Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94518, USA.
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
Reprod Health. 2023 Aug 19;20(1):121. doi: 10.1186/s12978-023-01663-3.
Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes.
We examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use.
Median participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods.
A high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.
女性生殖器瘘管主要由分娩过程中长时间的梗阻引起，通过手术修复进行治疗。为确保充分愈合和优化修复后效果，建议在修复后至少一段时间内避免怀孕。
我们使用混合方法，在生殖器瘘管手术后的一年中，检查了 60 名乌干达瘘管患者的避孕偏好和使用情况。术后 12 个月内，每季度记录性行为、避孕措施使用和妊娠情况。通过有针对性选择的参与者（n=30）的深入访谈，探讨了亲密关系、性体验、生育意愿和避孕措施使用情况。
参与者的中位年龄为 28 岁，近一半（48%）已婚或与伴侣生活在一起。97%的参与者接受了关于延迟性生活的咨询，但只有 59%接受了关于避孕的咨询。术后 6 个月有 32%报告有性行为，12 个月后有 50%报告有性行为。83%的人表示没有尝试怀孕。在有性行为的参与者中，基线时的避孕措施使用率较低（36%），但 12 个月时增加到 73%。有 6 名（10%）妇女怀孕，其中 2 名妇女在修复后 3 个月内怀孕。希望立即生育孩子的访谈参与者较为年轻，生育的孩子较少，在瘘管发展过程中经历过死产，并感受到来自伴侣的压力。女性采用避孕措施是为了从瘘管手术中完全康复并避免不良后果。其他人只是单纯地选择推迟生育。不采用避孕措施的原因包括与生育能力和避孕方法相关的误解，以及医疗保健提供者提供的关于其首选方法的建议不足或不明确。
相当一部分患者未接受医疗保健提供者关于避孕的咨询。在瘘管手术时及之后提供全面以患者为中心的避孕咨询，对于患者优化瘘管愈合、最小化复发率以及满足自身生殖偏好都很重要。
