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Female Fertility: A Conceptual and Dimensional Analysis
Journal of Midwifery & Women's Health
Abstract
Introduction:
Female fertility is commonly described as the biological nature of women, yet different meanings emerge when one takes a holistic approach to fertility while considering varying contexts and perspectives. An improved understanding of female fertility will enhance health care professionals' understanding of female fertility and improve communication with women and other health care professionals. This article presents a conceptual and dimensional analysis of female fertility.
Methods:
A search of the literature included the databases CINAHL, PsycINFO, Philosopher's Index, and Web of Science. Concept and dimensional analyses were performed using the Rogers' methodology and the Caron and Bowers' framework to define female fertility and explore the concept. Articles were examined to identify definitions, dimensions, perspectives, antecedents, and consequences of female fertility.
Results:
Biological self, psychosexual self, power, and paradox are the attributes of female fertility. The contexts of menarche, menstruation, menopause, infertility, fertility goals, society and culture, and health care were explored. Perspectives included those of women across many different fertility stages as well as perspectives of various clinicians. Necessary antecedents were sexual decision making and influences of culture and society. Consequences were realized fertility, stress, and an understanding of self. A definition of fertility was proposed: Female fertility is a paradoxical phenomenon of power between the biological and psychosexual self.
Discussion:
Antecedents, attributes, and consequences derived from the fertility literature can be used by health care providers for patient education and therapeutic interventions. This concept analysis may assist in facilitation of a greater understanding of biological and psychosexual self, as they relate to fertility across the lifespan.
... (2) Use of concepts in nursing literature A woman's fertility depends on changes in her life and environment, and it may be something she wants, but it is also used as a negative concept that she does not want and has to 21 . For example, regardless of the stage of mental maturity, with the onset of menstruation, a woman's body is ready for childbirth, but a woman must keep herself from becoming pregnant until menopause outside of family planning 22 . For this reason, "fertility" can be used as an opposing concept depending on the situation, such as women who are not planning to become pregnant should be careful not to become pregnant during intercourse, even though they can become pregnant 21 . ...
The purpose of this study was to clarify and analyze the concept of fertility preservation in young breast cancer patients.As the reproductive age of women increases and the number of young cancer patients increases, there is an uncertainsituation in which young cancer patients diagnosed with breast cancer may lose fertility in the course of cancer treatment.Fertility preservation is a widely used concept It is necessary to clarify the meaning and concept of fertility preservationin young breast cancer patients in order to reduce confusion in the selection of cancer treatment and fertility preservation.For this study the process of Walker & Avant’s analysis was used. Eleven studies from electronic data bases met criteriafor selection. Fertility preservation can be defined by the following attributes 1)basic human desire 2)voluntary choiceaccording to the individual’s point of view 3)change of perception through consultation. The antecedents of fertilitypreservation consisted of: 1)Appropriateness of providing information 2)differences in individual values 3)socioenvironmentalfactors. The consequences occurring as a result of fertility preservation were: 1)improvement distress and2)enhancement of quality of life. Results of this analysis provides a theoretical framework for oncology medical staff tobetter understand fertility preservation in young breast cancer patients, to improve quality of life.
... For example, compared with participants from only-child families, participants from non-only-child families had younger age of birth and tend to have a boy (Rasoulzadeh Aghdam et al., 2020). The female participants from single parent family tended to not have a child (Rodriguez, 2013). Parents' gender preference also influenced the next generation (Tanskanen & Danielsbacka, 2020). ...
... The main question of this article is whether self-perceptions of masculine and feminine traits are strengthened during and after the period in which individuals are expecting a child. Previous research acknowledges that for women, this life event entails a confirmation of fertility and thus of stereotypical femininity (Bailey, 2001;Söderberg et al, 2011;Rodriguez, 2013). Furthermore, both women and men experience a transition into parenthood and new responsibilities, especially first-time parents. ...
How stable is gender identity when facing important gendered life events? In the study of gender identity, little research has focused on adulthood experiences that might modify or reinforce self-perceptions of gender traits. This article uses pregnancy and early parenthood to study stability and change in self-perceived female and male traits. We make use of data from a large-scale citizen panel in Sweden that tracks respondents who eventually become pregnant. The overall conclusion is that self-perceptions of gender traits are mostly stable throughout pregnancy and early parenthood in the comparatively gender-equal context of Sweden.
Key messages
We study the effect of a gendered life event on changes in gender identity during adulthood.
Pregnant women and partners of pregnant women are followed over time, with pre- and post-test measures of gender identity.
While pregnancy and childbirth are often seen as reinforcing feminine identity, we expect only small changes in a gender-equal society like Sweden.
Results show that gender identity is stable during pregnancy and around childbirth for Swedish women and men.
... When investigating this issue, several factors could be pointed out in highlighting women's role and holding them responsible for infertility. Fertility is so meaningful and salient for women (22) and any kind of delay in pregnancy is not acceptable by them (14); considering that for most women, becoming a mother is part of feminine identity and gender role fulfilment. Therefore, by losing this opportunity in life, they suffer from various mental, personal and social distresses (18,23,24). ...
Background
Despite the fact that both men and women are equally subject to infertility, it is usually women who bear the burden of treatment and its consequences, even in cases of male infertility. Therefore, it is more necessary to recognize their health problems in order to help them.
Aim
To explore women’s perceptions and experiences of the challenges they face in the process of male infertility treatment.
Methods
This qualitative study was conducted during 2014–2015 using content analysis. Thirty semi-structured interviews were conducted with women whose husbands suffered from male infertility. Purposive sampling was conducted until data saturation was achieved. All interviews were recorded, transcribed and analyzed using conventional content analysis adopted by Graneheim and Lundman.
Results
From data analysis, the major category of “treatment-related stresses” and four subcategories of “high treatment expenses”, “inefficiency of healthcare system”, “being captive in the infertility treatment” and “treatment failure” emerged.
Conclusion
Experiences of women who face male infertility indicate their various concerns in the process of treatment. Therefore, it is required to develop emotional and financial support for the clients and to promote their quality of healthcare services. In addition, awareness of treatment challenges of these women can assist proper planning to promote the quality of services they need.
... Female fertility has been defined as ''a paradoxical phenomenon of power between the biological and psychosexual self.'' 3 On the other hand, female infertility is defined as the inability of a woman within childbearing age to conceive despite having frequent, unprotected intercourse for at least 1 year. 4 Infertility affects about 10% to 20% of couples trying to achieve pregnancy in many industrialized countries. ...
Female infertility and low birth rate are significant public health issues with profound social, psychological, and economic consequences. Some infertile women resort to conventional, complementary, or alternative therapies to conceive. The aim of this study was to identify the Chinese herbal products (CHPs) most commonly used for female infertility in Taiwan.
The usage of traditional Chinese medicine (TCM) and the frequency of CHP prescriptions to infertile women were determined based on a nationwide 1-million randomly sampled cohort of National Health Insurance Research Database beneficiaries. Descriptive statistics and multiple logistic regression analysis were employed to estimate the adjusted odds ratio (aOR) for TCM usage and potential risk factors.
In total, 8766 women with newly diagnosed infertility were included in this study. Of those, 8430 (96.17%) had sought TCM treatment in addition to visiting the gynecologist. We noted that female infertility patients with risk factors (e.g., endometriosis, uterine fibroids, or irregular menstrual cycle) were more likely to use TCM than those without TCM medication (aOR = 1.83, 1.87, and 1.79, respectively). The most commonly used formula and single CHP were Dang-Gui-Sha-Yao-San (17.25%) and Semen Cuscutae (27.40%), respectively. CHP formula combinations (e.g., Dang-Gui-Sha-Yao-San plus Wen-Jing-Tang 3.10%) or single Chinese herbal combinations (e.g., Semen Cuscutae plus Leonurus japonicus 6.31%) were also commonly used to treat female infertility. Further well-conducted, double-blind, randomized, placebo-controlled studies will be needed to evaluate the efficacy and safety of these CHP combinations for female infertility.
... Altro aspetto di complessità da considerare in PMA riguarda gli aspetti sociali che essa richiama. La gravidanza nella nostra società è infatti legata a grandi aspettative sociali: una larga parte dell'esistenza umana ruota attorno ai temi della riproduzione, della genitorialità e del costruire una famiglia e la capacità di procreare è strettamente connessa all'autostima personale, all'identità, alla sessualità e all'immagine corporea (Meyers et al., 1995;Rodriguez, 2013). Queste tematiche non sono neutre anche per l'operatore sanitario, in quanto lo mettono in gioco come persona oltre che come professionista e che inevitabilmente entrano nella relazione con i pazienti. ...
Il ricorso a tecniche di procreazione medicalmente assistita da parte di coppie infertili sta diventando sempre piu frequente. Le coppie che si rivolgono a un centro per l’infertilita portano con se un carico emotivo e psicologico appesantito da un percorso clinico lungo e faticoso e che non sempre conduce ai risultati sperati. Cosi come in altri ambiti della medicina, anche nell’ambito della procreazione medicalmente assistita e stata messa sempre piu in evidenza la necessita di un approccio di medicina centrato sul paziente che, al contrario di un approccio centrato unicamente sulla malattia, dia importanza al vissuto di malattia che il paziente porta nella visita e che tenga conto dei valori e delle preferenze del paziente rispetto al proprio percorso clinico. Il presente contributo intende approfondire, attraverso la storia clinica di una coppia, i diversi livelli di complessita che caratterizzano l’incontro medico/paziente nelle visite di procreazione medicalmente assistita. Da un lato la complessita relazionale del doversi confrontare con un paziente/ coppia, che porta nella visita diverse "agende"/vissuti di malattia, dall’altro la complessita comunicativa di dover gestire molteplici flussi comunicativi nella visita.
How stable is gender identity when facing important gendered life events? In the study of gender identity, little research has focused on adulthood experiences that might modify or reinforce self-perceptions of gender traits. This article uses pregnancy and early parenthood to study stability and change in self-perceived female and male traits. We make use of data from a large-scale citizen panel in Sweden that tracks respondents who eventually become pregnant. The overall conclusion is that self-perceptions of gender traits are mostly stable throughout pregnancy and early parenthood in the comparatively gender-equal context of Sweden.
Key messages
We study the effect of a gendered life event on changes in gender identity during adulthood.
Pregnant women and partners of pregnant women are followed over time, with pre- and post-test measures of gender identity.
While pregnancy and childbirth are often seen as reinforcing feminine identity, we expect only small changes in a gender-equal society like Sweden.
Results show that gender identity is stable during pregnancy and around childbirth for Swedish women and men. </ul
Female fertility is a complex phenomenon. Biological, personal, social and political factors shape this experience. Race, a social construction, was created to justify discriminative political and economic practices. Therefore, ‘Black’ differentiates the fertility experiences of Black women from other racial/ethnic groups, a group often marginalized in the United States. We explored a contemporary understanding of Black female fertility using Rodgers’ evolutionary method of concept analysis. A total of 36 articles were included in the final analysis extracted from PubMed, CINAHL Complete, PsychINFO, Web of Science and Google Scholar. Data and themes were categorized into groups within attributes, antecedents and consequences from multidisciplinary literature. Attributes were biological instability and sociopolitical influences on Black female fertility. Racial and bioethical injustices were notable antecedents. The consequences of racial and bioethical injustices persist in reproductive health disparities today. This review documents the need for health practices that end institutional racism that contribute to negative experiences for Black women seeking fertility related care. Many interdisciplinary professionals are perfectly positioned to be part of health care solutions to reduce contemporary health disparities.
This research was motivated by the need to develop positive feminist discourses about women who are infertile and who pursue medical interventions to achieve motherhood. This study analysed how 19 women who wanted children but who could not easily have them constructed their desire for children, motherhood and their infertility. Reasons for wanting children included motherhood as ‘natural instinct’, as ‘a stage in the development of a relationship’ and as ‘social expectation’. These were used to construct motherhood as physical, psychological and social completeness and fulfilment for women. Consequently, infertility was experienced as guilt, inadequacy and failure, reinforced by the language used to describe infertility. Women also discussed their desire for children in terms of reproductive decision-making, emphasizing notions of agency, becoming a parent as a stage in a relationship and infertility as a disruption of life plans. Our analysis argues for a broader definition of motherhood and a wider variety of culturally sanctioned roles for women.
Strong cultural messages are sent to women that their bodies are unacceptable as they are, thus encouraging engagement in a variety of body-altering practices. It seems that one of the obligations that women have in a culture that sexually objectifies their bodies is to conceal their bodies' more physical functions, such as menstruation. A new scale was constructed to measure women's attitudes and emotions toward menstruation. A study was conducted to test the relationship between self-objectification and women's menstrual self-evaluations. Results showed that women who internalize a more sexually objectified view of their physical selves have more negative attitudes and emotions, including disgust and shame, toward their own menstrual cycles.
A common definition of sub- and infertility is very important for the appropriate management of infertility. Sub- fertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Inferti- lity may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although—after 12 unsuccessful cycles—untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), ,5% of the couples are definitive infertile with a nearly zero chance of becoming spon- taneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.
We used phenomenological method to describe fertility as it was experienced by young women who have chosen to take contraceptive pills. The women lacked experience from pregnancy and parenthood. We interviewed ten women aged 23-27 years. We found that fertility was experienced as paradoxical, as follows: fertility as a power that has to be suppressed, experiencing fertility in the present time and as a future finite possibility, and having one's own fertile responsibility governed by society. Striving for a perfect life was a central aspect of fertility. Expectations on female fertility seem to influence young women's planning in life.
Women living in rural and urban areas of Mexico answered a questionnaire about what they were told at home about menstruation before their menarche (first menstruation), and answered the Beliefs About and Attitudes Toward Menstruation Questionnaire. Around half of both urban and rural women were told that they were going to experience negative perimenstrual changes. There were fewer urban than rural women who were advised to do or not to do certain activities while menstruating. Menstrual socialization affected the beliefs and attitudes concerning menstruation held by women as adults. These findings are discussed in light of the sociocultural background of the participants.
The increasing number of young survivors of cancer who have favorable outcomes necessitates planning for the preservation of fertility, which may mean modifying the strategy for oncologic treatment. In addition to in vitro fertilization in women and sperm banking in men, new methods on the horizon include in vitro follicle maturation and techniques for tissue transplantation.
Ectopic pregnancy is a potentially life-threatening event that represents the loss of a pregnancy and also may have longer-term consequences for fertility. Despite this triple threat to a woman's well-being, almost no systematic research exists on the psychological impact of ectopic pregnancy. We sought to reinterview 18 women who had been interviewed 2 months following an ectopic pregnancy as part of a longitudinal study of pregnancy loss 16 years previously. Thirteen of these women responded to questions about the long-term impact of the ectopic pregnancy on their lives in the intervening years. For many of the women, the ectopic pregnancy was a traumatic experience that impaired their fertility, strained their marriages, and led to a crisis of faith. Yet, despite the trauma of the event, overall the women found ways to interpret it positively and to use it as a source of meaning in their lives.
A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although--after 12 unsuccessful cycles--untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), approximately 5% of the couples are definitive infertile with a nearly zero chance of becoming spontaneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.
Attitudes and sociocultural perceptions provide the context within which women experience menopause. Cultural influences greatly affect how women perceive and manage their menopausal symptoms. Cultures may be categorized based on way of life, including traditional, immigrant, and modern. Varying perceptions and symptom experiences are described, including modifiable and nonmodifiable factors that affect the level of distress women feel with menopause. Helping women actively participate in management of menopausal symptoms including self-care strategies will contribute to feelings of control of menopausal symptoms and overall health. By using the highest levels of evidence regarding management of menopause, becoming familiar with the cultural and psychosocial influences of menopause and then empowering women to make decisions regarding management, health care providers can improve their care of perimenopausal and menopausal women.
The purpose of this study was to measure and compare women's attitudes toward menstruation and breastfeeding and to determine whether self-objectification was associated with negative attitudes toward these events. We hypothesized that women who viewed menstruation as shameful would also report high levels of shame about breastfeeding and that women with greater self-objectification tendencies would have more negative or shameful attitudes toward both menstruation and breastfeeding. One hundred and seventy-six undergraduate women completed questionnaires measuring self-objectification, as well as attitudes toward menstruation and breastfeeding. As predicted, women who viewed menstruation as shameful also reported shameful attitudes toward breastfeeding. Women who reported higher levels of Body Shame and Self-Surveillance had significantly more shameful attitudes toward these reproductive functions than women with lower scores on these measures of self-objectification. Health care providers may be able to reduce women's feelings of shame about reproduction or minimize its negative impact on women's health behavior.
To examine trends in fertility preservation attitudes and behaviors of pediatric oncology nurses and evaluate their awareness of fertility preservation guidelines published in June 2006 by the American Society of Clinical Oncology (ASCO).
Cross-sectional surveys conducted in 2005 and 2006.
Annual meetings of the Florida Association of Pediatric Tumor Programs.
115 pediatric oncology nurses in 2005 and 95 nurses in 2006.Methods: A 45-item survey was distributed to conference attendees.
Knowledge, current fertility preservation practices, and awareness of fertility preservation guidelines.
Nurses' attitudes about fertility preservation discussions with patients did not change during the survey period; however, the number of nurses believing that one of their duties was to discuss fertility preservation with patients decreased from 91% in 2005 to 81% in 2006. Nurses' likelihood to discuss fertility preservation with patients with specific characteristics significantly changed over time. Fertility preservation discussions were just as likely for single patients as they were for those married or recently engaged, although nurses were more likely to discuss fertility preservation with patients who had at least one child or who had a poor prognosis. Nurses' awareness of ASCO guidelines was less than 5%.
A majority of nurses perceive that fertility preservation options should be offered to patients. However, practice and patient family barriers exist that may impede discussion. Attitudes and behaviors will be monitored with the 2006 ASCO guidelines.
Nurses play a key role in survivorship discussions for pediatric patients with cancer and their families. Increased knowledge of fertility preservation guidelines may help promote the fertility preservation concept and lead to improved dissemination and implementation of training programs that focus on current ASCO fertility preservation guidelines and address the psychosocial needs of children aged 12-16 years.
This overview details the persistence of negative characterizations of the menstrual cycle as a feature of the current cultural context in which girls begin menstrual life in the United States. In addition, research on girls' current menstrual attitudes and experiences within this context are reviewed. Current research suggests that girls are not very knowledgeable about menstruation, and that menstrual education continues to provide girls with mixed messages, such as: menstruation is a normal, natural event, but it should be hidden. Girls' attitudes and expectations about menstruation are negatively biased and have been found to contribute to self-objectification, body shame, and lack of agency in sexual decision-making. Although preparation has been found to be associated with more positive menarcheal and menstrual experiences, specificity about what constitutes "good" preparation has not been well articulated. Implications for promoting the menstrual cycle among young girls as a vital sign in service of monitoring their health are discussed.
Objective: This study took a feminist psychology perspective, postulating that attitudes to breastfeeding can be understood in terms of broader attitudes towards the female body. It was a first test of the hypothesis that breastfeeding attitudes and behaviour would be related to attitudes to menstruation. Study design: Correlational questionnaire study with a British general population sample of 457 respondents (75% response rate) aged from 16 to 68 (mean = 30). Questionnaires included the Menstrual Attitudes Questionnaire, positive attitudes to breast and to bottlefeeding, and reactions to breastfeeding scenarios, along with questions on demographics and past breastfeeding behaviour. Results: The results showed weak but significant relationships between some menstrual attitudes and attitudes to breastfeeding, and with past breastfeeding behaviour. Conclusions: Feminist theory about the negative construction of the female body suggests that broader social attitudes may undermine women's belief in their ability to nourish their infant from their own body, and these results are consistent with this hypothesis. Such attitudes may need to be addressed if breastfeeding is to become more prevalent.
A review of the literature on girls' and women's experiences of menarche and menstruation revealed many negative representations, both in traditional and feminist research and theorizing, though a few studies have highlighted positive aspects. Qualitative research has begun to show how experience is constructed and, to develop this further, the aim of this article is to examine how girls construct meaning around menarche and menstruation in social interactions and specific contexts. Analysis is informed by a reflexive feminist constructionist approach. Data from nine girls, aged between 12 and 15, who participated in two focus group discussions are analysed alongside existing literature. It is theorized that developing and changing, context specific, socio‐cultural representations and practices construct meanings in relation to menstruation. In common with other feminist literature, menarche and menstruation were largely constructed as embarrassing, shameful and something to be hidden, specifically within the school context. Menstruation was also constructed as illness. The production and perpetuation of gender‐related difference narratives was also evident. Implications for individuals, as well as for the subjugation of girls and women, are discussed, and it is argued that current negative representations of, and practices in relation to, menarche and menstruation need to be challenged.
Beginning in their late twenties, women face the unique adaptive problem of declining fertility eventually terminating at menopause. We hypothesize women have evolved a reproduction expediting psychological adaptation designed to capitalize on their remaining fertility. The present study tested predictions based on this hypothesis—these women will experience increased sexual motivations and sexual behaviors compared to women not facing a similar fertility decline. Results from college and community samples (N = 827) indicated women with declining fertility think more about sex, have more frequent and intense sexual fantasies, are more willing to engage in sexual intercourse, and report actually engaging in sexual intercourse more frequently than women of other age groups. These findings suggest women’s “biological clock” may function to shift psychological motivations and actual behaviors to facilitate utilizing remaining fertility.
HALLIDAY LE and BOUGHTON MA. Nursing Inquiry 2011; 18: 135–142 Exploring the concept of uncertain fertility, reproduction and motherhood after cancer in young adult women
The topics of uncertainty in illness and infertility – as separate entities – are well covered and critiqued in the literature. Conversely, no research has been identified that specifically relates to the uncertain fertility, reproduction and motherhood challenges faced by young women after cancer. Therefore, there has been no opportunity to extend understanding, adequately acknowledge or effectively manage the needs of young women who may face unique reproductive uncertainties after cancer. The objective of this article is to provide a descriptive review of the literature and present what is currently known about uncertainty in the context of cancer and in relation to fertility, reproduction and motherhood. This article sets out the need for an increased research focus into this aspect of cancer survivorship to minimise the unique psychosocial challenges these women often face. Raising awareness and acknowledging the significance and impact of uncertain reproductive capacity on younger women’s psychosocial health will aid cancer co-ordinators, nurses and other health professionals to formulate and deliver timely and appropriate education, management and support.
Social norms surrounding sexuality, pregnancy, and childbearing may help guide women's health-related behaviors. In this study, we explore low-income women's perceptions of fertility-related norms by allowing women to describe their experiences with normative expectations. Semistructured interviews (n = 30) suggested that women in low-income subject positions articulate descriptive norms that generally correspond with mainstream descriptive norms, identify two major sources of injunctive norms concerning fertility and sexuality- authoritative and peer-oriented-and often align their behaviors according to subgroup expectations communicated in the form of peer-oriented injunctive norms. We discuss these results in light of the extant literature on social norms.
This article is a report of a systematic review and meta-ethnography of women's experience of menarche.
Adolescents may experience menarche at different ages, but menarche remains an important milestone in the female maturation process, representing the transition from childhood to womanhood.
Systematic review and meta-ethnography.
Electronic databases were systematically searched and supplemented with reference lists searching. Qualitative studies of women's experience of menarche were purposely selected and questions proposed by the critical appraisal skills programme was adapted and used to assess papers prior to synthesis. Key themes and concepts were extracted and synthesised using meta-ethnography.
Fourteen studies on menarche experience were identified. The majority of studies were descriptive. Five key concepts were identified from all 14 papers as being descriptive of women's experience of menarche. These included: menarche preparation, significant others' response to menarche, physical experience of menarche, psychological experience of menarche and social-cultural perspective of menarche.
Menarche experience had a major impact on women. Women went through physical, psychological and social-culture changes when their first menstrual flow came. Menarche preparation has been shown to have a beneficial impact on the menarcheal woman. School nurses have accurate knowledge about sexual health; they can and should provide appropriate menstrual education.
The findings can be used by school nurses working with adolescents as the basis for a framework of intervention strategies directed towards helping adolescents to better accept their menarche and transition into womanhood.
The high level of unintended fertility in the United States is a serious public health issue. Whether unintended fertility occurs across the population or is concentrated among a subset of women who experience multiple unintended births is unclear.
Data from the 2002 National Survey of Family Growth were used to determine levels of unintended, unwanted and seriously mistimed childbearing, and chi-square and t tests were used to identify group differences in these measures, in two cohorts of women (those born in 1958-1962 and those born in 1965-1969). Both births (by ages 33-37) and mothers were used as units of analysis.
The proportion of births identified as unintended was greater in the 1965-1969 cohort than in the earlier cohort (37% vs. 34%), largely because a higher proportion of births to women in the former cohort were unwanted. In both cohorts, more than a third of women (36-41%) reporting at least one unintended birth had had at least one more, and women reporting unintended or unwanted births had higher overall fertility than others. Levels of repeat unintended fertility were greatest among black women, and the proportion of blacks who reported two or more unwanted births was 94% higher in the 1965-1969 cohort than in the 1958-1962 cohort (19% vs. 10%).
Repeat unintended fertility is common, especially among black women, who may differ from other groups in their contraceptive and fertility decisions as well as in their access to and ability to afford family planning services.
Although numerous factors have been implicated in women's sexual decision-making, less attention has been focused on how their feelings about their bodies and reproductive functions affect these processes. Recent findings link menstrual shame to lower levels of sexual activity and higher levels of sexual risk; however the mechanisms behind these relations remain unexplored. Accordingly, this study investigates the contributions of menstrual shame and global body shame to sexual decision-making among 199 undergraduate women. Using structural equation modeling, we evaluated a mediated model, whereby menstrual shame is indirectly associated with sexual decision-making via body shame. As expected, women who reported feeling more comfort about menstruation also reported more body comfort and, in turn, more sexual assertiveness, more sexual experience, and less sexual risk.
The authors explored the experience of premature menopause by analyzing 1350 posted messages by 98 women, with unique usernames, to an online discussion board over a 90 day period between December 2005 and March 2006. Four particularly problematic aspects emerged that related to the following themes: legitimizing the symptoms, the impact of diagnosis ("losing me"), treatment ("regaining me"), and feeling alone. It appeared that premature menopause, regardless of the cause, was a largely negative experience, compounded by the often lengthy process of confirming a diagnosis based on ambiguous and often vague symptoms, the scarcity of suitable information about the condition, and the subjective lack of perceived support that the women received. Furthermore, a feeling of being different, through the lack of menstruation and fertility choices, often led to relationship problems and generally a loss of well-being. Women with premature menopause would benefit from the development of tailored information and support that addresses these problematic aspects of the condition.
Background:
Although interest in the intendedness or the planning status of a pregnancy goes back many centuries, it is only since 1941 that questions about these issues have been asked systematically in large-scale surveys. More recently, questions about intendedness have become standard features of the National Survey of Family Growth and of the Pregnancy Risk Assessment Monitoring System (PRAMS). Interest in and concern about the large numbers of unintended pregnancies reported in those surveys resulted in an Institute of Medicine report on the subject and the inclusion of a national health objective for increasing the proportion of pregnancies that are intended in Healthy People 2000 and Healthy People 2010.
Needs:
The terms, "intended," "unintended," "mistimed," "wanted," "unwanted," and "planned" are often used without significant attention being paid to their meaning or how they are derived from survey questions. There is a particular need to distinguish between terms that define attitudes and those that define behaviors. In addition, research has revealed that women are often happy despite experiencing an unintended pregnancy and that contraceptive failures do not always result in a report of an unintended pregnancy.
Objectives:
Researchers have begun to ask questions about the meaning of the intendedness concept and its relationship to what women express as their feelings about pregnancies and births. This article, and this entire issue, is an attempt to make the reader aware of the current issues in this area and to suggest additional research that is needed to enable policy makers and program planners to design programs that will better assist couples in meeting their fertility goals.
A qualitative approach was used to examine young women's experiences of menarche and menstruation that were included in personal stories of growing up sexually. The personal experiences were examined by cross-case analysis to learn more about the narrators' attitudes toward menarche and their menstrual-related education. This was a secondary analysis using data collected for a study of common themes in the stories gathered in a 1998 study by Beausang. The data came from 332 stories written by students taking a sexuality course in a Midwestern community college. Of 227 stories written by women, 85 stories included menstrual experiences. Eleven narrators described menarche as a positive experience. In 10 of these stories, the mother was the primary teacher. The two most frequently identified sources of information by narrators were mothers and schoolteachers, with most narrators having a primarily negative view of their menstrual education regardless of the source. Problems with menstrual-related education were described as perceptions of unwillingness by teachers to discuss menstruation, time limits for education, unclear instruction leading to misconceptions, and the presence of peers in group learning situations that lead to embarrassment.
To present the Shifting Perspectives Model of Chronic Illness, which was derived from a metasynthesis of 292 qualitative research studies.
The model was derived from a metasynthesis of qualitative research about the reported experiences of adults with a chronic illness. The 292 primary research studies included a variety of interpretive research methods and were conducted by researchers from numerous countries and disciplines.
Metastudy, a metasynthesis method developed by the author in collaboration with six other researchers consisted of three analytic components (meta-data-analysis, metamethod, and metatheory), followed by a synthesis component in which new knowledge about the phenomenon was generated from the findings.
Many of the assumptions that underlie previous models, such as a single, linear trajectory of living with a chronic disease, were challenged. The Shifting Perspectives Model indicated that living with chronic illness was an ongoing and continually shifting process in which an illness-in-the-foreground or wellness-in-the-foreground perspective has specific functions in the person's world.
The Shifting Perspectives Model helps users provide an explanation of chronically ill persons' variations in their attention to symptoms over time, sometimes in ways that seem ill-advised or even harmful to their health. The model also indicates direction to health professionals about supporting people with chronic illness.
To provide a review of the intimacy issues, (sexuality, fertility, and interpersonal relationships) that have an impact on the lives of cancer survivors.
Published articles, research studies, and textbook chapters.
The experience of living with cancer impacts the survivors interpersonal relationships, sexuality, and fertility. As cancer treatments become more effective in prolonging life, options that preserve sexual function and fertility will be more prevalent.
It is the responsibility of the oncology health care professional to become educated about options that preserve sexual function and fertility and inform patients before treatment decisions are made.
To describe women's experiences of miscarriage after infertility treatments. Published studies in which fertile women were interviewed after miscarriage have found that the women universally look to another pregnancy as the solution to their grief. However, for women undergoing infertility treatments, the possibility of another pregnancy is not a certainty. Despite this, little is known about the unique experience of this group of women. Appropriate interventions based on evidence require research to discover these women's needs.
Phenomenology.
Eight women who had experienced miscarriage after infertility were interviewed. Interviews were audiotaped and transcribed verbatim. Data saturation guided the sample size. Colaizzi's methods for phenomenologic analysis were used. Analyzed data were brought back to the women for fact checking and to ensure trustworthiness and reliability of the data.
Themes included : going back to "square one," an inner struggle between hope and hopelessness for future fertility, running out of time, anger/frustration, lack of understanding by others, guilty feelings, feeling alone/numb with their grief, and gaining strength from adversity.
This study provides a first glimpse of women who miscarry after infertility treatments, and demonstrates that they feel profoundly alone, and grieve intensely. They worry that they caused the miscarriage, and find it difficult to hope that they will ever become pregnant again. Several women described being hospitalized for their miscarriage on postpartum units. This was unbearable for them, and should remind all of us in healthcare that this type of unthinking treatment of women who miscarry after infertility is not acceptable.
The goal of an integrative science of women's health is bringing together childbearing with women's health during the lifespan. Enhancing a woman's ability to conceive and maintain a pregnancy is influenced by decisions made well before the beginning of a pregnancy. Identifying ovulatory disorders makes it possible to intervene early in a young woman's childbearing years. Gynecologic charting typically used in natural family planning provides information to the woman and to the healthcare provider that is useful for diagnosis. If young women have a better understanding of fertility and menstrual cycle function, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health. It may be possible to educate the young woman in health habits that will lead to a healthy pregnancy when she chooses and/or to treat the cause of the ovulatory disorder. This article focuses on polycystic ovary syndrome and hypothalamic dysfunction which can cause menstrual cycle abnormalities in which gynecologic charting is useful in young women.
To evaluate the efficacy of an abstinence-centered sex education program in adolescent pregnancy prevention, the TeenSTAR Program was applied in a high school in Santiago, Chile.
A total of 1259 girls from a Santiago high school were divided into three cohorts depending on the year they started high school: the 1996 cohort of 425 students, which received no intervention; the 1997 cohort, in which 210 students received an intervention and 213 (control group) did not; and the 1998 cohort, in which 328 students received an intervention and 83 (control group) did not. Students were randomly assigned to control and intervention groups in these cohorts, before starting with the program. We conducted a prospective, randomized study using the application of the TeenSTAR sex education program during the first year of high school to the intervention groups in the 1997 and 1998 cohorts. All cohorts were followed up for 4 years; pregnancy rates were recorded and subsequently contrasted in the intervention and control groups. Pregnancy rates were measured and Risk Ratio with 95% confidence interval were calculated for intervention and control groups in each cohort.
Pregnancy rates for the intervention and control groups in the 1997 cohort were 3.3% and 18.9%, respectively (RR: 0.176, CI: 0.076-0.408). Pregnancy rates for the intervention and control groups in the 1998 cohort were 4.4% and 22.6%, respectively (RR 0.195, CI: 0.099-0.384).
The abstinence-centered TeenSTAR sex education intervention was effective in the prevention of unintended adolescent pregnancy.
To identify the variety and extent of difficulties experienced by infertile women.
A cross-sectional survey study.
A regional infertility clinic.
Two hundred forty-two women undergoing evaluation and treatment of fertility problems, mostly at the initial stages of treatment.
List of difficulties administered along with infertility distress and well-being scales.
Infertility distress and well-being measures.
Twenty-two difficulties resulting from infertility and its treatment were identified. Findings show great variability among women in the extent to which they experience these difficulties. Greater experience of difficulties was related to more distress and lower well-being. Some difficulties were lower for mothers of two or more children, yet even mothers of one child experienced difficulties that were mostly at similar levels to those reported by childless women.
It is important to be aware of the great variability among women in their experience of infertility. The list of difficulties identified here, or similar lists identified using this procedure, could assist health care providers and psychosocial counselors in identifying misperceptions of difficulties that result in communication gaps between patients and providers and between patients and spouses.
The aim of this paper is to report a study exploring the discursive construction of contraceptive use within nurse consultations with women in family planning clinics.
This paper takes as its starting point the lack of a contraceptive 'strand' to the literature on the discursive construction of the female body generally, and the female reproductive system specifically, within health care practice. The literature in this field concentrates on pregnancy, menstruation and menopause, and the manner in which contraceptive use is discursively constructed is under-explored. Furthermore, the literature on nurse-women consultations in family planning clinics is also limited, with the current literature concentrating on assessing clinical skills rather than discourse.
Using a grounded theory methodology to explore how nurses educate women about contraception in family planning clinic, 49 consultations were audio-taped in two large family planning clinics in the United Kingdom (UK).
Open coding and subsequent axial coding resulted in the emergence of three elements of contraceptive education. One concerned reproductive anatomy, another reproductive physiology and a third education about contraceptive functioning. These three axial codes were formed into a core category: 'body education/reproductive vulnerability'. Within the consultation, nurses linked the 'vulnerable' reproductive system with the requirement for contraceptive 'protection'. This approach seems linked to ensuring women's future contraceptive use.
The discourse employed by nurses differs from the body discourse aimed at menopause and menstruation. These areas of women's health were constructed as disintegrating, malfunctioning and failing, whereas reproductive vulnerability suggests a fully functioning, active system, in need of restraint. However, this discourse still constructs the female body as fundamentally weak and unstable, requiring contraception to protect it and prevent transgression.
In-depth interviews about the experience of being pregnant and having decided on abortion were conducted with 10 young Swedish women. A phenomenological-hermeneutic study disclosed a complex life world summarised as "I'm happy about my fertility but I choose not to give life now." Four themes were revealed: encountering an unexpected understanding of oneself and one's fertility, desiring to be understood by trusted others, trying out different positions in relation to pregnancy and abortion, and approaching planned adult motherhood. The results indicate that addressing young women's concerns about fertility might be important in reproductive care.
Limited information is available about adolescents' beliefs about fertility in women and its link to sexually transmitted disease (STD) and whether men and women differ in their beliefs. This information may be useful for developing messages intended to motivate youth to seek STD screening while they are asymptomatic. The purpose of this study was to examine gender-based differences in fertility beliefs and knowledge.
Data were derived from the Adolescent Health Study, a population-based telephone survey study in which urban household adolescents from a high STD-prevalence community were queried about their sexual experience, fertility-related knowledge, beliefs related to timing of childbearing, and risk assessment of future fertility problems. Chi2 and regression analyses were used to evaluate group differences.
The majority of adolescents reported that having children was somewhat or very important, but that the 15- to 19-year-old age group was not the optimal time for a woman to have a child. Regression analyses indicated that female adolescents were more likely than male adolescents to identify chlamydia and pelvic inflammatory disease as causes of fertility problems. Seventy-two percent of adolescent girls thought there was some chance they would have future fertility problems and 58% thought they had little or no control over developing fertility problems in the future.
Additional health education is needed if we are to motivate adolescents to participate in asymptomatic STD screening programs. Involving male adolescents may be a more significant challenge given that fewer male adolescents understand the link between female fertility and common STD-related conditions. Given our findings, fertility preservation may be a valuable teaching tool and social marketing agent for STD prevention in adolescents.
Over the past generation, aging and female reproduction have been lodged within the gendered and gendering debates regarding women's involvement in the workforce and demographic shifts toward delayed parenting that culminate in discourses on the “biologicalclock”. Technological solutions to the biologicalclock, specifically in vitro fertilization, have led to clinical attempts to assess “ovarian reserve”, or qualitative and quantitative changes in the ovary that correlate with aging and with successful infertility treatment. Rupturing the longstanding historical connections between menstruation and female reproductive capacity by specifically focusing on the aging of a woman's eggs, the clinical designation of “diminished ovarian reserve” has come to imply that a woman has “old eggs”. This is associated in practitioners’ and patients’ minds with the eclipse of a woman's reproductive potential and with hidden harbingers of menopause.
In an ethnographic interview study of 79 couples in the US who conceived after using donor oocytes, we found that women voiced two different narratives that described their experience and attitudes when confronted with an apparent age-related decline in their fertility. The “eleventh-hour mom” narrative was voiced by women who initially tried to become pregnant with their own eggs and turned to donated oocytes as a second-choice option, whereas the “miracle mom” narrative was expressed by women who were generally older, some of whom had entered infertility treatment hoping to conceive with their own eggs, but some who knew from the outset that it was not going to be possible. Through their narratives women not only embodied and made meaningful “diminished ovarian reserve” in varying ways that connect with cultural, social, structural/organizational, symbolic and physical aspects of aging, they reproduced the socio-biological project of the biologicalclock, but rooted this social project in the metaphor of “old eggs” rather than menopause.
The concept of the ovarian cycle as a continuum considers that all types of ovarian activity encountered during the reproductive life are responses to different environmental conditions in order to ensure the health of the woman. During the normal ovulatory cycle, a series of sequential events have to occur in a highly synchronized manner. Fertility awareness is useful in helping women to identify the different stages of their reproductive life cycle. Fertility awareness is also a valuable tool in helping women to identify gynecological disorders. Persistence of irregularities within the mucus patterns and the menstrual cycle should be of concern to women presenting with these problems. These irregularities may be due to obstetrical, endocrine, gynecological or iatrogenic disorders. Insight into early pregnancy complications, ovulatory dysfunction and pelvic inflammatory disease can be ascertained from abnormalities within the menstrual cycle and mucus pattern. Thus, fertility awareness will also enable the recognition and early treatment of several metabolic, endocrine and infectious diseases.
The contradictions faced by women in the area of fertility management justify an in-depth qualitative study of contraceptive use. The experience of needing emergency contraception (EC) is an opportunity to study decision-making about fertility management. Thirty-two in-depth interviews were conducted with users of EC recruited in Melbourne, Australia. Women were juggling the needs of the sexual body and the fertile body. The sexual body was expected to be available in women's relationships, and the fertile body required protection from pregnancy in the present and preservation for the future. The needs of these two bodies were very often in conflict and women chose to resolve this conflict in subtly different ways; three strategies were identified. Some women chose to make sexual availability and security from pregnancy a priority; others felt forced to sacrifice sexual availability and security from pregnancy; and a final group chose to make the protection of the fertile body for the future a priority. This study provides a starting point for developing a context- based, woman-centered understanding of the experience of fertility management for women in developed countries.
This study aimed to compare and contrast detailed accounts of a community sample of women, with prospectively defined low or high premenstrual symptoms, highlighting differences/similarities.
Semi-structured interviews were conducted with 16 women (9 with 'low' and 7 with 'high' symptom levels) and analysed using template analysis.
'Low symptom' women perceived themselves as generally laid back but demonstrated a need for organization and control in the family environment. They accepted less than perfect relationships, compared themselves favourably to others and perceived themselves as having strong support networks. There was a negative perception of the introduction to menarche but this was coupled with strong maternal support. 'High symptom' women showed patterns of perfectionism, an emphasis on self-sacrifice and unfavourable comparison of self with others. They reported feeling alone, overwhelmed by tasks and experienced relationships as characterized by unresolved tensions. Menarche was viewed as a positive experience but accompanied by low maternal support. Both groups viewed their symptoms as irrational and controllable outside the home, but vented on partner, close family and children. There was acknowledgement of difference from 'normal' ('low') with an emphasis on the all-encompassing nature of symptoms ('high').
Women with high and low menstrual cycle symptoms viewed aspects of themselves and their relationships with others in both similar and different ways. A major issue for high symptom women was that they struggled to tolerate imperfections, both in their own performance or in their relationships with others, potentially emphasizing the role of cognitive appraisals in interventions.
Reproductive health awareness: a wellness, self-care approach. In: The Center for Development and Population Activities
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A randomized control trial of teen star. Paper presented at: Human Fertility: Where Faith and Science Meet
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Paper presented at: Human Fertility: Where Faith and Science Meet.
Washington DC: August 11–12, 2006.
Methods of application of dimensional analysis: a contribution to concept and knowledge in nursing
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BL, Knafl KA, eds. Concept Development in Nursing. Philadelphia:
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Pregnant bodies, fertile minds: gender, race, and the schooling of pregnant teens
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Reproductive health awareness: a wellness, self-care approach
- M Marshall
- Aumack Yee
Marshall M, AuMack Yee, K. Reproductive health awareness: a
wellness, self-care approach. In: The Center for Development
and Population Activities, ed. Chapter 1, 2007; 1-72. Available
at http://www.cedpa.org/uploaded˙files/rhawareness1.pdf. Accessed
January 15, 2012.