Menstrual disorders and related factors in women with multiple sclerosis

Introduction: Multiple sclerosis (MS) is the most common autoimmune disease that often affects women within the reproductive age. Among the common clinical complaints in these women is variety of menstrual disorders. Thus, we aimed to examine menstrual disordersand related factors in women with MS.Methods: A descriptive cross-sectional study was performed among 172 women with MS who visited the Neurology Specialized Clinic in Tehran, Iran, during 2016-2017. The participants filled out a questionnaire consisting of demographic (e.g., age, educational level, economic status, disease duration, vitamin D consumption duration, and Expanded Disability Status Scale EDSS) and disease characteristics (age at menstruation, duration of each period, interval between two periods, the amount of bleeding, presence or lack of presence of pain, and menstruation pain score). Data were analyzed by using SPSS version 22 and multiple logistic regression model, Chi-square test, and Spearman correlation coefficient. P-value less than 0.05 was considered significant.Results: Overall, 88 patients (51.2%) experienced irregular menstruation patterns, and 116 patients (67.5%) had some forms of menstruation disorders. Multiple logistic regression reflected statistically significant correlations between disability score (β=0.702, P=0.001), moderate (β=2.561, P<0.001) and high (β=2.730, P<0.001) menstrual bleeding, duration of vitamin D intake (β= -0.187, P=0.048), dysmenorrhea (β=1.246, P=0.006), age of the menarche (β= -0.298, P=0.05) and menstrual pattern (β=1.912, P<0.001) with menstrual disorders. Spearman correlation and Chi-square revealed the significant relationship of menstruation pattern, dysmenorrhea, and amount of bleeding with menstrual disorders, which corroborated the results of regression. Conclusion: The results of the present study showed that menstrual disorders have high prevalence in women with MS. Our results also indicated that factors such as duration of vitamin D intake, menstrual bleeding, menarche, menstrual pattern, dysmenorrhea, and EDSS affect menstrual disorders. © 2018, Mashhad University of Medical Sciences. All rights reserved

The relationship between cognitive schemas activated in sexual context and early maladaptive schemas among married women of childbearing age

Background: Healthy sex can be affected by cognitive schemas activated in the sexual context (CSASCs) and early maladaptive schemas (EMSs). Cognitive schemas are the nuclear structure of the cognitive system which facilitate the interaction between individuals and their environments. CSASCs are emotional and behavioral responses in the sexual context. EMSs are extremely stable, enduring and are developed throughout the life of the individual, beginning in childhood. The present study investigated the relationship between CSASCs and EMSs among married women of childbearing age. Methods: In a cross-sectional study, 260 married women of childbearing age participated. Using two-stage sampling , ten comprehensive urban health centers were first randomly selected and then 26 individuals from each center were invited to participate. Data collection included demographic variables, the Young Schema Questionnaire-Short Form (YSQ-SF) with 15 EMSs (emotional deprivation, abandonment, mistrust/abuse, social alienation, defectiveness, incompetence, dependency, vulnerability to harm, enmeshment, subjugation of needs, self-sacrifice, emotional inhibition , unrelenting standards, entitlement, and insufficient self-control), and the Cognitive Schema Activation in Sexual Context Questionnaires (CSASCQ) with five subscales (undesirability/rejection, incompetence, self-depreciation, difference/loneliness, and helplessness). Data analysis was performed using a uni-variable and multi-variable linear regression model with a stepwise method at a significance level of 0.05. Results: The mean age of the participants was 32.48 years and the average duration of their marriage was 10.34 years. The average score of early maladaptive schemas on the YSQ-SF was 151.5 (out of 450). Higher scores indicate more severe maladaptive schemas, although the total score has no defined cutoff point. Scores greater than 15 on each subscale constitute the internalization of that particular maladaptive schema. The highest average subscale scores were the schemas of self-sacrifice and unrelenting standards (M = 16.12, 15.90, respectively), indicating that these two schemas play important roles in the cognition of the participants. The mean score on the CSASCQ was 34.60 (SD ± 12.59; range: 25-125), with the highest mean reported on the loneliness subscale. Hypoactive sexual desire was the most common unpleasant sexual problem (6.9%) and disillusion was the most dominant feeling experienced by participants (33.3%). The results of the multivariable model showed that the following were significant predictors of the CSASC: three subscales of EMS (emotional deprivation [β = 0.28], social isolation [β = 0.31], and emotional inhibition [β = 0.14]) and two demographic variables (job [β = 0.11] and consanguineous marriage [β = 0.20]). In total, the multi-variable model explained 92% of variance of CSASCs. Conclusions: The present study found a significant and meaningful association between EMSs and CSASCs adjusting for the effect of socio-demographic characteristics. The findings indicate that the study of schemas and schema therapy should be considered in both premarital and marital counseling