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Physical etiology of sexual dysfunction in obstetric fistula patients: A prospective study
Rachel Mernoff1, Sperecy Chigwale2, Rachel Pope3
1Joint Medical Program, University of California, San Francisco and University of California, Berkeley, CA, USA.
Objective:
To understand how the physical etiology of sexual dysfunction among women with obstetric fistulas can inform repair.
Methods:
A prospective cohort study included women aged 18 years or over presenting at the Fistula Care Center, Bwaila Maternity Hospital, Lilongwe, Malawi, with obstetric vesicovaginal fistula before and after repair. The study took place between January 1, 2018, and December 31, 2018, and involved physical examinations and interviews. The primary outcome was sexual function.
Results:
115 were interviewed before and after repair. 44 (40.0%) preoperatively and 14 (12.2%) postoperatively reported sexual dysfunction. 94 women (81.7%) had little or no interest in sexual activity before repair. 55 women (47.8%) had little or no interest in sexual activity after repair. Before surgery, 69 women (60.0%) were not sexually active in the 30 days before coming to the Fistula Care Centre. After surgery, 32 women (27.8%) were not sexually active in the 30 days before returning to the Fistula Care Centre. Of those who were not sexually active in the 30 days before coming to the Fistula Care Centre (n=69), the majority cited their health as a reason before repair (n=45, 65.2%), while the most commonly cited reason after repair was an absent partner (n=23, 35%).
Conclusion:
Given the significant percentage of women with obstetric fistula reporting sexual dysfunction after repair, a more holistic perspective of health outcomes should be considered. Further investment should be made in screening tools and surgical techniques targeting sexual dysfunction.
