Objective To describe the prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in India.Design Cross-sectional survey.Setting Catchment area of primary health centre in Goa, India.Population Three thousand women aged 18-45 years randomly selected. A total of 2494 women consented to participate (83.1%).Methods Eligible participants were asked standardised questions regarding menstrual complaints over the past 12 months, and socio-demographic, psychosocial and reproductive risk factors. Vaginal or urine specimens were collected for the diagnosis of reproductive tract infections.Main outcome measures Dysmenorrhoea of moderate to severe intensity.Results A total of 2262 women were eligible. More than half reported dysmenorrhoea; moderate to severe dysmenorrhoea was reported by 755 participants (33.4%, 95% CI 31.4-35.4). There was a linear association between severity of pain and impact (medication and taking rest) and the onset of pain (premenstrual onset associated with more severe pain). On multivariate analyses, the risk of moderate-severe dysmenorrhoea was associated with the experience of violence (OR 2.23, 95% CI 1.5-34); other somatic complaints (OR 3.67, 95% CI 2.7-4.9 for highest somatoform symptom score category compared with the lowest); gynaecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI 1.3-2.3; dysuria: OR 1.98, 1.4-2.7); menorrhagia (OR 1.92, 95% CI 1.4-2.6); and illiteracy (OR 1.32, 95% CI 1.0-1.7). Having had a pregnancy (OR 0.53, 95% CI 0.4-0.7), older age of menarche (OR 0.70, 95% CI 0.5-0.9, for age >14 compared with <13 years) and older age (OR 0.43, 0.3-0.6 for age 40-50, compared with 18-24 years) were protective.Conclusions The burden of dysmenorrhoea is greater than any other gynaecological complaint, and is associated with significant impact. Social disadvantage, co-morbidity with other somatic syndromes and reproductive factors are determinants of this complaint.

Objectives: Low participation rates for gynaecological examination and low reliability of clinical reporting of gynaecological examination findings are problems in community studies of gynaecological morbidity in India. This pilot study aimed to describe the reliability of a new examination protocol for recording the findings of gynaecological examination and the reliability and acceptability of the use of self administered vaginal swabs for the diagnosis of reproductive tract infections. Method: 75 women attending a gynaecology outpatient clinic were purposively sampled. Each woman was examined by two gynaecologists independently who recorded findings on the new examination protocol. Two swabs were collected from each woman, one by the gynaecologist and one by the woman. Swabs were smeared on separate slides which were stained and read for bacterial vaginosis and candidiasis by laboratory technicians blind to the mode of collection of the slides. Results: The study showed a high inter-rater reliability for most of the items of the examination protocol. The interslide agreement for the diagnosis of the two RTIs was high. One third of women preferred the self administered swab. Conclusions:The examination protocol is a reliable method of recording gynaecological examination findings, and self administered swabs a useful way of obtaining vaginal specimens from women who did not wish to undergo gynaecological examinations in studies in the Indian setting. V aginal discharge is one of the commonest complaints in women in south Asia.1 2 There is poor concordance between self reported symptoms and laboratory confirmed reproductive tract infections (RTIs) limiting the usefulness of the syndromic approach to the management of RTIs.3 4 Many studies on gynaecological symptoms have suffered from low participation rates as a result of women's reluctance to undergo gynaecological examinations and the unreliability of gynaecological examination reports. This pilot study aimed to evaluate the reliability of a new examination protocol for vaginal examination 5 and to evaluate the acceptability and reliability of self administered vaginal swabs for the collection of vaginal specimens for the detection of candidiasis and bacterial vaginosis. The study was a pilot investigation aimed to guide the methodology of community studies of the aetiology of vaginal discharge where the use of self administered swabs could improve participation rates.This study aimed (1) to evaluate the inter-rater reliability of a new examination protocol for recording the findings of gynaecological examination; (2) to evaluate the acceptability of the use of self administered swabs versus gynaecologist administered swabs; and (3) to estimate the reliability of detection of RTIs (candidiasis and bacterial vaginosis) of such swabs by comparing the diagnostic yield of self administered and gynaecologist administered swabs. METHOD Setting and sampleWomen between 18-45 years of age attending the gynaecological outpatients department of Goa Medical College, were...