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Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study)
Deirdre O'Malley1,
Agnes Higgins2,
Cecily Begley2,3,
Deirdre Daly2 &
Valerie Smith ORCID: orcid.org/0000-0003-2249-60382
Many women are not prepared for changes to their sexual health after childbirth. The aim of this paper is to report on the prevalence of and the potential risk factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding) for sexual health issues (dyspareunia, lack of vaginal lubrication and a loss of interest in sexual activity) at 6 and 12 months postpartum.
A longitudinal cohort study of 832 first-time mothers who were recruited in early pregnancy and returned postnatal surveys at 3, 6, 9 and 12 months postpartum were assessed for sexual health issues and associated risk factors.
Nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth. On univariate analysis, vacuum-assisted birth, 2nd degree perineal tears, 3rd degree perineal tears and episiotomy were all associated with dyspareunia 6 months postpartum, but, of these only 3rd degree tears, in association with breastfeeding and pre-existing dyspareunia, remained significant on multivariable analysis. Breastfeeding, in combination, with other significant factors, was associated with dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum, and, dissatisfaction with body image emerged as a significant factor associated with lack of interest in sexual activity at 12 months postpartum. Pre-pregnancy dyspareunia and breastfeeding emerged as common factors associated with all three outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 months postpartum.
Breastfeeding and pre-existing dyspareunia are associated with sexual health issues at 6 months postpartum. Pre-existing dyspareunia is associated with a lack of vaginal lubrication at 12 months postpartum and breastfeeding is associated with dissatisfaction with body image. Preparing women and their partners during the antenatal period and advising on simple measures, such as use of lubrication to avoid or minimise sexual health issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Introducing the topic of pre-existing sexual health issues antenatally may facilitate appropriate support, treatment or counselling for women.
Discourse on women's sexual health after birth is gaining momentum across diverse disciplines, for example, midwifery, obstetric, sexology and psychology disciplines [1,2,3,4,5]. This increased interest and body of research in perinatal sexual health, however, is not evidenced in sexual health policy [6, 7] or maternity care policy [8, 9], although data demonstrating that women are not prepared for changes to their sexual health after birth [10], are available. Lack of knowledge and preparation for sexual health issues postpartum can be distressing for women, and their partner, while also negatively impacting on their ability to adapt to their new role as mothers [10,11,12]. Postpartum sexual health is challenging to theoretically define but cannot be separated from sexuality and sexual function, and is thought to be influenced by labour and birth events [13]. Attributes of good postpartum sexual health include; sexual desire, resumption of sexual intercourse after birth, pain free sex and orgasm. Several studies to date have focused on factors such as timing of resumption of sexual intercourse [4, 14] and frequency of sexual intercourse [15, 16] and are often limited to the first 3 to 6 months postpartum [17,18,19,20]. Others, in measuring women's postpartum sexual health tend to do so with instruments not validated for use in a postpartum population; for example, the Female Sexual Function Index [21,22,23], the Arizona Sexual Experience Scale [24] and the Golombok Rust Inventory of Sexual Satisfaction [25]. Furthermore, health professionals themselves have identified a lack of expertise on advising women about potential changes to sexual health after birth [26]. Studying women's sexual health for a lengthy period of time postpartum, for example, up to 1 year postpartum, from the perspectives of women themselves (i.e. self-report) is paramount so as to gain a deeper understanding of potential sexual health issues affecting women, insight into any issues that may persist or worsen over time and an understanding of factors that are associated with emergent issues. Gaining an understanding of issues can assist healthcare professionals plan healthcare practices or interventions to address these, and, in doing so, positively impact the sexual health of women who give birth.
The Maternal health And Maternal Morbidity in Ireland (MAMMI) study, launched in February 2012 (www.mammi.ie) is a longitudinal cohort study investigating the existence, extent and prevalence of an array of morbidities (mental health issues, sexual health issues, urinary incontinence, faecal incontinence, pelvic girdle pain, etc.) in nulliparous women antenatally and up to 1 year postpartum across three maternity units in Ireland. The survey was launched in the three maternity units on a rolling basis; February 2012 (site 1), September 2013 (site 2) and August 2015 (site 3). Data were collected via self-reported questionnaires in early pregnancy and at 3, 6, 9 and 12 months postpartum, and from hospital records, so that changes over time might be evaluated. Women received the study information, consent form and Survey 1 on their first visit (the booking visit) to the hospital. Those who completed and returned Survey 1 and the consent form were sent Surveys 2 to 5 by post with a stamped addressed envelope provided for return, at 3, 6, 9 and 12 months postpartum, respectively, unless they indicated, during this time, that they wished to withdraw from the study. At time of analysis, a total of 2764 women joined the study, representing 38% of all those who were invited to take part (n = 7348) and future plans involve following this cohort of women up to 5 years postpartum.
In this paper we report on the prevalence of sexual health issues (i.e., dyspareunia, lack of vaginal lubrication, a loss of interest in sexual activity) and the potential factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma, and breastfeeding) that might be associated with these at 6 and 12 months postpartum in a cohort of 832 women from one study site (site 1) who completed all 5 MAMMI study surveys between February 2012 and July 2015. Limiting to this site was necessary as data collection and entry in sites 2 and 3 was ongoing at the time of the analysis and complete data were only available from site 1.
A longitudinal prospective cohort study was conducted, evaluating sexual health issues self-reported by women, at 6 and 12 months postpartum, recruited to the MAMMI study from one large urban maternity hospital in Ireland. Surveys, providing the study data, were returned between February 2012 and July 2015 (see http://mammi.ie/surveys.php for downloadable copies of the MAMMI surveys).
Women were eligible to take part if they were nulliparous (no previous live birth or pregnancy ending in stillbirth), aged 18 years or over and had sufficient English to complete the surveys. No additional exclusion criteria were applied. Midwives and midwifery students offered eligible women the study invitation pack at women's first antenatal appointment, which takes place usually between 12 and 16 weeks gestation, and all women who accepted the study information were telephoned within 1–2 weeks of their booking visit. The purpose of this call was to offer women additional information on the study, answer questions, and determine their interest in taking part. Women were regarded as recruited to the study when they returned the completed consent form and Survey 1.
Ethical approval for the study was granted by the Faculty of Health Sciences Research Ethics Committee, Trinity College Dublin and the Research Ethics Committee of the participating hospital study site.
Data collection and outcomes measures
The MAMMI study surveys are A4 booklets of approximately 60 pages in length, taking 40–50 min to complete. All surveys sought information on sexual health issues, within a discrete survey section, and women's demographics (e.g. age, relationship status, employment status, highest level of education) were additionally collected in Survey 1. The surveys were developed from surveys used in a similar cohort study, the Maternal Health Study, in Melbourne, Australia [27], and were subsequently assessed for face validity (with 15 women), content validity (with 18 experts), tested for reliability using the test-retest method (with 11 women) (Cohen's Kappa co-efficient 0.87 to 1.0), piloted (with a sample of 33 women) and modified accordingly for use in an Irish maternity population with permission from The Maternal Health study team. Specific information that related to sexual health morbidity centred on issues such as the occurrence of a lack of vaginal lubrication, dyspareunia (pain during sexual intercourse), difficulty in reaching orgasm, inability to reach orgasm, vaginal tightness, vaginal looseness and a loss of interest in sexual activity. In Survey 1 women were asked to report on these symptoms, if any, in the previous 12 months and since becoming pregnant. In the four postpartum surveys women were again asked to self-report on any of these issues for the 3 months preceding their 3, 6, 9 and 12 months postpartum time-frames.
Data on mode of birth, perineal trauma and birth events were collected from the hospital records using a detailed pre-designed data extraction form and in the first postpartum (3 month) survey. Mode of birth was classified into 5 categories; spontaneous vaginal birth, vacuum birth, forceps birth (including failed vacuum birth), emergency caesarean section (CS) (included failed forceps birth) and elective CS (includes elective CS in labour). Grades of perineal trauma were classified into 6 categories; intact perineum (includes women who had a CS), 1st degree tear (includes women who had both sutured and unsutured 1st degree tears), 2nd degree tears, episiotomy (includes women who had an extended episiotomy), 3rd degree tears and labial and vaginal wall lacerations. Breastfeeding at each time point was ascertained through one question 'Are you still breastfeeding your baby or giving expressed breastmilk'? Women were also asked to rate their satisfaction with their body image at each time point, indicating if they were 'always satisfied', 'sometimes satisfied' or 'never satisfied' with their body image.
Data were analysed using IBM SPSS (version 23). Frequencies and descriptive statistics were used to present prevalence rates of sexual health issues in the year before this pregnancy, in early pregnancy and at 6 and 12 months postpartum. To determine if there was any statistically significant change over time in sexual health issues, McNemar's Chi-squared test for differences in correlated proportions was calculated [28].
Univariate and multivariable logistic regression analyses, using Odds Ratio (OR) and 95% Confidence Intervals (CI) were used to assess associations between pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding, and, dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 and 12 months. These three sexual health issues were chosen for the analyses as they are the more commonly reported of all sexual health issues. The multivariable logistic regression analysis model included the variables; age, pre pregnancy body mass index (BMI) and level of education. The Omnibus Test of Model Coefficients and the Hosmer and Lemeshow Test supported the models used.
Characteristics of the study participants
Women included in this study report (n = 1477) all gave birth between August 2012 and end of July 2014. Of these 1477 women who were recruited in early pregnancy, 1408 were eligible for follow-up. For those 69 women not available for follow-up, reasons included, gave birth elsewhere, withdrew at Survey 1, experienced a late miscarriage or stillbirth, and no consent provided. Subsequent 2, 3, 4 and 5 survey return rates were 1180 (84%) 1094 (80%), 1027 (77%) and 971 (74%), respectively. To determine, accurately, any changes over time only data from women who returned all five surveys (n = 866, 59%) and consented to having their hospital records accessed (n = 832, 56%) were included in these analyses (Fig. 1).
Analytical sample
Where it was possible to do so, study data were compared to data in the Irish National Perinatal Statistics Report for 2013 [29]. This allowed for an assessment of the national representativeness of the study participants. The National Perinatal Statistics Report is produced annually and collates data (hereafter referred to as national data) on the obstetric and social characteristics of every woman who gave birth in Ireland in the year preceding the report. Comparative assessments demonstrated that the study sample had proportionately fewer women under 24 years of age and more 30–34 and 35–39 year old women when compared to national statistics (30–39 years: 70.1% in the MAMMI study versus 52.5% in the national data). Greater than two-thirds (n = 566, 68.1%) of women in the MAMMI study are Irish with just over a quarter (n = 216, 25.9%) born in another European country. The five most common countries of birth after Ireland were; Poland (n = 58, 7%), United Kingdom (n = 45, 5.4%), France (n = 13, 1.6%), Germany (n = 12, 1.5%) and Romania (n = 12, 1.5%). Seventy-one percent of participants had a university degree or higher (n = 588, 70.6%). No data were available for this item from the National Perinatal Statistics Report; however, the Central Statistics Office reports a national rate of women aged 25–34 with a third level qualification in Ireland of 55.3% in 2014 [30].
Women in the MAMMI study were under represented in terms of spontaneous vaginal birth (35.6% versus 45.5% nationally), over represented for forceps births (12% versus 5.6% nationally) and representative for caesarean section rates (31.6% versus 27.2% nationally). One third (n = 301, 36.1%) of study participants had an episiotomy compared to nearly half (n = 1187, 46.3%) of nulliparous women at the hospital site in 2013. The study sample were representative in all other categories of perineal trauma compared to the research site. Table 1 presents the characteristics of the MAMMI study sample.
Table 1 Characteristics of study participants
Prevalence of self-reported sexual health issues over time
Table 2 presents the number and proportion of women who experienced sexual health issues pre-pregnancy, in early pregnancy and at 6 and 12 months postpartum. The prevalence of loss of interest in sexual activity was considerably elevated 6 months postpartum (46.3%) and remained significantly so at 12 months postpartum compared to pre-pregnancy levels (39.8% versus 33% p < 0.001). The proportion of women reporting dyspareunia at 6 months was significantly higher than those who experienced it pre-pregnancy (37.5% versus 29.3%, p < 0.001). Contrastingly, this was significantly lower than pre-pregnancy levels at 12 months postpartum (20.5% versus 29.3% p < 0.001). Six months postpartum 43% of women reported a lack of vaginal lubrication compared to 36.6% pre-pregnancy (p = 0.002). This decreased to 35.4% 12 months after birth (p = 0.761). Pregnancy and birth appeared to resolve difficulties women experienced with orgasm, as, pre-pregnancy, 34.1% of women experienced difficulty achieving orgasm and 19.7% were unable to achieve orgasm. The prevalence of these sexual health issues were significantly less, however at 12 months after birth (23.5% (p < 0.001) and 13.8% (p = 0.001), respectively). Figure 2 illustrates the prevalence of sexual health issues experienced by women at the different time points.
Table 2 Prevalence of self-reported sexual health issues pre pregnancy, in early pregnancy and at 6 and 12 months postpartum
Self-reported sexual health issues; pre pregnancy, in early pregnancy, 6 and 12 months postpartum
Univariate logistic regression analysis
Mode of birth as a risk factor for postpartum sexual health issues
Six months postpartum, vacuum-assisted birth was significantly associated with dyspareunia (OR 1.6, 95% CI 1.1–2.4), elective CS was associated with a reduced odds of experiencing dyspareunia (OR 0.5, 95% CI 0.3–0.9), and an emergency CS was protective of experiencing a loss of interest in sexual activity 6 months postpartum; these associations did not persist to 12 months postpartum. There was no significant association between vacuum-assisted birth and an increased lack of vaginal lubrication at 6 (OR 1.3, 95% CI 0.9–2.0) and 12 months postpartum (OR 1.3, 95% CI 0.9–1.9) (Table 3).
Table 3 Mode of birth as a risk factor for sexual health issues at 6 and 12 months postpartum
Perineal trauma as a risk factor for postpartum sexual health issues
Compared to women with an intact perineum, women who had 2nd degree perineal tears (OR 1.6, 95% CI 1.0–2.3), episiotomy (OR 1.7, 95% CI 1.2–2.5) or 3rd degree perineal tears (OR 3.7, 95% CI 1.5–9.3), were significantly more likely to experience dyspareunia at 6 months postpartum. This association persisted to 12 months for both episiotomies and 3rd degree perineal tears (Table 4). At 6 months postpartum a loss of interest in sexual activity was associated with both 2nd and 3rd degree perineal tears (Table 4).
Table 4 Perineal trauma as a risk factor for sexual health issues at 6 and 12 months postpartum
Breastfeeding as a risk factor for postpartum sexual health issues
When data on women who were breastfeeding and not breastfeeding were compared, the results showed that women who were breastfeeding were significantly more likely to experience dyspareunia (OR 1.9, 95% CI 1.3–2.6), a lack of vaginal lubrication (OR 1.7, 95% CI 1.2–2.3) and a loss of interest in sexual activity (OR 1.7, 95% CI 1.3–2.3) 6 months postpartum. This association was not significant at 12 months postpartum, likely due, perhaps, to the low numbers still breastfeeding 12 months after birth. It is noteworthy that for those breastfeeding, the ORs for dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity were all greater than 1.0 at 12 months postpartum, although none reached a level of significance (Table 5).
Table 5 Breastfeeding as a risk factor for sexual health issues at 6 and 12 months postpartum
Pre-pregnancy dyspareunia as a risk factor for postpartum sexual health issues
Women who reported pre-pregnancy dyspareunia were significantly more likely to report several postpartum sexual health issues including dyspareunia at 6 and 12 months postpartum, a lack of vaginal lubrication at 6 and 12 months and a loss of interest in sexual activity at 6 and 12 months postpartum compared to those who did not report it (Table 6).
Table 6 Pre-existing dyspareunia as a risk factor for sexual health issues 6 and 12 months postpartum
Multivariable logistic regression analysis
Dyspareunia at 6 and 12 months postpartum
Pre-existing dyspareunia was strongly associated with dyspareunia (over two and half times more likely) at 6 months postpartum (Adjusted OR (AOR) 2.6, 95% CI 1.8–3.6), and this association was even more pronounced at 12 months (AOR 3.8, 95% CI 2.5–5.8). Breastfeeding and a 3rd degree perineal tear were both associated with experiencing dyspareunia 6 months after birth. Having a vacuum-assisted birth was not a significantly associated risk factor for dyspareunia 6 months postpartum (AOR 1.7, 95% CI 0.9–2.7). Compared to women aged 18–29 years, women aged ≥30 years were less likely to experience dyspareunia at 6 and 12 months. This was most pronounced at 12 months for women ≥35 years of age (Table 7).
Table 7 Multivariable logistic regression of dyspareunia at 6 and 12 months postpartum
Lack of vaginal lubrication at 6 and 12 months postpartum
Pre-existing dyspareunia was strongly associated with a lack of vaginal lubrication at 6 months (AOR 1.6, 95% CI 1.1–2.2) and the association persisted to 12 months postpartum (AOR 1.7, 95% CI 1.2–2.5). Breastfeeding, being sometimes satisfied with one's body image and never satisfied with one's body image were all associated with a lack of vaginal lubrication 6 months postpartum. Compared to ideal weight women, being overweight or obese was protective of experiencing a lack of vaginal lubrication 6 months after birth. A non-significant association between a vacuum-assisted birth and an increased lack of vaginal lubrication at 12 months was also found (Table 8).
Table 8 Multivariable logistic regression of lack of vaginal lubrication at 6 and 12 months postpartum
Loss of interest in sexual activity at 6 and 12 months postpartum
Breastfeeding at 6 months and 12 months postpartum were associated with experiencing a loss of interest in sexual activity at these time-points (AOR 2.2, 95% CI 1.6–3.0 and AOR 1.6, 95% CI 1.0–2.1, respectively). Being sometimes satisfied and never satisfied with one's body image was a risk factor for a loss of interest in sexual activity 6 months after birth. This association persisted for women who were never satisfied with their body image to 12 months postpartum (AOR 3.6, 95% CI 1.9–6.7). Compared with women without degree-level educational qualifications, women who had a postgraduate qualification were more likely to experience a loss of interest in sexual activity 6 months after birth (AOR 1.5, 95% CI 1.0–2.3) (Table 9).
Table 9 Multivariable logistic regression of loss of interest in sexual activity at 6 and 12 months postpartum
Discourse on women's sexual health after birth is gaining momentum across diverse disciplines, for example, midwifery, obstetric, sexology and psychology disciplines [1,2,3,4,5]. This increased interest and body of research in perinatal sexual health, however, is not evidenced in sexual health policy [6, 7] or maternity care policy [8, 9], although data demonstrating that women are not prepared for changes to their sexual health after birth [10], are available. Lack of knowledge and preparation for sexual health issues postpartum can be distressing for women, and their partner, while also negatively impacting on their ability to adapt to their new role as mothers [10,11,12]. Postpartum sexual health is challenging to theoretically define but cannot be separated from sexuality and sexual function, and is thought to be influenced by labour and birth events [13]. Attributes of good postpartum sexual health include; sexual desire, resumption of sexual intercourse after birth, pain free sex and orgasm.
This study provides a further body of evidence demonstrating that women experience considerable sexual health issues after pregnancy and childbirth, and adds to the discourse on women's sexual health after birth from a maternity (midwifery and obstetric) perspective. Almost half of the women included in this study reported sexual health issues 6 months postpartum with more than 40% doing so 12 months after birth. A loss of interest in sexual activity was the most commonly reported issue (46.3% at 6 months and 39.8% at 12 months). This is somewhat less than that reported in the Australian Maternal Health Study (60.3% at 6 and 51.3% at 12 months) [1] and more than that reported by Barrett and colleagues at 6 months postpartum (37%) [17]. Information relating to sexual health issues that was sought in these 3 studies were almost identical; however, there is a 15-year interval from data collection in our study and that of Barrett and colleagues. It is, therefore, possible that over the past 15 years women have become more comfortable and confident in recognising sexual health issues, possibly as a result of the increased interest in the social media, weekender magazines and in other media which discuss women's sexual lives after birth [31, 32]. Experiencing a loss of interest in sexual activity during the first year after birth is relatively common, which suggests that altered desire for sex is a normal part of adapting to motherhood and new roles of both parents in the household. If viewed through the adaptation lens, one is left with questions around the appropriateness of including lack of sexual activity as an indicator of 'sexual dysfunction' in the DSM-5 definition of sexual dysfunctions [33], especially for this cohort of postpartum women. The high rate of reported loss of interest in sexual activity also points to the need for women and their partners to be forewarned of this potential change, as a routine part of perinatal care. By so doing much of the stress and anxiety identified by women interviewed by Olsson [10] and guilt reported by women in Woolhouse and colleague's study [11] around intimacy would be reduced.
In our study 37.5% of women experienced dyspareunia 6 months after birth, compared to 43.4% reported in the Maternal Health Study [1] and 31% in Barrett et al.'s (2000) study [17]. Our findings demonstrate that events that occur during labour and birth influence the extent with which women report dyspareunia 6 months after birth. The likelihood of women experiencing dyspareunia at 6 months was substantially higher in women whose birth was vacuum-assisted, had 2nd degree tears, 3rd degree tears and episiotomies compared to those who had a spontaneous vaginal birth and an intact perineum; although, when all other factors were considered, 3rd degree tears, only, along with pre-existing dyspareunia and breastfeeding emerged as significant factors for dyspareunia at 6 months postpartum. Our univariate results reflect the findings from previous studies which also report an association with episiotomy and poor sexual health outcomes [15], instrumental birth and dyspareunia [19, 34]. In addition, it raises questions about the rates of obstetric intervention experienced by women in Ireland. In our study 20.7% of women experienced a vacuum-assisted birth, similar to a national rate of 21.2% [29], double the rate of 10.4% in the Maternal Health Study in Australia [34] and much higher than the 5% in the nulliparous sample used by Connolly and colleagues [35]. Our high rate of vacuum-assisted birth could be related to the equally high uptake of epidural anaesthesia in Irish maternity settings, as 78% of women in this study used epidural analgesia (similar to the 72% of nulliparous women at the research site), and a 2011 Cochrane review identified that epidural analgesia increased the risk of an instrumental birth [36]. The association between episiotomy and persistent dyspareunia up to 12 months was found in our study, although it did not emerge as a risk factor for dyspareunia in multivariable analysis. In our study 36.1% of women had an episiotomy, while this may appear elevated it is worth noting that 33% of women had an instrumental birth which is commonly associated with an episiotomy. Our high rate of episiotomy (36.1%) compares poorly, internationally, where 16% of women in the Maternal Health Study had an episiotomy [34] and 14% in Connolly's research [35]. This finding does not necessarily suggest there is routine use of episiotomy but rather poses concern over the high rate of epidural uptake, consequent instrumental births, perineal trauma and associated long term dyspareunia.
Little has been published on the influence of breastfeeding on postpartum sexual health, with many studies choosing to focus on breastfeeding as a means of contraception [37] or the influence of breastfeeding on resumption of sexual activity and frequency of sexual activity [38,39,40]. In our study, breastfeeding, in association with other related factors, remained significantly present for all three of the outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum. This finding highlights the potential for cognitive dissonance to occur. Cognitive dissonance occurs when people experience inconsistency between cognitions or between cognitions and behaviour [41]. In a professional or practice context that emphasises women-centred care and disclosure, and a policy context that promotes breastfeeding, there is potential for internal conflict to arise. Practitioners may struggle with the professional imperative to inform women of the impact of breastfeeding on sexual activity, dyspareunia and vaginal lubrication at the same time as fearing a decrease in women's willingness to breastfeed if impact is known. However, information regarding breastfeeding needs to take account of these findings, if care is to be 'woman-centred' as opposed to 'breast-feeding centred' [42]. Without this information women may blame themselves for their loss of sexual interest, or struggle alone without information on the array of vaginal lubricants available to alleviate vaginal dryness.
Little attention has been given to pre-existing dyspareunia and its influence on sexual health after birth to date, however two studies found a similar association between pre-existing dyspareunia and experiencing sexual health issues after birth [17, 34]. In our study 29.3% of women experienced dyspareunia in the 12 months before becoming pregnant, and this, with other significantly related factors (e.g. 3rd degree tears and breastfeeding at 6 months and age > 35 years at 12 months) contributed to dyspareunia 6 and 12 months after birth. The majority of women do not seek professional support for postpartum sexual health issues, 15% in Barrett et al.'s study spoke to a health professional [17] and 24% in the Australian study were asked directly by a health professional about their sexual health postpartum [1]. This corresponds to conclusions from qualitative studies that demonstrated that women find it difficult to bring up sexual health issues with health professionals [10, 11, 43] and this occurs at a time when women have direct contact with a variety of health professionals during the postpartum period. Therefore it is very likely that women do not seek help for dyspareunia experienced before pregnancy as there may be limited contact with health services. The antenatal period, a time when women have frequent consultations with health professionals appears to be an ideal opportunity to ask them about their sexual health and discuss any problems, such as pain during sexual intercourse, they may be experiencing. It is potentially an ideal time to refer women to the most appropriate professional for help, be it the women's health physiotherapist attached to the maternity services, sexual health therapist or couples therapy. However, previous studies of healthcare professionals have shown that many lack competence and confidence in their abilities to help with sexual problems [44], which may be why so many women had not been asked. Managing dyspareunia during pregnancy will go some way to reducing the identified association between pre-pregnancy dyspareunia and a lack of vaginal lubrication and a loss of interest in sexual activity seen in this study. Similarly, it is probable that persistent postpartum dyspareunia at 6 and 12 months would be reduced if managed antenatally or at the very least women should be asked about sexual health issues, and would then know where to seek appropriate help.
This study is unique in its investigation of an association between perception of body image and sexual health issues after birth. In this study women with a poor perception of their body images 6 and 12 months postpartum were more likely to experience a lack of vaginal lubrication (in the context of being overweight, obese, breastfeeding and pre-existing dyspareunia) and a loss of interest in sexual activity (in the context of breastfeeding and pre-existing dyspareunia). The complex nature of the concept of postpartum body image and its influence on postpartum sexual health is poorly researched, and this led the first author of this paper to carry out qualitative one-to-one semi-structured interviews with some of the women who completed the survey and identified themselves as experiencing sexual health problems. Analysis of these data is in progress and will be reported at a later date.
The strengths of this study include the recruitment of a large sample of nulliparous women in early pregnancy, regular follow-up and a high retention rate to 12 months postpartum. The frequency of follow-up reduces the likelihood of recall bias and provides reliable data on changes to women's sexual health over time following birth. Some findings in our study are similar to other comparable studies. This strengthens the argument for introducing sexual health to antenatal and postnatal care pathways well beyond the traditional 6 week postnatal assessment.
A number of potential limitations have been identified that may influence the data. The study sample is from one maternity unit in Ireland, which is not entirely representative of a national sample. The survey did not include definitions of concepts such as lack of vaginal lubrication, hence they are open to individual interpretation on meaning. The association of breastfeeding and sexual health issues may be questionable as Ireland has a low breastfeeding continuation rate; for example, in a national study of infant feeding in Ireland, only 19% (n = 347) of women were exclusively breastfeeding at 3–4 months postpartum [45]. Data on other factors such as medications (e.g., psychotropic drugs) that may affect interest in sexual activity [46] were not collected. A further limitation is the lack of data on the sexual orientation of women in our study, thus it was not possible to identify if there was any difference between women in same sex relationships and those in opposite sex relationships.
The findings from this large prospective cohort study of nulliparous demonstrates that women experience considerable sexual health issues after pregnancy and childbirth. Dyspareunia, lack of vaginal lubrication and loss of interest in sexual activity at 6 months postpartum were all significantly associated with pre-existing dyspareunia and breastfeeding. Additionally dyspareunia was associated with 3rd degree tears, lack of vaginal lubrication was associated with being overweight, obese and dissatisfaction with body image was a risk factor for a lack of vaginal lubrication and a loss of interest in sexual activity. Preparing women and their partners for this during the antenatal period and advising on simple measures, such as use of lubrication to avoid issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Pregnancy and the frequent interactions it brings with health professionals provide an ideal opportunity to discuss pre-existing sexual health issues with women and their partners and suitable care pathways can be put in place with appropriate referrals made.
AOR:
Adjusted Odds Ratio
MAMMI:
Maternal health And Maternal Morbidity in Ireland
SPSS:
Statistical Package for the Social Sciences
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Pastore L, Owens A, Raymond C. Postpartum sexuality concerns among first-time parents from one U.S. academic hospital. J Sex Med. 2007;4(1):115–23.
O'Malley D, Higgins A, Smith V. Postpartum sexual health: a principle-based concept analysis. J Adv Nurs. 2015;71(10):2247–57.
McDonald EA, Brown SJ. Does method of birth make a difference to when women resume sex after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology. 2013;120(7):823–30.
Baksu B, Davas I, Agar E, Akyol A, Varolan A. The effect of mode of delivery on postpartum sexual functioning in primiparous women. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):401–6.
Safarinejad MR, Kolahi AA, Hosseini L. The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands. Journal of Sexual Medicine. 2009;6(6):1645–67.
Barrett G, Pendry E, Peacock J, Victor CR, Thakar R. Women's sexual health after childbirth. Br J Obstet Gynaecol. 2000;107(2):186–95.
Rathfisch G, Dikencik BK, Kizilkaya Beji N, Comert N, Tekirdag AI, Kadioglu A. Effects of perineal trauma on postpartum sexual function. J Adv Nurs. 2010;66(12):2640–9.
Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol. 2001;184(5):881–8. discussion 8-90
Chang SR, Chen KH, Lin HH, Chao YM, Lai YH. Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: a prospective follow-up study. Int J Nurs Stud. 2011;48(4):409–18.
Hosseini L, Iran-Pour E, Safarinejad MR. Sexual function of primiparous women after elective cesarean section and normal vaginal delivery. Urol J. 2012;9(2):498–504.
Baud D, Meyer S, Vial Y, Hohlfeld P, Achtari C. Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery. Int Urogynecol J Pelvic Floor Dysfunct. 2011;22(9):1127–34.
Chivers ML, Pittini R, Grigoriadis S, Villegas L, Ross LE. The relationship between sexual functioning and depressive symptomatology in postpartum women: a pilot study. Journal of Sexual Medicine. 2011;8(3):792–9.
Acele EO, Karacam Z. Sexual problems in women during the first postpartum year and related conditions. J Clin Nurs. 2011;21(7–8):929–37.
Dean N, Wilson D, Herbison P, Glazener C, Aung T, Macarthur C. Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence: a cross-sectional study six years post-partum. Aust N Z J Obstet Gynaecol. 2008;48(3):302–11.
Olsson A, Robertson E, Falk K, Nissen E. Assessing women's sexual life after childbirth: the role of the postnatal check. Midwifery. 2011;27(2):195–202.
Brown SJL, M J, McDonald EA, Krastev AH, Bessell C, Brennecke S, Burrows R, Gunn J, Mitchell C, Watson L, Wein P, MacArthur C, Klein M, Luoto R, Hegarty K. Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy. BMC Pregnancy and Childbirth. 2006;6
Field A. Discovering Statistics using SPSS. 2nd ed. London: Sage Publications; 2005.
Health Service Executive. Perinatal Statistics Report 2013. Dublin: Health Service Executive; 2014.
Central Statistics Office Men and women in Ireland. Dublin: Stationary Office, 2014.
Shanahan C. Sex after baby: groundbreaking research on what happens in the bedroom after birth. Irish examiner. In: 2016 10th; 2016.
Dillner L. How long after giving birth should I wait before having sex again. The Guardian. 2013;
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG Int J Obstet Gynaecol. 2015;122(5):672–9.
Connolly A, Thorp J, Pahel L. Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(4):263–7.
Anim-Somuah M, Smyth RMD, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011;12
Van der Wijden CKJ, Van den Berk T. Lactational amenorrhea for family planning. Cochrane database of systematic reviews. 2003;4 CD001329
Yee LM, Kaimal AJ, Nakagawa S, Houston K, Kuppermann M. Predictors of postpartum sexual activity and function in a diverse population of women. Journal of Midwifery & Women's Health. 2013;58(6):654–61.
Visness CMK K I. The frequency of coitus during breastfeeding. Birth-issues in. Perinatal Care. 1997;24(4):253–7.
Rowland M, Foxcroft L, Hopman WM, Breastfeeding PR. Sexuality immediately post partum. Can Fam Physician. 2005;51:1366–7.
Festinger L. A theory of cognitive dissonance. In: Stanford CA: Stanford university press; 1957.
Carroll M, Gallagher L, Clarke M, Millar S, Begley C. Artificial milk-feeding women′s views of their feeding choice in Ireland. Midwifery. 2015;31(6):640–6.
Buurman MBR, Lagro-Janssen ALM. Women's perception of postpartum pelvic floor dysfunction and their help-seeking behaviour: a qualitative interview study. Scand J Caring Sci. 2013;27(2):406–13.
Higgins A, Barker P, Begley CM. Sexuality: the challenge to espoused holistic care. Int J Nurs Pract. 2006;12(6):345–51.
Begley C, Gallagher L, Clarke M, Carroll M, Millar S. The National Infant Feeding Survey 2008. School of Nursing and Midwifery, Trinity College Dublin: 2010.
Higgins A. Impact of psychotropic medication on sexuality: literature review. Br J Nurs. 2007;16(9):545–50.
We are grateful to all of the women who participated in the MAMMI study, the midwives and midwifery students who recruited women to the study and to other members of the MAMMI research team who have contributed to data collection and data management.
This research was funded by a Health Research Board Healthcare Professional Fellowship grant awarded to Deirdre O'Malley (HRB HPF/2013/477-Begley). The funders had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
The data supporting our findings are contained within the manuscript. Previous presentations reporting results on sexual health and other maternal morbidities are available for viewing on the MAMMI study website; www.mammi.ie. The corresponding author may be contacted for further information or clarifications relating to the data.
Health Research Board, Research Fellow, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
Deirdre O'Malley
School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
Agnes Higgins, Cecily Begley, Deirdre Daly & Valerie Smith
Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Cecily Begley
Agnes Higgins
Deirdre Daly
Valerie Smith
DOM planned and conducted the analyses, interpreted data and contributed to writing the paper. VS and AH supervised the analysis, contributed to interpretation of data and reviewed and commented on all drafts of the paper. DD wrote the study protocol and took primary responsibility for the design and conduct of the MAMMI study, in conjunction with CB. CB was original supervisor to DOM and is the grant holder for this research. All authors have approved the final draft of the paper prior to submission.
Correspondence to Valerie Smith.
The research ethics committees of the Faculty of Health Sciences Trinity College Dublin and the Rotunda hospital Dublin approved the study. Written consent was obtained, and only women who returned a completed signed consent form were included in this study.
Valerie Smith is a member of the BMC Pregnancy and Childbirth Editorial Board. All remaining authors declare that they have no competing interests.
O'Malley, D., Higgins, A., Begley, C. et al. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 18, 196 (2018). https://doi.org/10.1186/s12884-018-1838-6
Sexual health postpartum
Sexual activity
Perineal trauma


How, exactly, to do you write toward a strict word count while still creating effective and engaging content? Not to fear—today, I'm breaking down my top three tips for making your copy count when writing with a word limit.
As a freelance writer in an age where content is King (scratch that—where content is QUEEN), one of the things I get asked to do the most is write blog posts on behalf of companies and organizations. Today, then, I'm officially giving away all of the magician's secrets (gasp!) and letting you in on my top tips for writing blog posts. Read on for all you need to know about crafting engaging, effective blog posts.


text:
Mavai-ye Sofla () may refer to:
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redpajama_set_name: RedPajamaWikipedia


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A "Statement of Intent" field by the student which indicates a renewed commitment and desire to pursue studies and the means to be used to achieve academic goals.
Satisfactory records of subsequent educational work at other colleges. Attendance at VACU is a privilege and not a right. The Administration reserves the right to dismiss any student who does not comply with the purposes, requirements, and regulations of VACU.


Convinced the hubbs to work the rest of the day from home and go with my on our YW hike up El Moro Canyon tonight...this is going to be a good night.
Also, how much would you all hate me if I drove a Scion XB? Are they too racer-wannabe-ish? They're so roomy and you can get them for decent prices...need opinions. UPDATE: I like the white ones best.
ALSO, about to eat a free taco.
I think the important question is, what color? Because that can definitely change the car from "wanna be old lady" to "punk teenager with rich parents" to "nice ride, Kari."


text:
Q: Where find default Windows 10 UWP icons I'm developing a UWP application, however I'm not able to find where are the default icons.
Where can I find a list of them?

A: you can use character map application and select the font as segoe mdl2 assets. All the available icons will be shown. Alternatively in xaml also you can use like below code:
<SymbolIcon Symbol="Sync" Foreground="Red"/>

redpajama_set_name: RedPajamaStackExchange


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I'm obsessed with notebooks myself. Tonight I was going over the bargain table at the bookstore looking for the "perfect" one. Didn't find it, but then again, I have several stockpiled at home!
My favourites are the ones which look like little old books. Far too pretty to use!
I love notebooks too! They are beautiful and fun to write in. Now that it is school supply season, though, I am stocking up on cheap spiral-bound notebooks. I think differently on paper than at a keyboard!
Oh, yes! I love it when the stores start stocking all that back-to-school stuff. My cheap notebooks definitely get more use than the pretty ones, which sometimes seem too nice to use!
The first page in a brand new notebook never fails to give me a little tingle. Whether it be a notebook I fell in love with at my fave shop or a cheap spiral bound, it's the beginning - and it's new, and clean. And mine. Must have something to do with school. I loved school. Stocking up for a new term was always exciting. And I kept notebooks for years afterwards because I could flip back through them and remember...not just what I was studying, but what was happening at that point in my life. I still have a few. Poor babies aren't fresh and clean any longer. Bit ratty. Stuffed with loose class notes (most have nothing to do with anything scholastic), stuff I tore or cut out of newspapers and mags, a photo here and there...and all those notes in the margins I wrote. To myself. In my own private version of shorthand. Ha! I'll never tell!
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I feel sorry for the kids who are not being taught cursive; being able to put pen or pencil to paper in that way has been an important part of my creative process. I've heard writing by hand uses a different part of our brain than typing does; I know that I need notebooks for drafts and brainstorming. Going straight to the computer will make me think I have to have a perfect piece, paragraph by paragraph.
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text:
---
layout: post
title: Entendendo o Ext.Ajax.request (Success X Failure)
date: 2014-01-20 07:00:04.000000000 -02:00
type: post
published: true
status: publish
categories:
- Ext JS 3
- Ext JS 4
tags:
- Callback
- Ext JS 3
- Ext.Ajax.request
- ExtJS
- Success X Failure
language: pt-br
category: pt-br
---

Olá pessoal,

Hoje vou falar um pouco sobre o Ext.Ajax.request, especialmente sobre as funções de callback de Success e Failure. Esse é um dos erros que mais vejo em códigos alheios por aí.

E por que especialmente sobre o Ext.Ajax.request? Mesmo quando a gente trabalha com Store ou com Submit de Forms no ExtJS, por trás o Ext.Ajax é chamado. Então entendendo como o callback funciona, podemos aplicar a mesma lógica para a Store e o Submit de um Form.

[caption id="attachment_6972" align="aligncenter" width="360"] Fonte da Img: http://cdn.worldcupblog.org/www.worldcupblog.org/files/2010/07/success-and-failure-sign.jpg[/caption]

Primeiro vou mostrar para vocês como esses callbacks são usados e de forma errada. Depois vou mostrar a forma como devem ser usados. E por último, uma maneira de deixar o seu código ainda mais limpo e bonito, reusando o máximo de código que a gente pode (afinal, não basta funcionar, código limpo e bonito também agrega valor né?).

Para exemplificar, suponha o cenário de uma página de Login. Para esse exemplo, criei 3 páginas de Login idênticas, apenas diferindo o xtype e um Controller. Tenho também um php que vai no banco buscar o usuário e senha entrado pelo usuário. Para nosso exemplo, vamos criar uma tabela usuário (com colunas usuário e senha) e vamos inserir apenas 1 linha nessa tabela: usuário "admin" e senha "admin". Segue o script:

CREATE SCHEMA `blog` ;

CREATE  TABLE `blog`.`user` (

  `username` VARCHAR(45) NOT NULL ,

  `password` VARCHAR(45) NOT NULL ,

  PRIMARY KEY (`username`) ,

  UNIQUE INDEX `username_UNIQUE` (`username` ASC) );

 INSERT INTO `blog`.`user` (`username`, `password`) VALUES ('admin', 'admin');

Claro que isso é apenas um exemplo viu gente!

No PHP, criei um arquivo login.php que apenas vai ao banco de dados fazer o SELECT com o usuário e senha passado no Form de Login. Se usuário e senha existem na base, retorna um success = true e msg = "Usuário Autenticado!". Caso contrário: success = false e msg = "Usuário ou Senha Incorretos.". Lembrando que o retorno para ExtJS é sempre no formato JSON.

Segue o código php - bem simples que é pra mesmo quem não programa em PHP (como eu! rs) conseguir entender:

<?php

require("db/db.php");

// username and password sent from form
$userName = $_POST['user'];
$pass = $_POST['password'];

$userName = $mysqli->real_escape_string($userName);
$pass = $mysqli->real_escape_string($pass);
$sql = "SELECT * FROM USER WHERE userName='$userName' and password='$pass'";

$success = false;
$msg = ' ';

if ($resultdb = $mysqli->query($sql)) {

        // determine number of rows result set
        $count = $resultdb->num_rows;

        // If result matched $userName and $pass, table row must be 1 row
        if($count==1){

                $success = true;
                $msg = utf8_encode('Usuário Autenticado!');

        } else {

                $success = false;
                $msg = utf8_encode('Usuário ou Senha Incorretos.');
        }

        /* close result set */
        $resultdb->close();
}

/* close connection */
$mysqli->close();

//JSON encoding
echo json_encode(array(
        "success" => $success,
        "msg" => $msg
));
?>

No final do post coloco um link onde é possível fazer download do código completo ok?

Entendendo o Problema

Vamos agora ao Form de Login:

Ext.define('MyApp.view.LoginIncorrect', {
    extend: 'Ext.form.Panel',
    alias: 'widget.loginincorrect',

    bodyPadding: 10,
    title: 'Login Incorrect',

    initComponent: function() {
        var me = this;

        Ext.applyIf(me, {
            items: [
                {
                    xtype: 'textfield',
                    anchor: '100%',
                    itemId: 'user',
                    fieldLabel: 'User',
                    allowBlank: false
                },
                {
                    xtype: 'textfield',
                    anchor: '100%',
                    itemId: 'pass',
                    fieldLabel: 'Pass',
                    inputType: 'password',
                    allowBlank: false
                }
            ],
            dockedItems: [
                {
                    xtype: 'toolbar',
                    dock: 'bottom',
                    ui: 'footer',
                    layout: {
                        pack: 'end',
                        type: 'hbox'
                    },
                    items: [
                        {
                            xtype: 'button',
                            formBind: true,
                            itemId: 'submit',
                            text: 'Submit'
                        }
                    ]
                }
            ]
        });

        me.callParent(arguments);
    }

});

É um Form com dois campos: usuário de senha e um botão de submit. Nada de mágico no form acima!

Então vamos lá! Quando o usuário clicar no botão de submit, a gente quer enviar o usuário e senha para o server e mostrar um alert na tela apenas - se usuário autenticado ou outra mensagem de erro.

No Controller, vamos ouvir o seguinte evento:

"loginincorrect button#submit": {
    click: this.onButtonClickIncorrect
}

Vamos agora implementar a função/método onButtonClickIncorrect:

onButtonClickIncorrect: function(button, e, eOpts) {
    var formPanel = button.up('form'),
        user = formPanel.down('textfield#user').getValue(),
        pass = formPanel.down('textfield#pass').getValue();

    Ext.Ajax.request({
        url: 'php/login.php',
        params: {
            user: user,
            password: pass
        },
        success: function(conn, response, options, eOpts) {

            Ext.Msg.show({
                title:'Info',
                msg: 'Login feito com sucesso',
                icon: Ext.Msg.INFO,
                buttons: Ext.Msg.OK
            });
        },
        failure: function(conn, response, options, eOpts) {

            Ext.Msg.show({
                title:'Erro',
                msg: 'Usuário ou Senha incorretos.',
                icon: Ext.Msg.ERROR,
                buttons: Ext.Msg.OK
            });
        }
    });
}

E é mais ou menos assim que a gente vê as funções de callback na maioria dos códigos Ext JS! Notou alguma coisa de errado? Se sim, ótimo! Se não, vamos passo a passo para entender.

Cenário 1: entre com usuário e senha "admin"

Esse é o resultado:

Parece ok né? É porque esse é o resultado esperado.

Cenário 2: entre com usuário "abc" e senha "abc"

Esse é o resultado:

Hum, não era esse o resultado né? No server estamos retornando o resultado success = false. A mensagem esperada era outra né?

Aí está o erro: muita gente espera que quando se retorna success = false no server, o callback a ser executado é o da função failure, o que não é verdade. O código está correto, mas o resultado que os desenvolvedores espera não está correto.

Quando o success e quando o failure são executados?

O success significa que o request conseguiu chegar ao server com sucesso, não importa o resultado no server (o seu success interno como true ou false). O success que usamos no server para retornar para o ExtJS não tem nada a ver com o callback success do Ext.Ajax.request! Se o request chegou ao server, automaticamente o callback success será executado!

Mas e o failure? O failure é executado quando acontece uma falha na comunicação. Seja porque não encontrou a URL (erro 404), o servidor está fora do ar, etc.

Vamos ver um terceiro cenário e entender o porquê precisamos do failure também.

Cenário 3: Renomeie o arquivo login.php para login_.php

Quando o ExtJS tentar executar o login.php, teremos um erro 404 - de URL não encontrada.

Entre com usuário e senha "admin".

Esse é o resultado.

Repare no console. O usuário nessa hora fica maluco, pois tá entrando com a senha e usuário corretos, mas a mensagem que o sistema mostra para o usuário é meio sem noção. Por isso é importante saber essas diferenças para que o seu sistema possa tomar as decisões corretas! O código acima não prevê todos os cenários e isso faz com que o sistema não funcione direito! O sistema funciona de maneira errada, e isso é um erro gravíssimo.

Maneira Certa de Usar

Vamos ver agora a maneira correta de prever esses casos. Temos 3 casos então.

Essa seria a função/método com os 3 cenários:

onButtonClickCorrect: function(button, e, eOpts) {
    var formPanel = button.up('form'),
        user = formPanel.down('textfield#user').getValue(),
        pass = formPanel.down('textfield#pass').getValue();

    Ext.Ajax.request({
        url: 'php/login.php',
        params: {
            user: user,
            password: pass
        },
        success: function(conn, response, options, eOpts) {

            var result = Ext.JSON.decode(conn.responseText, true);

            if (!result){ // caso seja null
                result = {};
                result.success = false;
                result.msg = conn.responseText;
            }

            if (result.success) {

                Ext.Msg.show({
                    title:'Info',
                    msg: result.msg,
                    icon: Ext.Msg.INFO,
                    buttons: Ext.Msg.OK
                });

            } else {

                Ext.Msg.show({
                    title:'Erro',
                    msg: result.msg,
                    icon: Ext.Msg.ERROR,
                    buttons: Ext.Msg.OK
                });
            }
        },
        failure: function(conn, response, options, eOpts) {

            Ext.Msg.show({
                title:'Erro - Contate Administrador do sistema!',
                msg: conn.responseText,
                icon: Ext.Msg.ERROR,
                buttons: Ext.Msg.OK
            });
        }
    });
}

Vamos por partes. Quando o success e o failure são executados, eles recebem alguns parâmetros que são passados no request. E temos como usar esses parâmetros. No server, estamos retornando success e msg, então vamos usar isso né? O parâmetro conn.responseText é que contém o success e a msg, porém estão em uma String com formato JSON. Se quisermos usar algum desses parâmetros, temos que decodificar (linha 14). Caso o server não envie nada (por exemplo, caso ocorra algum erro na conexão com o banco de dados) o resultado dessa codificação será null. Então vamos criar um objeto que podemos usar ( linhas 16 a 20 - nesse caso apenas o responseText vai conter alguma mensagem de execeção ou erro).

Agora sim vamos usar o success que usamos no server. Se ele for true, tudo ocorreu bem, então a gente mostra a mensagem que o server enviou (usuário autenticado - linhas 24 a 29). Caso contrário, a gente também exibe uma mensagem (que pode ser de usuário ou senha incorretos ou alguma mensagem de exceção/erro - linhas 33 a 38).

A gente está acostumado a retornar o success no ExtJS, mas como você pode ver, a gente pode retornar qualquer flag de true/false que nesse caso não faz diferença.

E caso tenha alguma falha de comunicação com o servidor, a gente também exibe uma mensagem para o usuário, pedindo para ele/ela entrar em contato com alguém, já que isso não é falha do usuário, e sim do sistema.

Vamos ver nossos 3 cenários novamente para ver o resultado e um cenário 4 (erro com banco de dados).

Cenário 1: entre com usuário e senha "admin"

Esse é o resultado:

Parece ok né? É porque esse é o resultado esperado.

Cenário 2: entre com usuário "abc" e senha "abc"

Esse é o resultado:

Resultado é o esperado.

Cenário 3: Renomeie o arquivo login.php para login_.php

Quando o ExtJS tentar executar o login.php, teremos um erro 404 - de URL não encontrada.

Entre com usuário e senha "admin".

Esse é o resultado.

Agora sim temos uma mensagem que significa algo!

Cenário 4: Erro/Exception com Banco de Dados

Vá no arquivo db.php e troque a senha do banco de dados - para uma errada. Queremos que o php lance um erro.

Entre com usuário e senha "admin".

Esse é o resultado.

Erro no banco de dados. Mesmo assim caiu no success (o request chegou ao servidor, mas teve um erro no código). E a gente consegue mostrar uma mensagem mais útil também.

Viu como codificar corretamente faz toda a diferença? :)

Usando Funções de Escopo

Bem, não basta codificar corretamente, temos que codificar bonito também! Esse terceiro tópico é uma boa prática a ser seguida, ou seja, é opcional, mas é sempre legal a gente seguir boas práticas (isso nos torna desenvolvedores melhores também!).

No nosso exemplo, tem pouco código dentro das funções de callback. Se você pegar um sistema de verdade, geralmente tem bem mais código, e deixar tudo junto assim acaba ficando muito grande e mais complicado pra ler (e também pra dar manutanção).

onButtonClickBestPractice: function(button, e, eOpts) {
    var formPanel = button.up('form'),
        user = formPanel.down('textfield#user').getValue(),
        pass = formPanel.down('textfield#pass').getValue();

    Ext.Ajax.request({
        url: 'php/login.php',
        params: {
            user: user,
            password: pass
        },
        scope: this,
        success: this.onLoginSucess,
        failure: this.onLoginFailure
    });
}

Pra deixar o código mais limpo e mais bonito e podendo reusar código, vamos usar funções de escopo. Vamos ter como escopo o próprio Controller (linha 12).

Se você quiser saber o que acontece em caso de success, basta ir até o função onLoginSuccess e caso failure, basta ir até a função onLoginFailure. Bem mais organizado.

Vamos ver a função onLoginSuccess primeiro:

onLoginSucess: function(conn, response, options, eOpts) {
    var result = Ext.JSON.decode(conn.responseText, true);

    console.log(result);

    if (!result){ // caso seja null
        result = {};
        result.success = false;
        result.msg = conn.responseText;
    }

    if (result.success) {

        this.showMessage('Info', result.msg, Ext.Msg.INFO);

    } else {

        this.showMessage('Erro', result.msg, Ext.Msg.ERROR);

    }
}

É o mesmo código que apresentamos no tópico anterior, só que criamos uma outra função que recebe o título, a mensagem e o ícone a ser mostrado no alerta:

showMessage: function(title, msg, icon) {
    Ext.Msg.show({
        title: title,
        msg: msg,
        icon: icon,
        buttons: Ext.Msg.OK
    });
}

Assim dá pra gente já fazer um reuso de código. Você ainda pode criar uma classe Util para funções assim. E por exemplo, na parte que faz o decode da mensagem do server e criar o objeto result, você pode criar uma função para isso também. Geralmente faço isso para seguir um padrão de retorno do server e também manter um padrão no código inteiro.

Vamos agora para a função de failure:

onLoginFailure: function(conn, response, options, eOpts) {
    this.showMessage('Erro - Contate Administrador do sistema!', conn.responseText, Ext.Msg.ERROR);
}

Muito mais limpo o código né?

São pequenas coisas assim que fazem a diferença. Pode parecer que isso não faz diferença, mas faz sim. Tem diferença na performance e quando fazemos o build de produção, o arquivo fica menor e com isso o javascript da app fica com um tamanho menor (em apps maiores - da vida real - é que a gente percebe essa diferença). E o melhor, faz muita diferença depois de um tempo que você (ou outro desenvolvedor) vai ler esse código.

Download do Código Fonte Completo

Quem tiver interesse de fazer download e brincar para ver a diferença, segue repositório do github (tá em forma de projeto do Sencha Architect 3 também): https://github.com/loiane/extjs-ajax-request-example

Espero que tenham gostado desse tutorial, tempo que não escrevia algo um pouco mais intermediário-avançado.

Se tiverem mais alguma boa prática que querem compartilhar, basta deixar nos comentários!

Até a próxima! :)

redpajama_set_name: RedPajamaGithub


text:
Leonard Randolph "Lenny" Wilkens, född 28 oktober 1937 i Brooklyn i New York, är en amerikansk före detta basketspelare och basketcoach i NBA. Han har blivit invald till Basketball Hall of Fame tre gånger. Först 1989 som spelare, sedan som coach 1998 och till sist som assisterande coach till det amerikanska "The Dream Team"-laget.

Lag

Som spelare
 St. Louis Hawks (1960–1968)
 Seattle SuperSonics (1968–1972)
 Cleveland Cavaliers (1972–1974)
 Portland Trail Blazers (1974–1975)

Som tränare
 Seattle SuperSonics (1969–1972)
 Portland Trail Blazers (1974–1976)
 Seattle SuperSonics (1977–1985)
 Cleveland Cavaliers (1986–1993)
 Atlanta Hawks (1993–2000)
 Toronto Raptors (2000–2003)
 New York Knicks (2004–2005)

Externa länkar

  (som spelare)
  (som tränare)
 Lenny Wilkens på Basketball-Reference.com(som spelare)
 Lenny Wilkens på Basketball-Reference.com (som tränare)

Födda 1937
Levande personer
Amerikanska baskettränare
Amerikanska basketspelare
Män
Personer från Brooklyn
Spelare i St. Louis Hawks
Spelare i Seattle Supersonics
Spelare i Cleveland Cavaliers
Spelare i Portland Trail Blazers
Huvudtränare i Seattle Supersonics
Huvudtränare i Portland Trail Blazers
Huvudtränare i Cleveland Cavaliers
Huvudtränare i Atlanta Hawks
Huvudtränare i Toronto Raptors
Huvudtränare i New York Knicks
Alumner från Providence College
Idrottare i Providence Friars


Newborn photos...oh so precious. I know some people prefer to wait until baby is more alert to capture the really early memories, but personally, I love myself a tiny, snuggly, SLEEPY babe. We had S's pictures taken when she was just nine days young, and I love each and every one! As you might notice, her older brothers were a bit less than cooperative (make sure you look at the family pics!...OMG!) on picture day, but our amazing photographer did an excellent job with photoshop to get one really special picture of our three little munchkins all together. As for S, she was the perfect little sweetheart, and after a mid-session nursing break, she did a wonderful job surviving her first photoshoot. Love our little family...or rather family filled with little people!


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How does the SDK send logs to AdTag?
This tutorial will teach you how to tag your application with our mobile SDK, in order to retrieve and leverage all the beacon interaction analytics related to alerts from the Adtag platform.
The Adtag platform generates many types of analytics around the beacon usage and interactions, based on the logs created by the mobile SDK.
While the mobile SDK automatically generates some logs, others need to be tagged manually in the application by developers.
The SDK uses the AdtagLogsManager to send logs to the Adtag platform.
The AdtagLogsManager saves the logs in a specific database, and sends them in a dedicated thread when a maximum number of logs or a maximum waiting time is reached.
A pushLogsNow method also exists in the SDK, to immediately send the logs saved in the database to the AdTag platform, each time a notification is displayed.
Each time a beacon alert is displayed, the SDK generates an analytics log automatically.
Every 'click-through' action from an alert opens a new Activity. Developers must 'tag' their application using the SDK to generate a corresponding log.
This is what Connecthings calls a redirect log.
and the login, password, and company informations received from Connecthings.
You must have completed the creating a beacon alert tutorial to continue.
In the viewDidLoad method, add the [ATBeaconManager sendRedictLog:beaconContent redirectType:redirectType from:from] method to generate an alert log.
In Xcode, launch the installation of the application you just built on your mobile phone.
The title of the alert appears, as defined in Adtag, along with a button and the following text: Click to get more information.
Click on the button and access the detailed content of the alert.
You have generated your first alert logs!


Returns will be accepted only with a previously approved Returned Merchandise Authorization (RMA). Only unopened and undamaged products will be accepted. The customer will be held responsible for shipping costs and a 20% restocking fee.


[Lee's Summit, MO, 10/11/2018] – Cornerstone Dermatology & Surgery Group is excited to announce Dr. David Fieleke has been named as the official team dermatologist for the Kansas City Mavericks ice hockey team for the 2018-2019 season, opening October 12, 2018. In his partnership with the team, Dr. Fieleke will use his knowledge of both general and sports dermatology to expertly treat Mavericks players.
Dr. Fieleke grew up in the Kansas City area cheering on hometown sports teams. He earned his medical degree from the University of Missouri in 2007. He remained in Columbia to complete his dermatology residency. After moving back to the Kansas City area, he completed a skin cancer surgery fellowship from 2013 to 2014.
He plans to provide Mavericks players not only with expert and efficient care for their acute skin health needs that arise throughout the season but also with access to comprehensive skin cancer exams, should they desire.
The Kansas City Mavericks, owned by Lamar Hunt, Jr., are entering their 10th year as Kansas City's professional hockey team. They play at Silverstein Eye Centers arena on a 72-game schedule that features 36 home dates. Single-game tickets, season tickets and mini packs for the upcoming season are all on sale. For information visit the Kansas City Mavericks online at www.kcmavericks.com or call (816) 252-7825.
Dr. Fieleke has served his hometown of Lee's Summit and the many surrounding communities with excellent, compassionate care since 2011. In July, 2018, he began caring for patients at his new practice, Cornerstone Dermatology & Surgery Group. For more information, contact Cornerstone Dermatology at (816) 287-1528 or visit www.cornerstonedermatology.com. Follow along with our practice on Facebook (Cornerstone Dermatology & Surgery Group) and Instagram (@cornerstonederm).
[Lee's Summit, MO, 9/4/2018] – Cornerstone Dermatology & Surgery Group welcomes the community to celebrate its grand opening with a Lee's Summit Chamber of Commerce ribbon cutting at 4 p.m. on Wednesday, September 12 at 601 NW O'Brien Road. A reception and open house will follow. Guests will be invited to tour the new office and enjoy food, drinks and skincare product samples.
Dr. David Fieleke is a board-certified dermatologist and fellowship-trained skin cancer surgeon, skilled in both general dermatology and the advanced surgical and reconstructive treatment of skin cancer. He and his family made Lee's Summit home in 2011. He appreciates the continued opportunity to care for patients of all ages in his new office location, which opened in July 2018.
The 3,350 square-foot medical office renovation began in March 2018 and was completed in June 2018. Each clinic room was designed for patients' comfort during medical consultation and also specially equipped for surgical procedures, including Mohs micrographic surgery.
Mohs micrographic surgery is an advanced treatment for basal cell and squamous cell carcinoma. It is used for higher-risk skin cancers or in areas where there is not as much surrounding skin or tissue, such as the face, ears, scalp and hands. Following his dermatology training, Dr. Fieleke completed a Mohs surgery fellowship during which he received extensive training in surgical and reconstructive techniques. He has since completed over 5,000 Mohs surgeries.
[Lee's Summit, MO, 7/23/2018] – David Fieleke, MD, board-certified dermatologist and skin cancer surgeon with Cornerstone Dermatology & Surgery Group in Lee's Summit, will hold a free American Academy of Dermatology SPOTmeTM skin cancer screening from 9:30 to 11:30 a.m. Saturday August 4 in the meeting room at Carnegie Village.
No appointment is necessary. Screenings will be offered on a first-come, first-served basis during specified hours. The screening is intended to check one or two areas of concern. A clinic appointment should be made for more extensive examinations or to discuss other skin concerns.
SPOTmeTM is the free skin cancer screening program of the American Academy of Dermatology. Since 1985, Academy dermatologists have conducted more than 2.4 million free skin cancer screenings and have detected nearly 238,000 suspicious lesions, including more than 26,500 suspected melanomas.
To learn more about the SPOT meTM free skin cancer screening program and to find a free skin cancer screening near you, visit www.spotme.org.
Dr. Fieleke has served his hometown of Lee's Summit and the many surrounding communities with excellent, compassionate care since 2011. He is originally from the Belton/Raymore area. For more information, contact Cornerstone Dermatology at (816) 287-1528 or visit www.cornerstonedermatology.com. Follow along with our practice on Facebook (Cornerstone Dermatology & Surgery Group) and Instagram (@cornerstonederm).
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology), Twitter (@AADskin) and YouTube (Academy of Dermatology).
Friday, June 1: 12 p.m. – 7 p.m.
Saturday, June 2: 10 a.m. – 7 p.m.
Sunday, June 3: 11 a.m. – 4 p.m.
"Skin cancer is the most common form of cancer and everyone is at risk, even those with darker skin types," says David Fieleke, MD. "While skin cancer is highly treatable when caught early, it can be deadly. That's why free screenings like this one are so important." No appointment is necessary. Screenings will be offered on a first-come, first-served basis during specified hours. The screening is intended to check one or two areas of concern. A clinic appointment should be made for more extensive examinations or to discuss other skin concerns. "Unlike other cancers, skin cancer can be detected by a dermatologist during a visual exam of your skin," says Dr. Fieleke. "A skin cancer screening only takes a few minutes and it could save your life." SPOTmeTM is the free skin cancer screening program of the American Academy of Dermatology. Since 1985, Academy dermatologists have conducted more than 2.4 million free skin cancer screenings and have detected nearly 238,000 suspicious lesions, including more than 26,500 suspected melanomas. To learn more about the SPOT meTM free skin cancer screening program and to find a free skin cancer screening near you, visit www.spotme.org.
Dr. Fieleke has served his hometown of Lee's Summit and the many surrounding communities with excellent, compassionate care since 2011. In July, 2018, he will begin seeing patients at his new practice, Cornerstone Dermatology & Surgery Group. For more information, contact Cornerstone Dermatology at (816) 287-1528 or visit www.cornerstonedermatology.com. Follow along with our practice on Facebook (Cornerstone Dermatology & Surgery Group) and Instagram (@cornerstonederm). Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology), Twitter (@AADskin) and YouTube (Academy of Dermatology). .