الفهرس 
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Abstract
SUMMARY
Human civilization probably is passing through the most critical juncture of this millennium while its existence is being challenged by the emergence of a novel severe acute respiratory syndrome coronavirus (SARS-Cov-2) encroaching newer territories all over the world expeditiously. COVID-19 had a significant impact on worldwide economies, social, cultural and organizational entities, as well as on individuals’ mental and physical health, reaching the level of crisis as defined by the World Health Organization, that is, an insidious process that cannot be defined in time.
Primary impacts of an outbreak are defined as the direct and immediate consequences of the pandemic on human health. Secondary impacts are defined as those caused by the pandemic indirectly, either through the effect of fear on the population or because of the measures taken to contain and control it. It is known that periods of stress and psychological distress can affect women’s menstrual health. Stressors can activate the hypothalamic-pituitary-gonadal (HPG) axis and can alter the neuro-modulatory cascade that drives gonadotropin releasing hormone (GnRH) regulation. This can result in functional hypothalamic amenorrhoea (FHA), chronic anovulation that is not due to an underlying organic cause. Behavioural modification such as cognitive behavioural therapy can reverse this amenorrhoea. FHA also occurs secondary to excessive exercise, dieting and caloric restriction and disordered eating.
Psychological distress is not only associated with missed periods but also worsening of symptoms associated with menstruation and psychosexual health. Dysmenorrhoea has been shown to be associated with high stress levels, emotional instability and depression. Pre-menstrual symptoms (PMS) and menorrhagia are also associated with high psychological distress. Higher perceived stress is also associated with lower libido in women.
It is estimated that more than a third of regularly menstruating women developed irregular cycles during the pandemic, with associated depression, anxiety, and stress.
Because sexual health is a fundamental determinant of people’s well-being, it is thought that sexual contact will be negatively affected by this condition, although it does not end completely during the COVID-19 pandemic. Therefore, social measures taken in response to COVID-19
Aim of the Study:
This study aimed to assess the effect of COVID 19 infection on the menstrual cycle and the sexual health among females in childbearing period;
Patients and Methods:
This was a Cross sectional study which was conducted in the outpatient clinic of the Obstetrics and Gynecology department on 384 female patients over a period of 6 months from Beni Suef University Outpatient Clinic and was started in May 2022.
Our most important results:
• Among the studied cases there were 79 (20.6%) on regular medications and 258 (67.2%) with previous section and according to weight the mean weight was 71.2 (±5.9 SD) with range (58.5-84.5) and according to cesarean section there were 93 (25.2%) with 1 CS, 81 (22%) with 2 CS, 54 (14.6%) with 3 CS, 14 (3.8%) with 4 CS and 1 (0.3%) with 5 CS according to no of vaginal deliveries there were 74 (20.1%) with 1 NVD and 1\7 (4.6%) with 2 NVD.
• The mean age at first menstruation of the studied cases was 13.1 (±1.4 SD) with range (11-15), the mean age at marriage was 22.5 (±1.5 SD) with range (20-25), there were 23 (6%) with mild to moderate period cramps and 22 (5.7%) severe to very severe period cramps and there were 106 (27.6%) with light period, 217 (56.5%) with medium period and 61 (15.9%) with heavy period
• According to parity there were 126 (34.1%) nulliparous, 89 (24.1%) with parity of 1, 61 (16.5%) with parity of 2 and 93 (25.2%) with parity more than 2, according to no of abortion there were 44 (11.9%) with previous 1 abortion and 19 (5.1%) with previous 2 abortion.
• Among the studied women there were (n=66, 18.13%) noticed any menstrual change, (n=50, 13.7%) noticed sexual change and there were (n=202, 55.49%) with weight decreased due to Covid-19 infection.
• The changes in menstrual cycle were change in regularity [(n=19, 5.22%) become irregular], and in menstrual cycle duration period, [(n=22, 6.04%) decreased and (n=24, 6.59%) increased].
• According to FSFI total score cut off (<26) for differentiating women with and without sexual dysfunction, (n=148, 40.7%) of the studied sexually active women in the current study showed sexual dysfunction with a total FSFI score <26 points.
• Only 58 of the sexually active women (15.9%) reported noticed change in their menstrual cycle post COVID-19 infection. This reported change showed significantly higher score in the desire subdomain compared to women with no-change in their menstrual cycle (p-value =0.033). This reported change showed non-statistically significant association with other subdomains and FSFI total score (p-values >0.05).
• Only 50 women (13.7%) reported noticed change in their sexual activity post COVID-19 infection, however this reported change showed non-statistically significant association with FSFI total score and its subdomains (p-values >0.05).
• According to Pearson correlation coefficient analysis, there was a statistically significant mild to moderate linear positive correlation between FSFI total score and its subdomains with duration since COVID-19 infection. As shown in figure (6), there was a statistically significant linear positive correlation between FSFI total score with duration since COVID-19 infection (r=0.506, p<0.001).
In conclusion,the risk of sexual dysfunction in women with COVID-19 history is high in the current analysis. Specifically, sexual dysfunction in terms of arousal, orgasm, and satisfaction is significantly worse in women with COVID-19 history. Menstrual status changes may be related to extreme immune response and inflammation, or psychological stress and anxiety due to the COVID-19 disease. These menstrual status changes are also not permanent and resolve within a few months following COVID-19 illness.