Objective To review the impact of uterine fibroids on women's sexual health and to highlight this often underreported aspect of clinical care.Methods A narrative review of the literature on uterine fibroids and female sexual dysfunction.Results Uterine fibroids are the most common benign uterine tumors, significantly impacting women's sexual health, yet this issue remains underreported in clinical practice. Symptomatic patients often suffer from heavy menstrual bleeding and progressive anemia, which reduces their overall quality of life and sexual desire. Factors such as severe dyspareunia, pelvic pressure and psychological distress—including fear of pain and low self-esteem—further contribute to impaired arousal and orgasm. Although surgical interventions such as myomectomy and hysterectomy often improve sexual function by alleviating physical symptoms, outcomes can vary depending on the surgical technique and potential nerve damage.Conclusions Clinicians should use validated tools to assess sexual health in women with uterine fibroids, which would lead to more comprehensive, patient-centered care.
BACKGROUND:Postpartum depression (PPD) is a common perinatal disorder that affects maternal and child health. Although vitamin D deficiency has been linked to depressive symptoms, the dose‑response relationship between perinatal serum 25(OH)D and PPD and predictive value remains unclear. OBJECTIVE:To investigate the dose‑response relationship between perinatal 25(OH)D and PPD and evaluate its predictive value. METHODS:A total of 326 perinatal women were enrolled, PPD was assessed within 6 weeks postpartum, and serum 25(OH)D was measured at 24-48 hours after delivery. Analyses included baseline characteristics, EPDS scores, risk factors, dose‑response, predictive performance, and interactions with supplementation. RESULTS:PPD incidence was 23.31%. The PPD group had lower 25(OH)D, negatively correlated with EPDS scores. Each 1 ng/mL increase in 25(OH)D reduced PPD risk by 25% (OR = 0.75, 95% CI: 0.68-0.82, P < 0.001). Primiparity and fair spousal relationship were risk factors; planned pregnancy, sunlight, and oral supplementation were protective. Positive interactions with sunlight and supplementation were observed, with linear dose‑response. The AUC was 0.822, with an optimal cutoff of 24.26 ng/mL (sensitivity 67.11%, specificity 85.20%). CONCLUSION:Perinatal 25(OH)D levels are linearly and negatively correlated with PPD risk and show good screening utility; exogenous supplementation appears to modify this protective effect.
BACKGROUND:Climate change is a significant threat to global health. While its psychological impacts are documented, research exploring the link between climate change anxiety and premenstrual disorders is scarce. OBJECTIVE:This study investigated the relationship between climate change anxiety and premenstrual syndrome (PMS) severity among young women. METHODS:A cross-sectional study was conducted with 1035 young women (mean age: 20.83 ± 1.76) in Türkiye. Data were collected using the Climate Change Anxiety Scale (CCAS) and the Premenstrual Syndrome Scale (PMSS). Data were analyzed using Pearson's correlation and linear regression. RESULTS:PMS prevalence was 60.8%. A significant positive correlation was found between total CCAS and PMSS scores (r = 0.188, p < 0.001). Higher levels of overall climate change anxiety were significantly correlated with increased PMS severity (r = 0.188, p < 0.001). Regression analysis revealed that climate change anxiety is significantly associated with PMS symptoms, explaining 3.5% of the variance (R2 = 0.035, p < 0.001). Age and menstruation-related daily life interference were also associated with higher climate anxiety. CONCLUSION:Climate change anxiety acts as a modern psychosomatic stressor contributing to premenstrual symptoms. Healthcare professionals should adopt holistic approaches, considering environmental distress a potential factor in menstrual health management for young populations.
Background Midwifery continuity models of care have been associated with positive health outcomes and positive childbirth experiences. Such models may be beneficial for women with fear of birth but remain uncommon in Sweden.Aim To explore thoughts and perceptions of midwifery continuity of care among women with fear of birth and describe their experiences of fragmented maternity care.Method A qualitative research design in which semi-structured telephone interviews were conducted during pregnancy and postpartum with women scoring above 70 on the Fear of Birth Scale. Data was analyzed using reflexive thematic analysis.Results Two themes were identified: A desire for knowing and being known and Unheld in the hands of many. These illustrate women's desire to feel secure and their belief that a trusting relationship with a known midwife throughout pregnancy, childbirth and the postpartum period could reduce their fear. Fragmented standard care was perceived as stressful, and all women expressed interest in midwifery continuity of care.Conclusion Women with fear of birth believed that relational continuity with a known midwife could foster trust, guidance and reduce fear. The fragmented standard care was perceived as uncertain, contributing to emotional distress. These findings highlight the need for personalized and relational midwifery care.
Background During the COVID-19 pandemic, pregnant women experienced increased psychological distress, while access to routine mental health care was often disrupted. Psychological interventions may provide an effective strategy to support maternal mental health under these circumstances.Objective This systematic review aimed to provide an overview of psychological interventions for pregnant women during the COVID-19 pandemic and to evaluate their effectiveness in reducing distress and enhancing resilience.Methods A systematic search of four databases was conducted up to 3 September 2025. Randomised and non-randomised studies evaluating psychological interventions during pregnancy were included.Results Sixteen studies met the inclusion criteria. Interventions included cognitive behavioural therapy, mindfulness-based interventions, psychoeducation, and other psychological approaches delivered through individual, group, digital, or hybrid formats. Most studies reported reductions in depression, anxiety, or stress, and some found improvements in resilience-related factors. However, the methodological quality was modest; with heterogeneous outcome measures and limited follow-up.Conclusions Overall, psychological interventions adapted for digital or hybrid delivery show promise for improving maternal emotional well-being in times of crises. The findings suggest that accessible and scalable psychological interventions may support maternal mental health during crisis situations when routine care is disrupted. Future research should prioritize larger, methodologically rigorous trials with standardized outcomes, and longer follow-up periods.
Objective Infertility negatively impacts mental health and quality of life, with social avoidance and distress (SAD) being a key but underrecognized issue. This study aims to analyze SAD risk factors in infertility patients.Methods A retrospective study of 205 infertility patients (October 2022–July 2025) was divided into SAD (n = 93) and non-SAD (n = 112) groups. LASSO regression and XGBoost identified key variables, followed by logistic regression and ROC analysis.Results Significant differences (P < 0.05) were found in age, education, residence, income, infertility stigma scale (ISS), self-esteem scale (SES), cognitive dismantling scale (CD-RISC) and social relationship quality scale (SRQS) scores. Five common factors (age, ISS, SES, CD-RISC, SRQS) were identified. Logistic regression showed age (OR = 1.333) and ISS (OR = 1.101) as risk factors, while SES (OR = 0.726), CD-RISC (OR = 0.876) and SRQS (OR = 0.863) were protective (P < 0.05). AUC values ranged 0.694–0.723, showing only modest discriminative ability.Conclusion SAD in infertility patients is independently associated with age, ISS, SES, CD-RISC and SRQS scores, each with moderate predictive value. These findings support the application of the above indicators for early identification and risk assessment of SAD among infertile populations.
OBJECTIVE:This study translates and validates an Assamese version of the Infertility Stigma Instrument-Female (ISI-F) among women seeking Medically Assisted Reproduction (MAR) in Assam, India. METHODS:The translated ISI-F was administered among 188 Assamese-speaking women in two healthcare facilities. Exploratory factor analysis (EFA), reliability assessment, and confirmatory factor analysis (CFA) were carried out. Convergent validity was examined using Spearman correlations between ISI-F and the Fertility Quality of Life (FertiQOL) subscales. RESULTS:EFA yielded a refined 15-item scale with four factors: Social Withdrawal, Perceived Social Pressure, Experienced Stigma, and Avoidant Coping, explaining 44.36% of the variance. The scale had acceptable reliability (Cronbach's α = 0.728; McDonald's ω = 0.911). CFA demonstrated a better fit to the four-factor Assamese model (RMSEA = 0.051; CFI = 0.92; TLI = 0.90) than the original ISI-F structure. ISI-F scores were significantly and negatively correlated with FertiQOL domains, supporting the convergent validity. Mean stigma score (44.6 ± 9.11) indicated moderate perceived infertility stigma. CONCLUSIONS:The Assamese version of the ISI-F is a reliable and culturally appropriate tool for measuring infertility stigma among MAR treatment seekers in Assam, India. The revised factor structure reflects context-specific distinctions between social pressure, experienced stigma, and coping responses.
Objective To examine the physical, emotional, and relational responses of expectant fathers and to elucidate how Couvade-related phenomena influence couple dynamics.Methods This qualitative study was conducted between July 2025 and October 2025 with nine married couples (n = 18). A total of 27 interviews were carried out, including 18 individual interviews and 9 joint couple interviews. Data were collected using a semi-structured interview guide developed by academic midwives, transcribed verbatim, and analyzed using Braun and Clarke's reflexive thematic analysis.Results Five main themes were identified: sharing of bodily reflections, emotional sensitivity and anxieties, questioning of masculinity norms, changes in relationship closeness and dynamics, and construction of fatherhood identity with supportive partnership. Findings revealed that Couvade syndrome extends beyond physiological symptoms, transforming men’s emotional experiences, strengthening partner communication, and contributing significantly to the preparation for fatherhood.Conclusion This study highlights that Couvade syndrome is not limited to physical manifestations but also represents a multidimensional process involving emotional sensitivity, relationship changes, questioning of masculinity norms, and construction of a fatherhood identity. Expectant fathers are not passive observers of pregnancy but active partners in this journey.
OBJECTIVE:Menopausal symptoms are complex psychosomatic experiences influenced by psychological resources and behavioural coping processes, in addition to hormonal changes. Although coping strategies have been widely examined, the factors associated with the implementation of coping behaviours remain unclear. This study examined how psychological hardiness relates to coping strategies, coping behaviour implementation, and menopausal symptoms. METHODS:This cross-sectional survey of 198 women aged 45-55 years assessed menopausal symptoms, daily stress, hardiness, coping strategies, and coping behaviour implementation. Coping behaviour implementation for menopausal symptoms was defined as self-reporting of practicing at least one coping behaviour. Coping behaviour implementation was evaluated as a behavioural outcome measure. Group comparisons and multiple regression and logistic regression analyses were performed. RESULTS:Women with higher hardiness reported lower psychological and somatic symptom severity and greater use of active coping strategies. Most coping strategies were not directly associated with symptom severity. Logistic regression showed that coping behaviour implementation was positively associated with psychological symptoms and commitment, and negatively associated with responsibility shifting. CONCLUSIONS:Psychological hardiness, particularly commitment, is associated with coping behaviour implementation rather than directly reducing symptoms. These finding suggest that psychological engagement may be relevant to adaptive self-management during menopause.
OBJECTIVE:To compare depression prevalence using the Hospital Anxiety and Depression Scale focused on depression (HADS-D), the Patient Health Questionnaire-9 (PHQ-9) and the Patient Health Questionnaire-2 (PHQ-2). It also evaluated the psychometric properties of these instruments and their agreement at different cutoff scores. METHODS:A cross-sectional study with 119 women with PCOS. Participants completed all three measurements to assess depression. The study compared depression prevalence and analysed psychometric properties using Cohen's Kappa (κ), coefficient (ρ), Spearman's correlation and Cronbach's alpha (α). RESULTS:Depression rate among PCOS women varied significantly by screening tool: 2.52%-26.89%. However, there was poor agreement and correlation between HADS-D and PHQ-9. In contrast, using cutoff scores of HADS-D ≥ 7 and PHQ-9 ≥ 10 yielded strong agreement (κ = 0.731) and correlation (ρ = 0.731). The PHQ-2 ≥ 3 had reasonable correlations with HADS-D ≥ 7 (κ = 0.596, ρ = 0.599) and PHQ-9 ≥ 10 (κ = 0.596, ρ = 0.599). CONCLUSIONS:Depression rates in PCOS women vary by evaluation technique. This study recommends a cutoff score of ≥7 for the HADS-D and ≥10 for the PHQ-9 to enhance screening accuracy among Thai PCOS women. The PHQ-2 also represents a convenient alternative tool due to its brevity and user-friendliness. We propose that the PHQ-9, with a score of ≥10, constitutes the most suitable screening instrument for Thai women with PCOS.
Objective This study aimed to explore the mediating role of marital adjustment between self-efficacy and quality of life in couples undergoing IVF treatment.Methods In this cross-sectional study, 293 infertile Chinese couples completed the General Self-Efficacy Scale, Marital Adjustment Test, and Fertility Quality of Life Scale. Data were analyzed using structural equation modeling based on the actor-partner interdependence mediation model.Results Both wives and husbands showed positive actor effects - their self-efficacy improved quality of life through their own marital adjustment. For partner effects, husbands' self-efficacy enhanced wives' marital adjustment, while husbands' marital adjustment unexpectedly reduced wives' quality of life.Conclusions Improving self-efficacy and marital adjustment can enhance quality of life for IVF couples. Healthcare providers should approach couples as an integrated unit and develop dyadic interventions to improve both partners' quality of life.
BACKGROUND:Risk factors for adverse emotional and psychological reactions to abortion have not been studied for their interactions. This study used factor analytic methods to develop concise screening scales for pre-abortion risk and post-abortion outcomes. METHODS:A topic-blind electronic survey was administered to a random sample of U.S. women aged 41-45. Among 2,191 respondents with reproductive histories, 466 (21.3%) reported a prior induced abortion; 409 completed the full survey. Participants rated 10 risk-factor and 25 outcome statements using 0-100 visual analog scales. Exploratory factor analysis (EFA) identified latent constructs, confirmatory factor analysis (CFA) tested model fit, and structural equation modeling (SEM) assessed relationships between risk and outcome factors. RESULTS:Risk-factor EFA supported two domains: attachment/support and internal conflict. Outcome EFA identified three domains: internalized distress, intrusive symptoms, and behavioral risks. CFA demonstrated good fit (CFI > .90; RMSEA < .08). SEM showed attachment/support more strongly predicted internalized distress (β = .65), intrusive symptoms (β = .58), and behavioral risks (β = .34) than internal conflict (β = .21-.30). Attachment/support and behavioral risks predicted greater survey-related stress (R² = .30). CONCLUSIONS:Two core risk dimensions predict post-abortion emotional and behavioral outcomes, supporting further development of factor-based screening tools for counseling.
OBJECTIVE:To evaluate a Snyder's hope theory-based psychological intervention for promoting post-traumatic growth (PTG) in women after perinatal loss. METHODS:This single-blind randomised controlled trial enrolled 140 women (≥20 years) who had experienced perinatal loss. Participants were randomised to an intervention group (n = 70, four weekly hope-based sessions plus routine care) or a control group (n = 70, routine care only). The primary outcome was PTG, with secondary outcomes including grief, hope and post-traumatic stress symptoms. Assessments were conducted at baseline, post intervention and at 1-month follow-up. RESULTS:The intervention group demonstrated significantly greater improvements in PTG than the control group (post intervention: 69.4 ± 10.2 vs 58.3 ± 11.9; follow-up: 71.9 ± 9.6 vs 59.5 ± 11.0; both p < 0.001), with a large effect size (Cohen's d = 1.21). Significant benefits were also observed in grief reduction, hope enhancement and reductions in trauma-related symptoms (all p < 0.001). Regression analysis identified post-intervention hope as a robust predictor of PTG (β = 0.44, p < 0.001). CONCLUSIONS:Snyder's hope theory-based intervention effectively promoted PTG and improved psychological outcomes in women experiencing perinatal loss. This approach represents a promising therapeutic framework for supporting women through the complex process of moving from trauma to growth following perinatal loss.
BACKGROUND:The endometriosis painful symptoms-4 dimensions ENDOPAIN-4D is a multidimensional questionnaire designed to assess endometriosis-related pain. This study aimed to translate, culturally adapt, and validate ENDOPAIN-4D for European Portuguese. METHODOLOGY:Translation and content validity assessment were assessed in 32 women with endometriosis. For psychometric validation, 386 patients completed an online sociodemographic and clinical questionnaire, the Portuguese ENDOPAIN-4D, and the Endometriosis Health Profile Questionnaire-30 (EHP-30). Statistical analyses included descriptive statistics, exploratory factor analysis, internal consistency, item-total correlation, and concurrent validity. RESULTS:Factor analysis of the "usual pain" dimension supported the original four-factor structure, accounting for 63.7% of variance (Cronbach's α = 0.91). A novel three-factor structure was identified for the "worst pain" dimension, previously psychometrically untested, with good internal consistency (Cronbach's α = 0.83) and acceptable item-total correlations. Concurrent validity with the EHP-30 ranged from weak to strong across domains. CONCLUSIONS:The Portuguese ENDOPAIN-4D is a culturally adapted and validated instrument for multidimensional pain assessment in European Portuguese women with endometriosis, with validity likely limited for other Portuguese-speaking communities. The newly identified three-factor structure for worst pain may aid individualized pain management and follow-up in clinical and psychosomatic care. Further studies should evaluate concurrent validity and the stability and responsiveness of the new algorithms.
BACKGROUND:Postpartum depression (PPD) disrupts early mother-infant synchrony, a key determinant of healthy socio-emotional development. The relational impact of prior early pregnancy loss (EPL) remains largely underexplored. OBJECTIVE:This exploratory cross-sectional study examined the independent and combined effects of PPD severity and prior EPL on mother-infant synchrony. METHOD:Ninety-six mother-infant dyads, recruited from a population vulnerable to depressive symptoms, were assigned to a control group or to one of three PPD severity groups (mild, moderate, severe). Dyadic synchrony was assessed using the CARE-Index, and EPL history was recorded. Chi-square tests and binary logistic regressions evaluated the effects of PPD severity and EPL on low synchrony. RESULTS:EPL significantly predicted low synchrony (OR = 7.50, 95% CI [1.16-48.36], p = 0.034), independently of PPD severity. Although depressive symptoms showed no overall significant effect (p = 0.123), a severity-response trend emerged: mild (OR = 3.06, p = 0.09), moderate (OR = 3.57, p = 0.06), severe (OR = 7.50, p = 0.01). No interaction between EPL and PPD was found. CONCLUSIONS:Prior EPL appears to have lasting effects on mother-infant synchrony, independent of current depressive severity. Larger studies are needed to confirm these findings.
Background Rates of hypertensive disorders affecting pregnancy are increasing, and bipolar disorder is more common in pregnancy than previously thought.Objective The authors investigated differences in the incidence of hypertensive disorders of pregnancy between those with and without bipolar disorder (BPD) and between those receiving and not receiving pharmacotherapy for BPD. Differences in the incidence of hypertensive disorders of pregnancy in those with BPD between those on prophylactic aspirin (ASA) and not, were also examined.Methods EPIC COSMOS was used to examine records from 2019 to 2023.Results The authors found a meaningful difference in proportions between those with and without BPD when observing development of hypertensive disorders of pregnancy across years. Slightly increased odds of hypertensive disorders were found among those reporting BPD pharmacotherapy compared to those not. Slightly increased odds of hypertensive disorders occurred in those with BPD reporting ASA.Conclusions The increased odds among those reporting BPD pharmacotherapy could be due to sequelae of disease, medication used, or comorbidities. These findings further corroborate prior evidence of the increasing prevalence of both maternal health complications and mental health disorders int eh United States.
Background/Objective This study investigates factors associated with long-term posttraumatic stress following later termination of pregnancy due to fetal anomaly.Methods N = 159 women undergoing later termination of pregnancy were assessed at four time points: pre-termination (T0), at four months (T1, N = 115), one year (T2, N = 99), and four years post-termination (T3, N = 90). Participants answered a questionnaire containing questions about posttraumatic stress (IES), optimism (LOT-R), social support (F-SozU) and several sociodemographic as well as pregnancy related variables. To assess changes in posttraumatic stress over time and possible predictors, generalized estimating equations were calculated.Results Average posttraumatic stress declined significantly from T1 (52.3% above average) to T2 (20.0%) and T3 (17.8%). Optimism at T0 was a significant predictor for lower overall posttraumatic stress, avoidance and intrusion. Having previous children and higher gestational age were significant predictors for higher intrusion scores.Conclusions Findings align with research indicating that most women recover from the initial distress, though some experience prolonged symptoms and should thus receive adequate psychological support. Lower optimism, having previous children and higher gestational age may be risk factors for higher posttraumatic stress levels. Further research should examine the sources of posttraumatic stress among people seeking abortion later in pregnancy due to fetal anomaly.
Objective This study aimed to investigate mental health disparities and their underlying determinants among women with pelvic organ prolapse (POP) in urban and rural China.Methods From August 2022 to August 2023, a convenience sampling method was employed to select 322 POP patients at a tertiary specialized hospital in Nanjing, China. The study used a general information questionnaire, General Health Questionnaire-28, and Perceived Social Support Scale. Influencing factors on mental health were analyzed using univariate and multivariate logistic regression.Results Among the 322 POP patients, 68.01% (219 cases) were from urban areas, and 31.99% (103 cases) were from rural areas. Significant baseline differences were observed, with urban patients having higher education levels and rural patients having a greater number of childbirths and longer disease duration. Based on the General Health Questionnaire-28, urban POP patients scored higher on somatic symptoms, anxiety and insomnia, severe depression, and overall score, compared to rural POP patients (P < 0.05).Conclusions Mental health issues are prevalent among POP patients, with urban POP female patients facing a greater mental health burden than rural patients. Our findings highlight the need for targeted nursing and psychological interventions for this group, especially for urban patients, to improve health conditions.
OBJECTIVES:To assess the reliability of the 10-item and 4-item Perceived Stress Scale (PSS-10 and PSS-4) in the obstetric population, compared with the original 14-item scale (PSS-14). METHODS:Data were drawn from two Brazilian multicenter studies: a prospective cohort of pregnant women at 27-29 weeks and a cross-sectional study of postpartum women. Central tendency measures and centiles were compared across versions for overall, pregnant, and postpartum groups. Analyses included concordance, internal consistency, correlation, and reliability. RESULTS:A total of 1,034 women completed the PSS-14. Median scores differed significantly across versions (PSS-10: 47.5; PSS-4: 43.7; PSS-14: 46.4; p < 0.001). Both shortened versions correlated strongly with PSS-14 (PSS-10: r = 0.958; PSS-4: r = 0.814), but agreement was poor (mean difference PSS-14 vs. PSS-10: -0.366 [-8.56 to 7.83], p < 0.001; vs. PSS-4: 5.700 [-14.43 to 25.83], p < 0.001). Reliability was acceptable for PSS-10 (Cronbach's α = 0.704) but low for PSS-4 (α = 0.516). CONCLUSION:In the obstetric population, PSS-10 may overestimate and PSS-4 underestimate stress levels compared to PSS-14. Further studies are needed to refine the psychometric properties of shorter versions and clarify the clinical implications of score differences. SYNOPSIS:Our findings indicate that the current shortened versions of the Perceived Stress Scale (PSS-10 and PSS-4) might not be a suitable alternative to the original version (PSS-14) in the obstetric population.
Objective Infertility is a global health challenge with profound psychosocial consequences. Couples navigate this journey within social media and online communities. These digital spaces offer opportunities for support, coping and information exchange, but also expose users to comparison culture, misinformation, and inequities. This scoping review aims to synthesize the available evidence on how social-media and online communities shape the psychosocial experience of infertility, identifying both supportive and harmful dimensions.Methods Following Joanna-Briggs Institute methodology PRISMA-ScR guidelines, a comprehensive search was conducted. Eligible studies included qualitative, quantitative and mixed-methods designs. Data were charted using a standardized extraction tool and synthesized thematically. Of 6,935 records screened, 19 studies were included.Results A qualitative content analysis was undertaken to identify four domains: (1) Psychosocial impact of infertility in online spaces, (2) Coping strategies and peer support, (3) Information sharing and misinformation, and (4) Gender, equity and global perspectives. Through studies, supportive functions coexisted with significant risks particularly misinformation, commercial exploitation and exacerbation of stigma.Conclusions Social media functions both as a lifeline and a liability in the infertility journey. Harnessing its supportive potential while mitigating risks requires clinician engagement, digital literacy initiatives, culturally sensitive research and ethical oversight.
