الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) affects 8% to 16% of the individuals globally. Women with CKD on hemodialysis, disruptions in gonadotropin-releasing hormone (GnRH) production result in an
abnormal sex hormone profile, ultimately resulting in low levels of estradiol and commonly leading to gynecological problems which are frequently unrecognized such as, menstrual disorders, sexual
dysfunction, early menopause and infertility among the hemodialysis
women (Jha, Garcia-Garcia & Iseki, 2013).
Fertility rates among women of childbearing age with CKD are
low, pregnancy in women with advanced CKD can result in serious adverse maternal and fetal outcomes (Hladunewich et al., 2014). The majority of hemodialysis women experience sexual dysfunction (SD). It is also contribute to low pregnancy rates among women on hemodialysis. Sexual difficulties are often worsened by the hemodialysis with a lowered frequency of intercourse, reduced sexual desire and an increased incidence of sexual failure (Lessan - Pezeshki, 2012). The purpose of the present study was to assess the gynecological problems that occur among women on hemodialysis. The present study was carried out in the hemodialysis units at four settings in Menoufia governorate: Menoufia University Hospital, Shebin El-Kom Teaching Hospital, Sirs-Elian Hospital and Menouf
Hospital. descriptive cross sectional research design was utilized in this study. A purposive sample (non-probability) from the hemodialysis
patients (females) who fulfilled the inclusion criteria: women Summary 101 undergoing hemodialysis for at least three months and women at average age of 20- 45 years old. The sample size of this study was 64 women in the reproductive age Throughout the course of the present study, data were collected using four instruments which are revised by a jury of qualified experts and then tested for validity and reliability. Instruments were: Instrument I: Interviewing questionnaire included socio- demographic data, past medical history and previous obstetric history Instrument II: Anthropometric measurements, it includes: D- Height (cm) E- Weight (kg) F- Body Mass Index (BMI) = weight (kg) / height (m2). Instrument III: Menstrual cycle questionnaire to assess the regularity of the menstrual cycle before and after the hemodialysis, the menstrual pain before and after the hemodialysis and the obstetric and gynecological diseases that occur after hemodialysis. Instrument IV: Female sexual function index (FSFI): This instrument was adapted from Rosen et al., (2000) to assess the female sexual function. Female Sexual Function Index (FSFI): It is one measure that has been popular worldwide. It was considered to have six sexual domains (sexual desire, arousal, lubrication, orgasm, satisfaction and pain during the sexual intercourse). It is consisted of 19 questions. Modifications were carried out to create short version of the FSFI t be used for rapid assessment and corresponded with the Egyptian culture. The short version consisted of 9 questions cover all the domains of the sexual function which used to assess the level of women’s sexual function. Summary 102 Female Sexual Function Index (FSFI) is a likert scale. The total score of female sexual function index was 27. Instrument V: Fertility questionnaire included occurrence of the conception after the hemodialysis, complications during pregnancy (abortion, hypertension, pre-eclampsia, polyhydramnious), fetalcomplications, referral to the health care provider specialized in
obstetrics and gynecology and using of fertility medications.
An approval from the Committee of Hearing and Ethics was
obtained from Faculty of Nursing, Menoufia University on 14/2/2018.
Approaches ensuring the ethics were considered in the study regarding
confidentiality and informed consent. The researcher introduced
herself to the study participants and explained the purpose of the study
in order to obtain their acceptance to be recruited in the study as well
as to gain their cooperation.
Confidentiality was achieved by the use of closed sheets with
the names of the participants replaced by numbers. All women were
informed that the information they provided during the study would be
kept confidential and used only for statistical purpose and after
finishing the study, the findings would be presented as a group data
with no personal participant’s information remained.
After explanation prior to enrollment in the study, informed
consent was obtained verbally from all women. Each woman was
informed that participation in the study was voluntary, and that she
could withdraw from the study whenever she decided to and each one
was given the opportunity to freely refuse the participation. They were
free to ask any question about the study details.
Upon completion of data collection, each answer was coded and
scored. The researcher coded the data into a coding sheet so that the
data could be prepared for computer use. Data was statistically
Summary
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analyzed using (Statistical Package for the Social Sciences, version
22, SPSS Inc. Chicago, IL, USA.
The findings of the present study were answered the study
question: what are the gynecological problems that occur among
women on hemodialysis?
The findings of the present study showed that:
There was a highly statistical significant difference among the
study participants between before and after the hemodialysis
regarding oligomenorrhea, secondary amenorrhea and
menorrhagia.
There was no a statistically significant difference regarding the
menstrual pain between before and after initiating the
hemodialysis.
There was no significant correlation between the menstrual cycle
disorders and the initiation of hemodialysis among the study
participants.
There was no significant correlation between the menstrual cycle
disorders, age and body mass index.
There was a significant correlation between the sexual function
and the age of the study participants.
There was no significant correlation between the conception after
hemodialysis, number of gravidity, number of parity,
contraceptive use and the initiation of hemodialysis.
There was a highly significant correlation between abortion and
conception after the hemodialysis.
There was a highly statistical significant correlation between the
conception after hemodialysis and the menstrual cycle disorders.