Introduction
Menopause is a fundamental change in a woman’s life with various essential aspects. Besides, attitudes toward it affect the management of this period [1]. Despite the similarity of biological events in menopause, attitudes toward menopause vary between different cultures and societies [2]. Such differences, in addition to menopause, affect sexual function during this period [3]. Menopause could be influential in causing, aggravating, or eliminating sexual complications. According to reports, 35% of postmenopausal women suffer from decreased sexual desire [4]. Iran is a multicultural country where certain sociocultural factors affect sexual function [5]; however, studies in this field are scarce [6]. Therefore, the current study aimed to investigate the relationship between sexual function and attitude toward menopause in postmenopausal women.

Methods & Materials
The present descriptive study was conducted on 200 postmenopausal women referring to health centers in Torbat-e Heydarieh City, Iran, in 2016. By cluster and convenience sampling methods, healthcare centers and menopausal women were selected, respectively. The study inclusion criteria included Iranian citizenship and having sexual relationships with a spouse. Moreover, the study exclusion criteria were abnormal and premature menopause, diabetes, cardiovascular disease, cancer, as well as malformations or injuries of the genital area. We conducted the present research after receiving the approval of the Ethics Committee and obtaining written consent forms from the study samples. 
Research tools included demographic data form, the Menopause Attitude Scale (MAS), and Female Sexual Function Index (FSFI). The MAS includes 20 items and 5 different dimensions; reasoning, goals, achieving aspirations and goals, self-concept, and appropriateness. This questionnaire is answered by a two-answer scale, including yes and no; a score of 0 is dedicated to disagreeing and 1 for agreeing. Its average obtainable score equals 12.4. The FSFI consists of 19 questions that measure 6 dimensions of sexual function (desire, arousal, lubrication, orgasm, satisfaction, & pain during intercourse) in the past 4 weeks. The appropriate cut-off point for sexual function detection was considered as 26.55. The validity of the MAS and sexual function questionnaire was evaluated implementing a content validity approach. The reliability of the sexual function and MAS was determined by the internal consistency method and calculating Cronbach’s alpha coefficient (r=0.82 & r=0.78, respectively). After sampling, the obtained data were analyzed using SPSS and statistical tests. P<0.05 was considered significant.

Results
A total of 200 postmenopausal women aged 85-45 years were investigated in this study. The Mean±SD age of the explored women was 7.93±57.18 years. The highest age distribution fell in the range of 51 to 55 years (53.7%). The Mean±SD duration of menopause was 7.00±7.00 years in the study participants. Furthermore, 176 (89%) females were housewives and 167 (83.5%) were educated below high-school diploma. The income of 145 (72.5%) study samples were reported to be sufficient. The FSFI scores revealed that the mean total score of sexual function was equal to 22.53±5.91 (Range: 14.40-35.60). Table 1 presents 6 areas of sexual function in percentage. 



The present research results indicated that the lowest obtained score belonged to the area of sexual desire (2.96±1.11) and the highest score was related to the area of sexual satisfaction (4.40±1.05). The scores of the other domains were as follows: sexual arousal (3.25±1.35), lubrication (4.03±1.29), orgasm (3.85±1.26), and pain (4.02±1.36). In total, 27.5% of all studied postmenopausal women presented desirable sexual performance and 35.5% of them had a positive attitude toward menopause.
The Chi-squared test data revealed that the postmenopausal women (45.5%) who had an undesirable sexual function, also reported a negative attitude towards menopause; only 8.5% of these women had both desirable sexual performance and a positive attitude towards their menopause. However, the Chi-squared test results suggested no significant relationship between sexual function and attitude toward menopause (Table 1). In other words, the sexual function did not affect attitude toward menopause (P=0.07).

Discussion
The present study demonstrated no relationship between sexual function and attitude toward menopause in the study participants. The sexual function of postmenopausal women did not affect their attitudes toward menopause. In total, 64% of the explored women presented a negative attitude toward menopause. Menopause is among the most critical stages of a woman’s life and is associated with numerous symptoms and complications, including sexual dysfunction; thus, having sufficient and positive awareness and attitude about this phenomenon is a logical manner to cope with it [7].
Accordingly, optimal planning is required to modify women’s attitudes and improve their health status and quality of life. A limitation of this study was the restricted range of samples in terms of demographic characteristics, and generalizability of the obtained results. It is suggested that future research provides training on menopause and sexual function.

Ethical Considerations
Compliance with ethical guidelines
We conducted the present research after receiving the approval of the Ethics Committee|: IR.THUMS.REC1397.29 and obtaining written consent forms from the study samples.

Funding
The present study is the result of a research project with the code IR.THUMS.REC.1395.5 of Torbat Heydariyeh University of Medical Sciences, which was supported with the financial support of the Vice Chancellor for Research.

Authors' contributions
Conceptualization, methology, software, validation, supervision, project administration: Minoo Safaei; Formal analysis, resources, data curation, writing-original draft preparation, writing review & editing, visualization: Somayeh Alirezaei; Investigation: Samira Rajabzadeh; Funding acquisition: All authors.

Conflicts of interest
Authors declare no actual or potential conflict of interest related to this study.

Acknowledgements
We thank of the Torbat Haydariyeh University of Medical Sciences to provide the resources needed for this report.