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BACKGROUND: Recently known as the genito-pelvic pain/penetration disorder (GPPPD), Dyspareunia is considered a negative factor affecting a couple's sexual health. This paper analyzes pain in Dyspareunia cases and determines protective factors causing lower levels of sexual distress among patients. METHODS: In a population-based cross-sectional study conducted in 2017, the cluster quota sampling technique was adopted to randomly select 590 Iranian married women aged 18-70 years from 30 health centers. The research tools included demographic data, a sexual distress scale, and Binik's GPPPD questionnaire. RESULTS: In this study, the prevalence of self-report Dyspareunia, confirmed moderate Dyspareunia, and confirmed severe Dyspareunia (based on Binik's proposed criteria) were 33 %, 25.8 %, and 10.5 %, respectively. Interestingly, 32 (34 %) out of 94 women who experienced severe pain based on Binik's criteria reported no sexual distress. Compared to women with distress, they also had more positive body images, higher self-confidence, higher levels of sexual satisfaction, and more intimacy in their relationships (P = 0.000). In contrast, 8.5 % of the participants reported significant sexual distress even without confirmed Dyspareunia. CONCLUSIONS: Improving intrapersonal characteristics such as self-confidence and body image as well as interpersonal factors such as sexual satisfaction and intimacy with a spouse can effectively treat Dyspareunia by alleviating sexual distress. The partner's role in female pain and distress management would be more critical than previously thought.

Dyspareunia is a condition that can negatively affect sexual health among individuals and couples. This paper addresses the pattern of sexual pain as well as some interpersonal and intrapersonal factors that may lessen sexual pain by mitigating sexual distress. This population-based cross-sectional study was conducted on 590 randomly selected Iranian married women aged 18­70 years. According to the research results, the prevalence of self-report sexual pain was 33 %. However, based on strict Binik's criteria and sexual distress, the prevalence of severe Dyspareunia decreased to 10.5 %. The most common location, time, and type of pain were reported to be in the vaginal entrance at the beginning of intercourse with irritation.Interestingly, a substantial number of women reported no sexual distress, despite having severe Dyspareunia. Compared to patients with distress, they experienced higher levels of sexual satisfaction, more positive body images, higher levels of self-confidence, and more intimacy in their relationships (P = .000). In addition to the routine management of sexual pain, clinicians should consider these protective factors that can lead to better pain tolerance and less sexual distress among patients. The research findings emphasized the importance of attendance and collaboration of spouses in the treatment process.At the same time, observing the sexual distress of women with no sexual dysfunctions would clarify that their own perception of sexual difficulty per se is an important factor. In other words, "sexual dysfunction" and "sexual problems" are both significant because defining sexual problems is subjective and depends on a woman and her partner's values, desires, and sexual knowledge.

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INTRODUCTION: To date, few studies have investigated the prevalence of sexual pain in the context of the new diagnostic concept of genito-pelvic pain/penetration disorder (GPPPD). AIM: To evaluate the prevalence of GPPPD and its associated factors. METHODS: This was a population-based, cross-sectional study of 590 healthy married women age 18-70 years conducted between May and October 2017 in Tehran, Iran. MAIN OUTCOME MEASURES: Research tools included demographic characteristics checklist, factors affecting GPPPD, sexual distress and self-reporting of pain during intercourse, 2 standard questionnaires on depression (Patient Health Questionnaire 9) and Binik's guideline for the diagnosis of GPPPD. RESULTS: 196 women (33%) reported pain or fear in answer to self-report questions. Administration of Binik's guideline yielded a GPPPD prevalence of 16% (n = 94 women); however, this number decreased to 62 women (10.5%) when sexual distress was taken into account; thus, the final prevalence of GPPPD was considered to be 10.5%. However, if the threshold in Binik's guideline was lowered to also include those reporting "somewhat" pain in addition to the group reporting "moderate" and "quite a bit or always," then the prevalence of GPPPD increased to 25.8%. The results of backward logistic regression identified a strong aversion to looking at or touching the genitalia (odd ratio [OR] = 4.3), low sexual satisfaction (OR = 3.1), and severe depression (OR = 6.6) as independent risk factors for a diagnosis of GPPPD and secure financial status (OR = 0.3) and a high level of marital satisfaction (OR = 0.2) as protective factors against a diagnosis of GPPPD. CLINICAL IMPLICATIONS: Reliable diagnosis of GPPPD is crucial. Application of validated tools may mitigate the overestimation of GPPPD prevalence. Simultaneously, clinicians' judgment is essential in assessing a reasonable threshold and preventing underestimation that leads to the exclusion of women suffering from pain. STRENGTHS & LIMITATIONS: The present study is one of the few evaluating the prevalence of GPPPD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition and Binik's guideline. The study also aims to point out some new perspectives on merging the 2 concepts of vaginismus and dyspareunia. Study limitations include the evaluation of factors affecting GPPPD based on self-reporting and possible recall bias. CONCLUSION: Further research is needed to determine the appropriate threshold for a diagnosis of GPPPD. We suggest that a woman with mild to moderate pain or fear of vaginal penetration is under sexual distress and cannot be neglected. In addition, problems may arise following the DSM-5 merging of the 2 disorders of vaginismus and dyspareunia, owing to the significant prevalence and distress of lifelong vaginismus in some cultures. Alizadeh A, Farnam F, Raisi F, et al. Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women.J Sex Med 2019;16:1068-1077.

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PURPOSE: Alumina substrates are one of the commonly used scaffolds applied in cell culture, but in order to prevent formation of biofilm on the alumina substrate, these substrates are modified with carbon nanotube. METHODS: The alumina substrate was made by a two-step anodization method and was then modified with carbon nanotubes by simple chemical reaction. The substrates were characterized with FTIR, SEM, EDX, 3D laser scanning digital microscope, contact angle (CA) and surface free energy (SFE). To determine how this modification influences the reduction of biofilm, biofilm of two various bacteria, Escherichia coli (E.coli) and Staphylococcus aureus (S. aureus), were investigated. RESULTS: The biofilm on the modified substrate decreased due to the presence of carbon nanotubes and increased antibacterial properties. Dental pulp stem cells (DPSCs) were cultured onto flat alumina (FA) and nanoporous alumina-multiwalled carbon nanotubes (NAMC) substrates to examine how the chemical modification and surface topography affects growth of DPSCs. CONCLUSION: Cell attachment and proliferation were investigated with SEM and Presto Blue assay, and the findings show that the NAMC substrates are suitable for cell culture.

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PURPOSE: Nanoporous membranes have been employing more than before in applications such as biomedical due to nanometer hexagonal pores array. Biofouling is one of the important problems in these applications that used nanoporous membranes and are in close contact with microorganisms. Surface modification of the membrane is one way to prevent biofilm formation; therefore, the membrane made in this work is modified with carbon nanotubes. METHODS: In this work, nanoporous solid-state membrane (NSSM) was made by a two-step anodization method, and then modified with carbon nanotubes (NSSM-multi-wall carbon nanotubes [MWCNT]) by a simple chemical reaction. Techniques such as atomic force microscopy (AFM), energy dispersive X-ray (EDAX), field emission scanning electron microscopy (FESEM), Fourier-transform infrared spectroscopy (FTIR), contact angle (CA), surface free energy (SFE), protein adsorption, flow cytometry, and MTT assay were used for membrane characterization. RESULTS: The BSA protein adsorption capacity reduced from 992.54 to 97.24 (µg mL-1 cm-2) after modification. The findings of flow cytometry and MTT assay confirmed that the number of dead bacteria was higher on the NSSM-MWCNT surface than that of control. Adsorption models of Freundlich and Langmuir and kinetics models were studied to understand the governing mechanism by which bacteria migrate to the membrane surface. CONCLUSION: The cell viability of absorbed bacteria on the NSSM-MWCNT was disrupted in direct physical contact with carbon nanotubes. Then, the dead bacteria were desorbed from the surface of the hydrophilic membrane. The results of this research showed that NSSM-MWCNT containing carbon nanotubes have significant antimicrobial and self-cleaning property that can be used in many biomedical devices without facing the eminent problem of biofouling.

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