SUMMARY OBJECTIVE: The aim of this study was to investigate and compare the sexual function of Brazilian adolescents and young women who were using popular contraceptive methods. METHODS: This cross-sectional study took place in 2012–2014 in a free family planning clinic of a tertiary teaching hospital in Brazil. Participants were female adolescents (10–19 years) and young adults (20–24 years) who were using barrier (condom) or hormonal contraceptive methods. The Female Sexual Function Index questionnaire was used to assess the sexual function in the last 4 weeks. RESULTS: A total of 199 women (128 adolescents and 71 young adults) were included. There were no significant differences in the mean total Female Sexual Function Index scores of adolescents and young adults (26.6±5.7 versus 27.6±6.2, respectively, p=0.264). Compared to young adults, adolescents had significantly lower mean scores for orgasm (3.9±1.5 versus 4.4±1.4, p=0.020) and dyspareunia (4.4±1.6 versus 5.2±1.5, p=0.001; lower scores indicate more dyspareunia). There were no significant differences in the proportion of adolescents versus adults classified as being at risk for sexual dysfunction (38.3 versus 42.3%, p=0.651) or at risk of low desire (18.0 versus 21.1%, p=0.579). CONCLUSION: Nearly 40% of Brazilian female adolescents and young adults are at risk for sexual dysfunctional symptoms and 19% have low desire, without significant differences between the two age groups.

ABSTRACT BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

Resumo Objetivos Relatar a experiência de um curso de educação a distância sobre questões sexuais na gestação e puerpério para médicos residentes. Métodos Estudo prospectivo de intervenção educacional, realizado entre abril e setembro de 2014, por investigadores da Universidade Federal de São Paulo. Os participantes foram 219 médicos (R1 a R6). O curso teve carga horária de 24 horas (10 videoaulas e discussões online). No início do curso, os participantes responderam perguntas sobre treinamento, atitude e prática relativas a questões sexuais na gestação; antes e após o curso, responderam perguntas de conhecimento sobre o tema; ao final, preencheram questionário sobre a qualidade do curso. O teste t de Student foi utilizado para comparar os testes de conhecimento, antes e após o curso; valores de p < 0,05 foram considerados estatisticamente significantes. Resultados Um total de 143 residentes concluiu o curso; a maioria estava no 1° (27,2%) ou 3° (29,4%) anos de residência. Houve aumento significativo nas notas médias dos questionários que avaliavam o conhecimento sobre o tema: 4,4 (1,6) versus 6,0 (1,3; nota máxima: 10), no início e final do curso, respectivamente (p < 0,0001). A maioria dos participantes (74,1%) declarou que a qualidade geral do curso atingiu suas expectativas, e 81,1% recomendariam o curso a um amigo. Conclusões O curso de Sexologia online para residentes de Ginecologia e Obstetrícia promoveu o aumento do conhecimento sobre questões sexuais no ciclo gravídico puerperal, e atendeu às expectativas dos participantes. Essa experiência pode servir de modelo para outros cursos de sexualidade voltados para esse público.

Abstract Purpose To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents. Methods This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant. Results A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in themean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (1.6) versus 6.0 (1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend. Conclusions The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants’ expectations. The experience described heremay serve as a model for other sexuality courses targeting similar audiences.

<sec><title>OBJETIVO:</title><p> Comparar a qualidade do sono de gestantes com e sem sobrepeso no segundo e terceiro trimestres.</p></sec><sec><title>MÉTODOS:</title><p> Estudo transversal incluindo 223 gestantes com ≥14 semanas: 105 com sobrepeso (índice de massa corporal - IMC - pré-gestacional ≥25,0 km²) e 118 eutróficas (IMC 18,5-24,9 kg/m²) em acompanhamento pré-natal. A versão brasileira do questionário <italic>Pittsburgh Sleep Quality Index</italic> (PSQI-BR) foi utilizada para avaliação do sono. Testes do χ² e <italic>t</italic> de Student foram utilizados para comparar diferenças entre os grupos; p<0,05 foi considerado significante.</p></sec><sec><title>RESULTADOS:</title><p> A maioria (65,9%) apresentou baixa qualidade de sono (escore total >5) e essa proporção foi significativamente mais alta entre as mulheres com sobrepeso (80/105), em comparação às eutróficas (67/118) (76,2 <italic>versus</italic> 56,8%, p=0,004). No 2º trimestre, essa proporção não alcançou significância estatística (72,5 <italic>versus</italic> 53,7%, p=0,06), mas o escore médio total do PSQI-BR foi mais alto entre aquelas com sobrepeso (7,0±3,8 <italic>versus</italic> 5,5±3,2, p=0,02). Nesse período, os escores médios de latência e qualidade subjetiva do sono foram significativamente mais altos entre as mulheres com sobrepeso (1,4±1,0 <italic>versus</italic> 1,0±0,9, p=0,02, e 1,3±0,8 <italic>versus</italic> 0,8±0,8, p=0,02, respectivamente). No 3º trimestre, a proporção de gestantes com baixa qualidade do sono foi mais alta entre as mulheres com sobrepeso, mas sem diferença significante (79,6 <italic>versus</italic> 60,8%, p=0,06). Nessa fase, o escore total do instrumento foi semelhante entre as mulheres com e sem sobrepeso (9,4±4,2 <italic>versus</italic> 8,3±4,6, p=0,2). No entanto, gestantes com sobrepeso apresentaram escores médios mais altos para distúrbios do sono (2,3±0,7 <italic>versus</italic> 2,0±0,8, p=0,04).</p></sec><sec><title>CONCLUSÃO:</title><p> Mulheres com sobrepeso pré-gestacional apresentaram sono mais comprometido do que as eutróficas, no segundo e terceiro trimestres da gravidez.</p></sec>

<sec><title>PURPOSE:</title><p> To compare sleep quality of overweight <italic>versus</italic> normal weight women in the second and third trimesters of pregnancy.</p></sec><sec><title>METHODS:</title><p> A cross-sectional study involving 223 women with 14 or more weeks of pregnancy, 105 of them overweight (pre-pregnancy body mass index - BMI - ≥25.0 kg/m²) and 118 of normal weight (BMI 18.5-24.9 kg/m²), attending the prenatal care clinic. The Brazilian version of the Pittsburgh Sleep Quality Index (PSQI-BR) questionnaire was used to evaluate sleep quality. The Student t-test and the chi-square test were used to compare differences between groups and a p value <0.05 was considered statistically significant.</p></sec><sec><title>RESULTS:</title><p> Most of the participants (67.7%) were poor sleepers (total score >5); this proportion was significantly higher among overweight (80/105) <italic>versus</italic> normal weight (67/118) women (76.2 <italic>versus</italic> 56.8%, p=0,004). During the second trimester, this difference did not reach statistical significance (72.5 <italic>versus</italic> 53.7%, respectively, p=0.06) but mean total PSQI-BR scores were significantly higher among overweight participants (7.0±3.8 <italic>versus</italic> 5.5±3.2, p=0.02). In the 2^nd trimester, overweight women also had higher scores for sleep latency (1.4±1.0 <italic>versus</italic> 1.0±0.9, p=0.02) and subjective sleep quality (1.3±0.8 <italic>versus</italic> 0.8±0.8, p=0.02). In the third trimester, the proportion of women with poor sleep quality was significantly higher in the overweight group, but did not reach statistical significance (79.6 <italic>versus</italic> 60.8%, p=0.06). During this period, total mean scores were similar for women with and without excess weight (9.4±4.2 <italic>versus</italic> 8.3±4.6, p=0.2). However, overweight women had higher mean scores for sleep disturbance (2.3±0.7 <italic>versus</italic> 2.0±0.8, p=0.04).</p></sec><sec><title>CONCLUSION:</title><p> Overweight women had a poorer sleep quality than normal weight women in the second and third trimesters of pregnancy.</p></sec>

OBJETIVO: Avaliar em gestantes saudáveis no segundo trimestre a associação entre função sexual e qualidade de vida, e função sexual e satisfação sexual. MÉTODOS: Estudo transversal com 51 gestantes em acompanhamento em ambulatório de pré-natal de baixo risco. A função sexual foi aferida por meio do Quociente Sexual - Versão Feminina (QS-F). A qualidade de vida e a satisfação sexual foram avaliadas pelo Instrumento Abreviado de Avaliação de Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-bref). Os critérios de inclusão foram idade gestacional entre a 15ª e a 26ª semana, idade materna igual ou superior a 20 anos, mínimo de 5 anos de educação escolar, ter parceiro fixo há pelo menos 6 meses, ter tido relação sexual com penetração vaginal nos últimos 15 dias. Foram excluídas mulheres vítimas de violência sexual, com história pregressa ou atual de depressão, antecedente de aborto habitual ou complicações na gestação atual (amniorrexe prematura, trabalho de parto prematuro ou hemorragia). Para a análise dos dados foram utilizados os testes do χ² e exato de Fisher e p<0,05 foi considerado significante. A análise estatística foi realizada com o Statistical Package for the Social Sciences (SPSS). RESULTADOS: A maioria das gestantes (64,8%) obteve o QS-F de "regular a excelente" e 58,8% classificaram sua qualidade de vida como "boa". Assinalaram que estavam satisfeitas com a vida sexual 35,3% das gestantes, e 15,7% estavam muito satisfeitas. O estudo mostrou que existe associação entre QS-F "nulo a ruim" com qualidade de vida "ruim" (p=0,002) e que QS-F "regular a bom" e "bom a excelente" estão associados com "satisfação" e "muita satisfação" sexual (p<0,001). CONCLUSÃO: A função sexual está associada à qualidade de vida e à satisfação sexual em gestantes saudáveis, no segundo trimestre da gestação.

PURPOSE: To evaluate, in healthy women in the second trimester of pregnancy, a possible association between sexual function and quality of life, and between sexual function and sexual satisfaction. METHODS: This cross-sectional study involved 51 pregnant women managed at a low-risk antenatal care clinic. Sexual function was evaluated through the Sexual Quotient - Female Version (QS-F) questionnaire. Quality of life and sexual satisfaction were evaluated though the brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-bref). Inclusion criteria were pregnancy between 15-26 weeks, maternal age 20 or more years, at least five years of scholling, in a relationship with a single partner for the last 6 months, having sexual intercourse with vaginal penetration in the last 15 days. We excluded women with a history of sexual violence, previous or current depression, habitual abortion or obstetric complications in the index pregnancy (premature rupture of membranes, preterm labor or hemorrhage). The χ² and Fisher exact tests were used for statistical analyses and p<0.05 was considered significant. RESULTS: Most of the participants (64.8%) obtained "regular to excellent" grades on the QS-F and 58.8% classified their quality of life as "good". As to sexual satisfaction, 35.3 and 15.7% declared that they were "satisfied" and "very satisfied" with their sexual life, respectively. The study detected significant associations between "bad to poor" QS-F grades with a "poor" quality of life (p=0.002), and with "regular to good" and "good to excellent" QS-F grades with "satisfaction" or "high" sexual satisfaction" (p<0.001). CONCLUSIONS: Sexual function is associated with quality of life and with sexual satisfaction in healthy women in the second trimester of pregnancy.

OBJETIVO: Comparar a funcao sexual de gravidas adultas saudaveis a de mulheres com Diabetes Mellitus Gestacional (DMG) no terceiro trimestre da gravidez. MÉTODOS: Estudo transversal com dois grupos de gestantes em acompanhamento pre-natal. Foram criterios de inclusao: idade materna .20 anos, idade gestacional .28 semanas, relacionamento heterossexual com o mesmo parceiro ha pelo menos 6 meses e ser alfabetizada. Os criterios de exclusao foram: presenca de intercorrencias clinicas e/ou obstetricas que contraindicassem atividade sexual; hipertensao arterial controlada por medicamentos; gravidez resultante de estupro; parceiro sexualmente indisponivel ou ausente no ultimo mes; internacao hospitalar no ultimo mes; uso de cremes vaginais nos ultimos 30 dias; gestacao gemelar; uso regular de alcool e/ou drogas ilicitas; uso de medicamentos que interferissem na funcao sexual. Oitenta e sete pacientes preencheram os criterios de selecao e participaram do estudo. Para avaliacao da funcao sexual destes grupos utilizou-se o questionario Quociente Sexual . Versao Feminina (QS-F). Testes X² e t de Student foram utilizados para comparar diferencas entre os grupos, com valores p<0,05 considerados estatisticamente significantes. A analise estatistica foi realizada com o software Instat 3. RESULTADOS: A idade gestacional media nos dois grupos era de 34 semanas. Nao foram detectadas diferencas significantes nos escores medios totais do QS-F nos dois grupos (62,5 saudaveis vs 62,8 DMG, p=0,9). Aproximadamente metade das participantes (47 e 47,5% das saudaveis e DMG, respectivamente, p=0,9) teve escores totais de ate 60 na escala do QS-F, o que indica comprometimento em algum dos dominios avaliados (desejo e satisfacao sexual, excitacao, orgasmo, dispareunia e vaginismo). CONCLUSÕES: A prevalencia de comprometimento do desempenho sexual foi alta em gestantes no terceiro trimestre, nao diferindo significativamente entre mulheres saudaveis e aquelas com DMG.

To compare the sexual function of healthy adult pregnant women with that of gestational diabetes patients (GDM) in the third trimester. METHODS: This cross-sectional study enrolled two groups of women managed antenatal care clinics. Inclusion criteria were: maternal age .20 years, gestational age at least 28 weeks, being in a heterosexual relationship with the same partner for at least 6 months, and being able to read. We excluded women with a medical recommendation for sexual abstinence due to clinical or obstetric disorders; hypertension controlled through medications; pregnancy resulting from rape; absent or sexually unavailable partner in the last month; hospital admission in the last month; use of vaginal creams in the last 30 days; multiple pregnancy, regular use of alcohol or illicit drugs or use of medications that can interfere with sexual function. Eighty-seven patients fulfilled the selection criteria and were included in the study. The Sexual Quotient . Feminine Version (QS-F) questionnaire was used to assess sexual function. Student's t and X² tests were used to compare differences between groups and p<0.05 was considered significant. RESULTS: The mean gestational age of the participants was 34 weeks. There were no significant differences in the mean QS-F scores between groups (62.5 healthy vs 62.8 GDM women, p=0.9). Approximately half the participants (47 and 47.5% of the healthy and GDM women, respectively, p=0.9) had total scores up to 60, indicative of dysfunction in one of the assessed domains (desire, sexual satisfaction, arousal, orgasm, dyspareunia and vaginismus). CONCLUSIONS: The prevalence of sexual dysfunction was high among women in the third trimester of pregnancy and did not differ significantly between healthy women and women with GDM.