Obstetric fistula and safe spaces: discussions of stigmatised healthcare topics at a fistula centre.

Obstetric fistula can have major psychosocial repercussions for women and their families, which are often hidden as a result of stigmatisation. We investigated how the sexual function of women with vesicovaginal fistula differs before and after fistula repair at the Fistula Care Centre in Lilongwe, Malawi. Structured interviews and physical examinations were conducted with 115 women from the central region of Malawi. The average age of participants was 32 years and the majority lived in rural communities. Patients were more responsive than expected to discussing how genital modification, gender-based violence, marital relationships and traditional medicine impact their sexual function. Of the 115 participants interviewed, 107 (93%) reported stretching their labia and 42 (37%) were coerced into sexual activities before surgery. Before repair, 56 (49%) women reported husbands being unfaithful. 12 (10%) had new cowives after surgery. 38 (33%) used traditional medicine to enhance their sexual function before surgery. We conclude that specialised centres providing care for women, such as a fistula centre, might offer a unique space in which women can more comfortably discuss stigmatised subjects. This suggests that such issues should be incorporated into services where appropriate.