The burden of reproductive disease in rural women in the Gambia, West Africa

Morison

Fiander

et al. 2002

BJOG

Pelvic organ prolapse has a high prevalence in this first community-based study of prolapse in West Africa. Many of those affected did not complain about their problem, thus increasing the large, silent burden of reproductive morbidity in this population. Parity was confirmed to be the strongest risk factor followed by age and anaemia. Ethnic origin was a previously unknown risk factor suggesting possible genetic factors in the pathogenesis of prolapse.

Section: Discussionsupporting

confidence: 92%

“…The methodology of the study has been described extensively elsewhere 11 . Briefly, a cluster sampling scheme was used.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of pelvic organ prolapse in rural Gambia, West Africa

Morison

Fiander

et al. 2002

BJOG

“…Use of modern family planning is uncommon (6%) and only 3.1% of women have attended primary school. Around 95% of women report farming and working in the household as their main occupation (Walraven et al . 2001).…”

Section: Introductionmentioning

confidence: 99%

The long‐term reproductive health consequences of female genital cutting in rural Gambia: a community‐based survey

Morison

Tropical Med Int Health

Ekpo

et al. 2001

212

146

SummaryThis paper examines the association between traditional practices of female genital cutting (FGC) and adult women's reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15±54 years, to estimate the prevalence of reproductive morbidity on the basis of women's reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classi®cation type II) and were performed between the ages of 4 and 7 years.

“…The authors describe symptoms of genital infection as ‘robust’ indicators of sexual activity, even while acknowledging the poor correlation between these and laboratory diagnosed conditions. Even if symptoms do give some indication of actual infection, other studies in West Africa 3 show these to consist mainly of the endogenous conditions bacterial vaginosis and candida rather than the sexually transmitted infections chlamydia or gonorrhoea. Finally, if differences between cut and uncut women in prevalences of those reporting symptoms did indicate differences in prevalence of sexually transmitted infections, this might imply differences in sexual behaviour patterns or biological susceptibility to infection but would not allow conclusions about sexual fulfilment or feelings.…”

mentioning

confidence: 93%

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

Morrison

2003

BJOG

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria Sir,We feel that the conclusion of Okonofua et al. 1 that female genital cutting 'did not attenuate sexual feelings' is a dangerous over-interpretation of their results.The authors do not acknowledge the difficulties inherent in gathering data on sexual pleasure. Their conclusions are based in part on responses to structured questions about frequency of orgasm and sensitivity of body parts that make many assumptions about women's understanding of sexual pleasure, anatomy and willingness to answer such questions. There is no discussion of the validity of the responses to these questions or the subtle ways in which sexual experiences might be understood and reported differently by cut and uncut women. The authors also ignore the fact that women may initiate sex for reasons other than sexual pleasure, such as in order to conceive 2 and that pressures for high fertility may be stronger among cut women. Nor do they mention the possible bias inherent in the inclusion only of women attending family planning and antenatal clinics (i.e. sexually active women).The authors describe symptoms of genital infection as 'robust' indicators of sexual activity, even while acknowledging the poor correlation between these and laboratory diagnosed conditions. Even if symptoms do give some indication of actual infection, other studies in West Africa 3 show these to consist mainly of the endogenous conditions bacterial vaginosis and candida rather than the sexually transmitted infections chlamydia or gonorrhoea. Finally, if differences between cut and uncut women in prevalences of those reporting symptoms did indicate differences in prevalence of sexually transmitted infections, this might imply differences in sexual behaviour patterns or biological susceptibility to infection but would not allow conclusions about sexual fulfilment or feelings.Therefore, while we agree that there is no suggestion from the data that cut women are less sexually active or less susceptible to genital infections or pregnancy at an early age than uncut women, the conclusion that female genital cutting does not attenuate sexual feelings does not follow.Finally, even if the conclusion that female genital cutting does not attenuate sexual feelings appears to undermine the arguments of traditional defenders of female genital cutting, it also undermines the efforts of anti-cutting advocates. Researchers in this sensitive area must be careful to interpret data objectively rather than meet advocacy needs. First, we are happy that the authors acknowledge that the relationship between female genital cutting and sexuality is an important issue to study, as part of efforts to examine the wider implications of the practice in sub-Saharan Africa. This is because the need to reduce sexual feeling and promote chastity have been shown to be the most important reasons proffered by advocates of female genital cutting in many parts of Africa. We recognise ...