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Abstract Background and Objective: Diabetes mellitus and its complications are the leading factors of mortality and morbidity in human. This study aimed at determining the prevalence of Diabetes Mellitus (DM) and some related factors in the north of Iran. Material and Methods: This crossectional–descriptive study was carried out on 1998 cases (1000 men and 998 women) aged 25- 65 years old. The subjects were chosen by stratified sampling. A socioeconomic questionnaire was filled out. We meseared Fasting Blood Sugar (FBS) and Anthropometric indexes such as height, weight and waist. Diabetes mellitus (DM) was defined when Fasting Blood Sugar (FBS) was equal or over 126 mg/dl. Data was analyzed by SPSS software, using Chi Square and T.test (P<0.05). Results: The mean age is 44.2 years. FBS of male is 94.51±32.91 mg/dl and of female is 98.2±40.1. The prevalence of diabetes mellitus (DM) is 8.3% [(men = 6.8% and women =9.7%), (urban =10.5% and villages=6.4%0)]. There is a positive correlation between FBS and age, waist circumference and BMI (P=0.01). Blood glucose is controlled by diet and physical activity 64.1% and 24.2%, respectively. Conclusion: One out of twelve of adults in Golestan province suffer from DM. Obesity, Overweight and central obesity are coexisting problems with DM. it is a necessity to present a protocol based on screening and education of DM patients.

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Background and Objective: 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 Methods: 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.

Results: 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<0.001), and between negative SSC and sexual performance (r= 0.38, p<0.001). Furthermore, positive SSC directly and negative SSC inversely was the predictor of sexual performance of married women.

Conclusion: 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.

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Background: Sex education is one of the challenging areas of educational systems that has always been accompanied by many problems due to some obstacles and constraints. This has led to occurrence of many behavioral problems and deviations. The aim of this study was to determine the sex education gaps in university curriculum from the students' perspective.

Methods: This was a descriptive-survey on students of universities in Kashan (15235 students), during academic year 2013-14. Overall, 220 students were enrolled in this study using stratified random sampling. Data collection tool was a questionnaire of sex education with 28 questions and six components (objectives, content, procedures, experiences and learning opportunities, cultural and advisory institutions’ performance and university atmosphere) using a 5-point Likert scale. The content validity was confirmed by experts. The reliability was estimated as 0.89 using Cronbach's alpha coefficient. Descriptive and inferential statistics were used to analyze the obtained data.

Results: The mean level of sex education gaps (3.97±0.56) in the university curriculum was above the average (3). The highest mean was related to the component of procedures (4.1±0.63) and experiences and learning opportunities (4.1±1.01).

Conclusion: The results showed that the average level of gaps in sex education in the university curriculum is higher than the assumed mean level. The gaps are present in all components of objectives, content, procedures, experiences and learning opportunities, cultural and advisory institutions’ performance and the university atmosphere.

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Effectiveness of Schema Therapy and Group Cognitive Therapy on Anxiety in Women with High-Risk Sexual Behavior

Background and Objective: Due to the effectiveness of psychological interventions on mood and anxiety disorders, the schema therapy interventions and group cognitive therapy were used in this study to reduce anxiety in women with high risk sexual behaviors.

Methods: This was a pilot study using cluster sampling method. The statistical population consisted of 500 women (20-60 years old with diploma degree or higher) with a history of high risk sexual behaviors who had referred to the Shohada Ceneter of Hamedan for HIV test. Concurrently, DASS questionnaire with 21 items and psychiatric interview were performed; 250 of them had symptoms of depression, anxiety and perceived stress and 85 of them had symptoms of anxiety; 45 were randomly selected and were divided into three groups: two intervention groups and one control group. 12 group cognitive therapy sessions and 12 schema therapy sessions were considered; each session was 90 min. At the end of the treatment, all groups were post-tested.

Results: Comparison of the mean difference of the anxiety in three groups of schema therapy, cognitive therapy and control showed that there was a significant difference among these groups. Moreover, there was a significant difference between the mean of anxiety in cognitive therapy group and schema therapy (-2.376, p =0.01).

Conclusion: The results showed that schema therapy is more effective than cognitive therapy on anxiety of the women who referred to Shohada Ceneter of Hamedan.

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Background: Youths and adolescents are considered as valuable assets of any society. The preservation and promotion of health in this population is an issue of significant importance from the social and economic dimensions. Globalization has resulted in the emergence of several health risks for this age set. Sexual curiosity and sexual experiences are some of these dangers, which can cause irreparable damages if neglected. Regarding this, the present narrative review was conducted to identify the guidelines from different parts of the world for the preservation and promotion of sexual and fertility health among the Iranian adolescents and youths. The integration of these strategies can provide appropriate solutions conforming to the Iranian culture.
Methods: This narrative review was conducted on the articles and sources published within 1958-2015. The search was performed using the valid international databases, including Pubmed, Google Scholar, Google, WHO, ProQuest, and the Persian databases, such as Iranmedex and SID. In addition, we performed library research to obtain the papers investigating the issue of interest. The keywords used during the searching process entailed: “Reproduction Health”, “Youth”, “Adolescents”, and “Sexual Health”. In this review, out of 85 evaluated sources, 53 articles, books, thesis, and websites were selected.
 Results: As the reviewed studies indicated, the lack of knowledge, an unclear horizon of the future, and inaccessibility to reproductive health services threaten the health of the youths and adolescents. Therefore, the provision of sex education by parents, schools, or peers can have a significant impact on the promotion of sexual health in this population. Moreover, screening and identifying the adolescents and youths at risk and educating the necessary skills to this age set can prevent the occurrence of high-risk sexual behaviors. Similar to other countries but with a lower prevalence rate, there are some problems in sexual and fertility health of the youths and adolescents in Iran. Therefore, it is recommended to teach the sexual health promotion techniques to this population according to their religion and culture.

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Introduction: Sexual satisfaction is an important indicator of sexual health and is strongly associated with satisfaction of interpersonal relationships. Self-awareness refers to pay attention to the thoughts, feelings, and it is the introduction of interpersonal relationships. Due to this relationship,a study was conducted to determine the impact of individual counseling based on self-awareness skills on sexual satisfaction in women of reproductive age of Gorgan, Iran.
Methods: An interventional study was conducted as a field trial on 76 women of reproductive age referred to Gorgan health centers in the fall of 1395. The samples were availablility selected and randomly divided into intervention and control groups. In the first step, the Hudson Sexual Satisfaction Persian Questionnaire were completed by all women. Then,the women in the intervention group were consulted with six sessions of individual counseling based on self-awareness skills intervention. One month after counseling, both post-tests were performed in both groups.  Variables with T-student and Mann - Whitney using SPSS 16 software were analyzed.
Results: There was no statistically significant difference between mean score of sexual satisfaction before intervention between two controls (103.21 ± 10.15) and intervention groups (102.36 ± 10.00). But, there was a statistically significant difference between mean score of sexual satisfaction after intervention; 103.39 ± 10.04 for the control group and 112.1 ± 7.97 for the intervention group (P-Value<0.0001).
Conclusion: The results show that to increase sexual satisfaction promoting the awareness about sexual issues is not the only solution, but also promoting the self-awareness skills via recognizing their positive and negative characteristics is necessary. Hence, healthcare providers can use individual counseling based on self-awareness skills to increase sexual satisfaction.

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Background: Sexuality is a complex aspect of the human being’s life and is more than of only the sexual act. Normal sexual functioning consists of sexual activity with transition through the phases from arousal to relaxation with no problems, and with a feeling of pleasure, fulfillment and satisfaction. Rheumatic diseases may affect all aspects of life including sexual functioning. The reasons for disturbing sexual functioning are multifactorial and comprise disease-related factors as well as therapy.
Methods: Searching performed in some databases like PubMed, google scholar, Scopus, Springer and Science Direct. 22 full text articles in English from 2000 until 2019 were found
Which their topic was similar to our topicThe presence of sexual dysfunction was assessed with the questionnaire ‘Female Sexual Function Index (FSFI)’. The FSFI was self-administered and consisted of 19 questions covering six domains; desire, subjective arousal, lubrication, satisfaction, orgasm and pain. The patients’ answers were based on the 4 weeks prior to completing the questionnaire. A total score of ≤ 26 indicated sexual dysfunction.
Results: In rheumatoid arthritis and ankylosing spondylitis patients, pain and depression could be the principal factors contributing to sexual dysfunction. On the other hand, in women with Sjögren’s syndrome, systemic lupus erythematosus and systemic sclerosis sexual dysfunction is apparently most associated to vaginal discomfort or pain during intercourse. Finally, sexual dysfunction in patients with fibromyalgia could be principally associated with depression, but the characteristic symptoms of fibromyalgia (generalized pain, stiffness, fatigue and poor sleep) may contribute to the occurrence of sexual dysfunction.
Rheumatic diseases affects sexual health as a result of pain, reduced joint mobility, fatigue, depression and body image alterations. Sexual function is closely related to satisfactory quality of life. The treatment of sexual dysfunction will depend on the specific patient’s symptoms, however, there are some general recommendations including: exploring different positions, using analgesics drug, heat and muscle relaxants before sexual activity and exploring alternative methods of sexual expression.
 Conclusions: Sexual dysfunction in females with rheumatic diseases is multifactorial due to chronic disease aspects, disease activity and drugs. A multidisciplinary approach is essential in order to offer preventive measures for these patients.
The investigated material provides few solutions to sexual health problems of female patients. The most commonly mentioned solution is increased information and communication between health professionals and patients. Further research is needed to understand which types of intervention can help women with rheumatic disease to improve their sexual health
The results of this studies indicated that more attention should be paid to the sexual health of women suffering from rheumatic diseases as a neglected aspect of their treatment, which requires an interdisciplinary approach to shift the care of these patients from a biomedical model to a biopsychosocial model.

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Background: Lack of information in marital relationships can be an important factor in sexual dysfunction and dissatisfaction. Many marital problems are caused by dissatisfaction with sex. The lack of awareness in this area is due to marriage in adolescence age and regarding sex as a taboo in religious, cultural and social matters. In such cases, it may be appropriate to take advantage of modern teaching methods. Due to the increase in technology, the present study was designed and conducted to determine the role of multimedia education on sexual satisfaction in Afghan refugees’ adolescent women.
Methods: The present study is a quasi-experimental educational intervention in which Afghan adolescent women referred to selected charity centers in Mashhad were selected as the intervention (n = 34) and control (n = 34) using sortation method. Sampling was convenience and women with inclusion criteria brought in the study. Inclusion criteria were Afghan adolescents aged 10-24 years, having ability to communicate in Persian (reading and writing), formal marriage, first marriage and single marriage, residing in Mashhad, Marriage duration of at least one year, no formal and comprehensive sex education, no underlying medical conditions (diabetes, thyroid dysfunction, liver and kidney disease), non-addicted and non-psychiatric couples, lack of stress experiences in the last 3 months, no pregnancy, abortion, or delivery in the last 3 months, living with spouse in a shared home at the time of research, having sex with spouse, accessing a computer or CD player, and knowing how to use these devices or having access to the person helping the participant to use them. First, the participants completed the demographic characteristics Questionnaire and Sexual Satisfaction Questionnaire. The second questionnaire had 25 questions (13 negative and 12 positive answers) which were answered by likert scale of 1 to 7. The overall scores` range was from 25 to 175 and it categorized sexual satisfaction in three level: low level (score between 25 and 67), moderate level (score between 67 and 100) and high level (score above 100). To assess the validity of the questionnaire, face validity was approved by a survey of 6 midwifery experts and then the content validity was evaluated by 14 experts to assess the simplicity, clarity, necessity, relevance and importance. The results of the data analysis indicated that all the questions were simple and clear. The index for the whole instrument was 0.91, indicating that the instrument was content valid. By calculating the CVR index for each item, the lowest value was 0.57, and according to the Lauvche table, the allowable value for this index was 0.51, and all the questions were sufficiently valid. Test-retest method was used to evaluate the reliability of the tool. The questionnaires were given to 20 members of the study population who were not present in the study sample and after two weeks the questionnaires were again completed by the subjects; correlation coefficients were 0.79. The intervention program consisted of 4 sessions (every session was 60-minute) and 4 CDs provided to the intervention group every week to be observed during the week. Delivering subsequent educational content to participants was based on the researcher's assurance of viewing previous educational content and it was proved by asking a few questions about those contents. All educational contents were first collected by the researcher from various books about sexual subject and finally approved by a qualified professor in this field from the viewpoint of psychology. Control group participants received routine charity programs. The sexual satisfaction questionnaire was completed again at the end of training (4 weeks) and 8 weeks after the beginning of the study. After checking the data normality for data analysis and descriptive statistics such as adjusting frequency distribution tables, calculating numerical indices and inferential statistics of chi-square, independent t-test, paired t-test, One-way analysis of variance was used.
Results: The mean ± SD of the intervention group age was 22.88 ±1.200 and for the control group was 22.44 ± 1.637. 15 and 12 participants in the intervention and control group, respectively, had undergraduate education. 20 and 22 participants had high school diploma or higher. Before the intervention, sexual satisfaction was not significantly different between two groups (P = 0.729), while it increased significantly at week 4 (P = 0.013) namely 8 weeks after the intervention (P <0.001). In the intervention group, the mean of sexual satisfaction was 130.11 ± 24.54 which subsequently increased to 140.50 ±20.51 after intervention and 148.35 ± 18.88     8 weeks after intervention which in turn indicates the persistence of information. There was also an increase in scores of participants. In the control group, the mean sexual satisfaction was 128.82 ± 19.88 in the first week, 128.26 ± 19.57 in the fourth week and 128.41 ±19.65 in the 8^th week which showed no significant difference.
Conclusions: Due to the nature of sex education which is associated with shame, using multimedia method was more effective and cost-effective. This method also does not need face-to-face visits and improved the sexual satisfaction of adolescent Afghan refugee women therefore it can be used in sex education for Afghan couples.

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Background: Mothers with high risk pregnancies, in addition to medical problems, experience behavioral, and emotional problems. One of the problems mothers with high risk pregnancies encounter is the effect of high risk pregnancy conditions on their marital relationships. Therefore, caregivers' attention to mothers with high-risk pregnancies and counseling in this regard is necessary in order to lessen the care of mothers. It is recommended to focus on preventing sexual intercourse in high risk pregnancies. Therefore, the researchers conducted a qualitative study to understand and experience mothers with high risk pregnancies of marital relationships during pregnancy.
Methods: In this study, through a qualitative content analysis, data was collected via interviews. The research population including all mothers with high risk pregnancies were collected by sampling method. The research area was the public and private hospitals in Mashhad. Completing the legal and ethical steps and approving the plan, the researcher introduced himself to the ethics committee of Mashhad University of Medical Sciences and also to the participants. In addition, they presented the purpose of the research to the participants and obtained the written informed consent form. Subsequently, with a semi-structured, isolated face-to-face interview with contributors, they discovered the feelings, perceptions, and thoughts of contributors. The interviews were completely recorded by an MP3 Player device after getting permission of the participants. Data analysis was carried out simultaneously with data collection, in a conventional way of content analysis, based on the approach of Graneheim, Lundman (2004), and MAXQDA1 software used to manage the data.
Results: 12 pregnant women with high risk pregnancy were saturated. Interviews lasted between 45 and 75 minutes. 1000 codes were obtained. The resultant subcategories included: distance in marital relationships, damaged sexual relations, sexual dysfunction in high-risk pregnancies, and values priority in high risk pregnancies. The final theme extracted is "marital and sexual relations are considered as the missing ring in high risk pregnancies."
 Conclusions: Sexual and marital relationships and marital status are neglected in high risk pregnancies, which in turn causes mothers to experience negative emotions, therefore consultation with mother’s .should be considered.

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Background: Because of the importance of adolescence, the priority of reproductive health in the world is adolescent reproductive health. What distinguishes this age from other phases of life is the emergence of fertility. Sexual ability, especially among this age group, is a matter of great significance. In fact, today's adolescents, like their peers at all times, are sexually active, with the difference that they are exposed to more sexual stimuli comparing to the past. Moreover, through promoting views about pro-individuality, freedom, opposite-sex friendship, and even establishing advanced relationships are encouraged more than ever. Hence, adolescents face unique reproductive health challenges. The purpose of this study was to discover the views of mothers of adolescent girls about sexual education for adolescent girls.
Methods: In this qualitative study, data were collected through 4 focus group discussions with 26 mothers who had at least one adolescent girl between the ages of 14 -19, not married, living with parents, and attending public schools of Mashhad in 2016. The sampling method, given that the interviews were conducted at the adolescent girls' school, was designed to purposely select schools in a way that encompassed all three high, low, and medium economic and social situations of city dwellers. The number of participants in the focus group sessions ranged from 6 to 8 and the duration of each session was between 60 to 90 minutes. All focus groups were recorded using two digital recorders and field notes with the consent of the interviewees. Having been transcribed, the data were coded and categorized using the conventional content analysis method with the Grunheim and Lundman approach and using MAXQDA10 software.
Results: Data were collected in four main categories: Self-study over time- Sexual education is a moral deviation factor- The need to increase mothers' sexual literacy- and School and family participation
 Conclusions: Most participants` mothers emphasized the need for adolescent girls' sexual education and believed that this should be done with the participation of schools and families. However, they disagreed with the exact time of initiation into teaching. Some of the mothers believed that the best time for initiation to teaching is the time of marriage, and others, considering the prevailing conditions in the community, especially easy access to Internet, surmise that the sexual education should begin during adolescence and before marriage, however, they though that pre-marriage sexual education should initiate according to certain criteria, in this regard, they emphasized the school's involvement which, in turn, needs the government appropriate policies.

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Background: General self-concept refers to the set of emotions and perceptions of one's self, while sexual self-concept refers to the perception of each individual as a sexual being. General and sexual self-concepts are affected by various life problems including infertility. Infertility can affect people's self-concept by affecting their personal and sexual life. Lack of negative mood management can also affect people's self-concept by creating psychological problems such as anxiety and depression. Mood regulation skill as a protective factor for people experiencing psychological problems in their relationships, will modify emotional responses which in turn leads to improve their physical and psychological health through positive and adapted behaviors. The purpose of this study is to determine the effect of mood regulation education on general and sexual self-concept in infertile women.
Methods: This clinical trial study conducted in 1397, 34 infertile women referred to the only infertility center in Gorgan who were included in the study and were selected by available sampling method, (n=17) in the intervention group and (n=17) in the control group. Education program of mood regulation was performed in four, 90- minute-long sessions of a one-time workshop for individuals in the intervention group. Inclusion criteria were: Iranian nationality, high school education, not having any stepchild, primary infertility, absence of known physical and psychological illnesses (according to their own declaration), not taking psychiatric medication, non-drug addiction of both the woman and the spouse and not having any life skills training. Exclusion criteria were: not attending in educational sessions more than once and unwillingness to continue this study. Both groups completed Rogers' Persian self-concept questionnaire and Snell's self-concept questionnaire before, immediately and one month after the intervention. Data analysis was performed using SPSS software (version 16), repeated measures analysis of variance, and adjusted Bonferroni test (P <0.05).
Results: In this study, the mean age of the samples in the intervention group was 33.18 ± 6.07 and 30.41 ± 4.54 in the control group. Results showed that before intervention, general self-concept in intervention group was 9.41, positive sexual self-concept 123.76, negative 12.17, and situational was 43.17. One month after intervention, general self-concept was 6.21, positive sexual self-concept 139.29, negative 5.70 and situational was 54.23. The results of repeated analysis of variance showed that mood regulation education had a positive effect on promotion of general self-concept and sexual self-concept of infertile women one month after intervention, therefore this effect was statistically significant.
 Conclusions: Mood regulation education improves the general and sexual self-concept of infertile women and can be used in health care, infertility and midwifery centers.

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Background: Sexual self-concept is a cognitive evaluation which refers to a person's perception of tendencies and self-sexuality and may be affected by factors such as chronic illnesses. Therefore, this study was conducted to compare sexual self-concept in married diabetic women with married non-diabetic women.
Methods: This Analytical cross-sectional study was performed on 200 married diabetic women and 200 non-diabetic women referred to healthcare centers of Gorgan. Inclusion criteria were: high school education or more, Iranian nationality, living with their spouses for the past 4 weeks, and getting married once. Exclusion criteria were: history of adverse events in the past three months, identified physical, psychological and sexual problems, having psychiatric disorders diagnosis by a psychiatrist, current couple's drug and alcohol addiction, pregnancy, menopause, infertility, and lactation. Samples were selected by systematic random sampling. Data were collected using Farsi Multidimensional Sexual Self-Concept Questionnaire and were analyzed by SPSS16 software using Mann-Whitney nonparametric test.
Results: The results showed that the mean of positive sexual self-concept (103/2 ± 25/59) and the mean score of situational sexual self-concept (33/6± 11/3) in diabetic women were significantly lower than the mean scores of similar areas in non-diabetic women who showed positive sexual self-concept as 111.41 ±24/59 and situational sexual self-concept as 38/2 ± 11/04. Furthermore, the mean score of negative sexual self-concept (27/9 ± 8/5) in diabetic women was significantly higher than the mean scores of similar areas in non-diabetic women (24/9 ± 7/09).
 Conclusions: Diabetes is known as an effective factor on women's sexual issues such as sexual self-concept. According to the results of this study, it seems that some interventions must be designed to improve the positive and situational sexual self-concept and to reduce negative sexual self-concept.

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Background: Sexuality is an important and inseparable part of the life of every woman. Female sexual dysfunction (FSD) has a major influence on quality of life and can lead to personal distress and anxiety. This study aimed to determine the prevalence of sexual dysfunction and predisposing factors in women.
Methods: This cross-sectional study was carried out on 400 outpatient women aged 15-49, who had a health record in the health care centers of Rasht, Iran during 2015-2016. Samples were selected through multi-stage cluster sampling method. Data collection tool included demographics and reproductive information, the standard questionnaire of female sexual function index (FSFI). Multivariate linear regression analysis was used to determine the predictors of sexual dysfunction in SPSS 13.
Results: The mean±SD score of total FSFI was 28.14±3.82, ranging from 2 to 36. The frequency of sexual dysfunction was 34.3% in total. Multivariate linear regression analysis showed a significant correlation between FSFI and some factors including age, education level, age at menarche, frequency of sex, and knowledge on sexual function. These factors accounted for 12% of the variance in the sexual function index of women.
Conclusions: Considering the critical impact of sexual function on the health of couples, paying attention to sexual function in women and its predictors are important to help and plan prevention programs.
 

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Background: Sexual function is particularly important aspect of pregnant women’s lives that can affect mental health and family cohesion. The present study aimed to determine the effect of sex education on sexual function of primigravid pregnant women.
Methods: This randomized clinical trial study with four parallel groups (two intervention and two control groups) was conducted on 100 primigravid women in 2019. The Two intervention groups (n=50) received three sessions of sex education, once a week and two control groups (n=50) didn't received sex education. The Female Sexual Function Index was completed at the beginning of the study and after eight weeks. Data were analyzed with SPSS (version 18) and One-way analysis of variance (ANOVA), paired t-test, Fisher's exact test were used for analysis and significance was set at 0.05.
Results: The Given that the mean sexual function in the groups before the intervention was significantly different (P=0.0004), the Mean difference rate of change (Mean DRC) was used for inter-group comparisons.  Mean DRC of sexual function in the first intervention group (sex education and prenatal education) was 0.173±0.563 (17% increase) and the second intervention group (only sex education), was 0.106±0.209 (10% increase). However, Mean DRC of sexual function decreased significantly in the two control groups (-0.0364±0.205) (-0.009±0.132) (P<0.05).
Conclusion: The results confirm the positive effects of sex education on sexual function during pregnancy. In addition, combination of sex education with conventional prenatal education can have a greater impact on the overall sexual function than each intervention separately.

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