Emasu Alice, Ruder Bonnie, Wall L Lewis, Matovu Alphonsus, Alia Godfrey, Barageine Justus Kafunjo
TERREWODE Administration, Central Avenue, Soroti, Uganda.
Department of Anthropology, Oregon State University, Corvallis, OR, USA.
Int Urogynecol J. 2019 Jul;30(7):1101-1110. doi: 10.1007/s00192-019-03896-y. Epub 2019 Feb 27.
Genitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery.
A cross-sectional survey of 61 young women aged 14-24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS.
Ongoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although >90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery-including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies-negatively impacted women's relationships and self-esteem.
Young women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.
泌尿生殖瘘（通常在产程延长受阻后出现）对低收入国家的女性而言危害极大。手术修复往往困难且延迟。尽管人们对手术技术问题给予了诸多关注，但手术治疗后回归正常个人、家庭和社区生活所面临的挑战却较少受到研究人员的审视。我们对从泌尿生殖瘘手术中康复的乌干达年轻女性进行了调查，以评估她们术后社会重新融入的需求。
术后6个月对61名年龄在14 - 24岁的年轻女性进行了横断面调查。使用标准化的、由访谈者主导的半结构化问卷以当地语言进行访谈。数据用EpiData录入并用SPSS分析。
持续的重新融入需求涉及相互关联的医疗、经济和心理社会领域。尽管超过90%的瘘管成功闭合，但超过一半的女性有需要持续治疗的合并症。身体限制，如足下垂和盆底肌肉功能障碍影响了她们工作和恢复婚姻关系的能力。对生活安排、收入、体力、未来生育能力、配偶/伴侣的忠诚和支持以及可能遭受经济剥削的担忧很常见。术后性功能障碍，包括性交困难、性欲减退、性交恐惧以及对未来妊娠结局的焦虑，对女性的人际关系和自尊产生了负面影响。
从泌尿生殖瘘手术中康复的年轻女性需要对其社会重新融入需求进行个体化评估。必须加强术后社会重新融入服务以有效做到这一点。
