Background: The beginning of 2020 was characterized by the COVID-19 pandemic. The world governments have adopted restrictive measures to reduce the spread of infection. These measures could affect the sexual function and quality of life of women living with their partner. Aim: The aim is to assess the impact of the social distancing measures caused by the COVID-19 pandemic on sexual function and quality of life of noninfected reproductive-age women, living with their sexual partner. Methods: Observational analysis on sexually active women, living with their partner, and without COVID-19 infection was performed. The population previously answered FSFI, FSDS, and SF-36 questionnaires. 4 weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for an evaluation during the COVID-19 outbreak. Main Outcome Measures: The primary endpoint was the assessment of the women's sex function change during the social restriction period, by analyzing the FSFI and FSDS questionnaires. The secondary endpoint was the evaluation of the impact on the quality of life calculated by the SF-36 questionnaire. Results: 89 patients were considered. The median age was 39 (28e50) years. Mean sexual intercourses/month decreased from 6.3 ± 1.9 to 2.3 ± 1.8, mean difference: À3.9 ± 1.2. FSFI decreased significantly (29.2 ± 4.2 vs 19.2 ± 3.3, mean difference: À9.7 ± 2.6) and FSDS increased significantly (9.3 ± 5.5 vs 20.1 ± 5.2, mean difference: 10.8 ± 3.4). The SF-36 showed a significant change from 82.2 ± 10.2 to 64.2 ± 11.8 4 weeks after the introduction of the restrictive measures; mean difference: À17.8 ± 6.7. The univariable analysis identified working outside the home, university educational level, and parity !1 as predictive factors of lower FSFI. In multivariable analysis, working outside the home and combination of working outside the home þ university educational level þ parity !1 were the independent factors of a lower FSFI. Clinical Implication: The negative impact of the COVID-19 epidemic period on sexual function and quality of life in women shows how acute stress might affect the psychological state. Thus, psychological or sexual support could be useful. Strengths and Limitations: To our knowledge, this study is the first that analyzes the change in sexual activity in women during the COVID-19 outbreak period. The limitations were the low number of the analyzed participants, psychological tests were not included, and no data were collected on masturbation, self-heroism, solitary, and nonpenetrative sex. Conclusion:The COVID-19 epidemic and the restrictive social distancing measures have negatively influenced the sexual function and quality of life in not-infected reproductive-age women who live with their sexual partners.

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The hormonal activity of the pineal gland is influenced by both the dark-light cycle and the seasonal cycle, causing it to play an important role in the neuroendocrine control of reproductive physiology. This is especially evident in seasonally breeding animals, in which reproductive function is clearly influenced by seasonal variations in the duration of night and day. Humans are not seasonal breeders. Nevertheless, seasonal fluctuations have been described in human reproduction, and the pineal gland also appears to exert an important role in the neuroendocrine regulation of human reproductive physiology. There is evidence that the epiphysis is involved in the control of sexual maturation. In rats, the maternal pineal appears to influence the gonadal and genital development and function of offspring; this hypothesis has yet to be confirmed in humans. The pineal apparently influences human reproductive function not only at the hypothalamic-pituitary level, by inhibition of the hypothalamic pulsatile secretion of gonadotrophin-releasing hormone, but also at the gonadal level, where melatonin receptors have also been found. In addition, melatonin is reported to increase serum prolactin concentrations in both rats and humans. It has been suggested that melatonin is involved in the control of menstrual cyclicity.

A literature review of 22 cases of pregnancy following cardiac transplantation up to 1995 and a case report are presented here. A 30 year old woman, gravida 3, para 1, contacted us for obstetric care at 8 weeks gestation, about 55 months after orthotopic cardiac transplantation. The transplant had been performed for a familial dilative cardiomyopathy, which had become manifest during her previous pregnancy. The course of the current gestation was uneventful. The patient's cardiovascular function was good throughout the pregnancy. Immunosuppressive therapy, the dose of which was increased during pregnancy, included cyclosporine and azathioprine. Because of an increase in the patient's plasma uric acid concentration and an initial rise in her blood pressure, despite therapy, a repeat Caesarean section was performed at 37 weeks gestation. A female baby weighing 2330 g, Apgar scores 7/9, was delivered. Mother and infant were discharged on postoperative day 15 and are doing well 14 months postpartum. Through a review of literature and our case, the issues and problems related to pregnancy after a heart transplant are discussed, in particular the maternal-fetal risks, management, therapy, delivery, neonatal problems and follow-up postpartum of mother and baby.

This study provides evidence of the positive impact on maternal anxiety of a multidisciplinary approach in prenatal management of fetal surgical anomalies.