function Index (FSFI), and Anne Hooper's Sexual Self-Esteem questionnaire. The data were analyzed using SPSS software.
Findings: Differences in average desire, arousal, and orgasm scores among the underweight, normal body mass index, and obese individuals were significant (P The results showed that body mass index is not the only effective factor on sexual function, sexual self efficacy, and sexual self-esteem in women; intra-psychological, interpersonal, and socio-cultural factors should to be considered as important mediatings, too.

Widowhood is a stressful event for women that is often associated with loss of health, human relations, and financial support. This study was conducted with aim to explain the experiences of Iranian widows about their effort to meet emotional and sexual needs.
This study was performed with descriptive phenomenology approach. Data were collected through semi-structured interviews with 10 widows who were selected by purpose-based method. Colaizzi's method was used for analysis of data.
After analyzing of interviews, three main concepts along with sub-concepts were identified that main concepts included: Motherhood vs. Femininity, Sexual needs: apparent but not spoken issue, and ambiguous future of the second marriage.
The results demonstrated a close-up shot of Iranian widow's problems regarding unsuitable cultural and social beliefs about their emotional and sexual needs. Widows described their sexual needs as obvious but inexpressible regarding to the limitations of society. They faced a dilemma of need and fear to meet their sexual needs which is aggravated during the time after their spouse's death. They described unmet emotional needs as mothering role vs. femininity and explained how their need for nonsexual touch and emotional support by men faced them with the hesitancy about their role as a mother. The results showed that how the social norms force widows toward a nonsexual life to support their children.

Vaginismus is considered as one of the most common GenitoPelvic Pain/Penetration Disorders. The complication of vaginismus is extensive. Therefore, this study was performed with aim to investigate the efficacy of Cognitive Behavioral Therapy on catastrophic thoughts on women with vaginismus.
In this single-case experimental trial of multiple-baseline type, four women with vaginismus who had referred to Ahvaz psychosexual clinics in 2015 were recruited. Catastrophic thoughts were assessed in participants by multidimensional vaginal penetration disorder questionnaire at baseline and after the intervention. After determining the base lines in dependent variable, the subjects were respectively entered in Cognitive Behavioral Therapy and they were individually treated by 8 sessions per week. In this study, clinical significant is used. To analyzed data and evaluated the effectiveness this methods, used visuals or graphical chart analysis, diagnosis improve and six indicators Ingram.
After the treatment, all participants reported successful intercourse without pain and fear. The findings also showed that catastrophic cognitions significantly improved by Cognitive Behavioral Therapy in women with vaginismus (P The results of the study showed that Cognitive Behavioral Therapy can be considered as an effective treatment for vaginismus. Therefore, it is recommended to consider this therapy in the interventions for these patients; future studies with larger sample sizes and control groups is also suggested.

Enhancing the quality and dynamicity of higher education programs requires continuous evaluation of curriculums. Reproductive health PhD program was established in 2006 in Iran while recommending that its curriculum be evaluated by assessing graduates’ performance in workplace and surveying students, faculty members and managers. This study aimed to explore challenges of the curriculum of reproductive health PhD program.
Employing a qualitative content analysis approach and using purposive and sometimes opportunistic sampling, experiences and viewpoints of 33 graduates and students of reproductive health PhD program, educational managers and reproductive health board members about the curriculum of reproductive health PhD program were collected through individual interviews and notes in 2014-15. Data were transcribed and important expressions were coded. Classification of similar codes led to preliminary categories. Five main categories were extracted by further classifications.
The five main categories included inadequacy of course topics and contents, challenges of student education, failure in realizing curriculum goals, long research period, and ambiguity in graduates’ professional status were appeared; each of these included various subcategories.
Results showed that the curriculum of reproductive health PhD program required revisions to meet the program’s mission and designing courses such as sexual health and reinforcing the clinical nature of the program were necessary. Moreover, the results emphasized that the establishment of an independent educational department of reproductive health for managing higher education affairs and greater supervision of the reproductive health board on educational affairs was necessary. Furthermore, reproductive health specialists should be employed in different positions to meet society’s reproductive health needs.

Sexual self-concept (SSC) is considered as an important factor in human sexual performance. This study aimed at assessing the relationship between SSC and sexual performance in a group of Iranian married women.
Material and This correlational study was conducted on 374 married women selected via cluster random sampling in health centers of Mobarakeh, 2013. The data was collected by Multidimensional Sexual Self-concept Questionnaire (MSSCQ) and female sexual function index (FSFI), and analyzed by pearson correlation and multiple regressions.
In accordance with the mean scores of positive SSC (106.32±35.03), negative SSC (36.64±5.16) and sexual performance (22.30±2.68), there was a significant correlation between positive SSC and sexual performance(r= 0.23, p Given the results, the women with higher positive SCC may have better sexual function. It seems that SCC score can be a significant predictor of women's sexual functioning.

Abstract Aim and Gender Dysphoric disorder is a phenomenon with unclear cause and has a strong impact on affected person and his/her family. We designed a study to compare perception of people with and without Gender dysphoria regarding Family function. Methods and Materials: During a correlatioal study and through easy sampling we included 30 Gender dysphonic people and 30 non Tran’s participants from people who were referring to Navid bakhsh clinic in Isfahan. All participants completed Farsi version of FAD-53 questionnaire and additional questions regarding their demographic data. Data was analyzed using SPSS version 19 with compare means by independent-samples T test. The analysis of data indicated a significant differences between two groups about their perception regarding Relationship components (p=0.000), Emotional involvement (p=0.001), Role Playing (p=0.000), Problem solving (p=0.049). The person’s with Gender Dysphonic disorder had a low Performance in these components. Our results show that Gender Dysphoric people have more difficulties in relationship and emotional issues, role playing and problem solving in their families. Our findings might be helpful in planning for intervention in this type of families. Further studies are warranted with greater sample size to compare family functioning and attachment style of gender dysphonic people.

To protect the safety of newborns after birth, they have to endure the pain caused by painful procedures. Pain is the destructive experience and have complications immediate, short-and long-term on physical and mental health of newborn. Regular monitoring of pain in newborns from beginning of birth to face the painful invasive procedures, is necessary. This study aimed to determine the behavioral and physiological signs of pain in newborns after birth in Bandar Abbas.
In this descriptive study, behavioral and physiological signs of pain caused by injection of vitamin K and injectable vaccines examined at birth in 75 infants born in Bandar-Abbas Hospitals in 2012. Newborns were selected using convenience sampling method. Pain was assessed using the Neonate-Infant pain scale (NIPS) and observation checklist of behavior. Analyzing the data was done by using descriptive statistics, -t-test were used. Version of SPSS 20 software and. The significance level was less than 0.05 and acceptable.
The findings showed that were 44 (58.7%) male and 31 (41.3%) female newborns. Mean weight was 3020.47 ± 447.93 gram and mean neonatal pain score was 5.85 ± 1.84. Among the behavioral signs, change in breathing patern with 86.7% and crying with 81.3% and among the physiological sign, facial flushing with 85.3% were the highest rate. Also mean heart and respiratory rate during the procedure had significant increase compared to the previous ones (p Pain is indicated in newborns in response to invasive procedures mostly through behavioral signs, but few manifest of the physiological signs, are not reason for the pain absence. So nurses can without need of any sophisticated instrument, using a combination of behavioral and psychological signs identifying and controling the inevitable pain of painful procedures in newborns

Anxiety is one of the most common psychological disorders during pregnancy especially third trimester of pregnancy and many factors influence on the incidence of this disorder. This study was performed with the aim to determine maternal anxiety status at third trimester of pregnancy and its related factors. This longitudinal study was performed in 2012 on 75 pregnant mothers referred to gynecology clinics of Bandar-Abbas Hospitals for routine prenatal care. Data was collected using Spielberger's questionnaire at three times (29-32, 33-36 and 37-42 weeks of pregnancy) and demographic questionnaire was collected. Data were analyzed using SPSS software (version 20), and T-test, ANOVA (analysis of variance) and one-way ANOVA. P< 0.05 was considered significant. The results of the study showed that about half of the mother had moderate and high scores of state and trate anxiety (42.6% and 45.3%, respectively), but there was no significant correlation between mean of maternal state and trate anxiety at three times of measurement (P=0.107, P=0.16). Also, no significant relations were found between maternal age, education level, job status, parity and abortion, baby gender with their state and trate anxiety at third trimester of pregnancy (P>0.05). Maternal anxiety at third trimester of pregnancy is at high level. Therefore, Preparation of the programs related to health assessment during pregnancy care seems to be logical.

Aim and Unconsummated marriage (UCM) is a problematic worldwide sexual disorder. It becomes complicated in the societies with conservative sexual norms. Yet there is clear consensus in scientific societies that UCM should be defined as a phenomenon beyond a specific individual، organic and psychological problem. Drawing upon Sexual scripts theory by Gagnon and Simon (1973) this review article aimed to answer a question: «Which socio-sexual scripts out of them the UCM in couples emerged and is maintained? ''Methods and Materials: A review was conducted focusing on UCM and the social scripts about wedding night، marriage، intercourse and virginity. Most of the new published studies were conducted in conservative communities and reported varied etiological factors for UCM، based on the specialty of researchers and referred clinics. It seems that during UCM، mutual transaction between the individual and social norms in her/his community about vaginal intercourse، is impaired and caused to guilt feeling so may lead to nondisclosure of the problem and make it prolonged. Sexual education for new couples by health care givers may decrease UCM prevalence and its challenges.