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June 2004, Vol. 10, No. 2 Women's Health Since the late 1980s, comprehensive studies from Egypt, India, Nigeria, and Turkey have revealed the widespread prevalence of reproductive tract and other gynecologic disorders. These findings have prompted researchers to expand this work to explore the pervasiveness of these illnesses and to shed light on factors that place women at risk. But what are the best ways to conduct this type of research? Population Council senior program associate Shireen Jejeebhoy; Michael Koenig, associate professor, Bloomberg School of Public Health, Johns Hopkins University; and Christopher Elias, president, Program for Appropriate Technology in Health (PATH), have collaborated on a book, Reproductive Tract Infections and Other Gynaecological Disorders: A Multidisciplinary Research Approach, that tackles this question. The editors draw upon the considerable experience of their contributing authors and provide a synthesis of the best approaches for studying this topic. A spectrum of reproductive ailments can affect women. Reproductive tract infections (RTIs) are some of the most common. They can be transmitted sexually, produced by an overgrowth of normal microorganisms, or result from infections related to abortion, childbirth, sterilization, or the insertion of an intrauterine device. Women may also develop gynecologic cancers, endocrine disorders, genital prolapse (a painful condition in which the uterus or vagina is displaced downward), obstetric fistulae (a loss of tissue between the vagina and bladder and/or rectum caused by obstructed labor), infertility, sexual dysfunction, and menopausal symptoms. Discomfort caused by these conditions can impair a woman’s ability to engage in a wide range of activities and can damage marital and sexual relationships and psychological well-being. Although it is important to determine the prevalence of these disorders, it is equally crucial to understand their social, behavioral, and biomedical precursors. Jejeebhoy and Koenig offer a conceptual framework for exploring the social context of gynecologic disorders. Key to this framework is the difference between disease and illness. Although many infections among women produce no symptoms, clinical examination and, in particular, laboratory tests can confirm the presence of disease. Conversely, many women who report symptoms have no medically verifiable disease. The authors underscore the fact that the association between self-reported, clinically diagnosed, and laboratory-tested conditions remains poor, and draw a distinction between disease, which can be medically confirmed, and illness, which involves women’s perceived symptoms. Best study practices Koenig and contributor Mary Shepard, also of Johns Hopkins University, suggest that facility-based studies—which can enroll women seeking family planning or health services, or women in settings such as schools or the workplace—are less expensive, often more feasible than community-based studies, and likely to achieve high compliance rates. However, they are subject to selection bias and ethical concerns related to women’s voluntary participation. One of the challenges posed by the research that has already been done on gynecologic disorders is the lack of consistency across studies due to different definitions of disease, different clinician assessments, and the inclusion of different diseases. Elias and contributors Nicola Low of the University of Bristol and Sarah Hawkes of the London School of Hygiene and Tropical Medicine recommend that all broad-based studies of gynecologic disease include laboratory testing for a core group of reproductive-tract pathogens. Although many women have declined to participate in such studies because they wish to avoid pelvic examinations, new methods for diagnosing disease may help to overcome this hurdle. These techniques include self-administered vaginal swabs, urine tests, saliva tests, and finger- stick blood tests. An integrated approach Because studies of gynecologic disorders are so complex, the authors contend, they should be conducted infrequently, using multidisciplinary research teams, and only when financial and infrastructural resources are in place. And, while researchers do not typically implement interventions, they should disseminate findings to the broader community of health care providers, educational institutions, media, policymakers, and program managers and make practical suggestions for action. The research approaches outlined in this volume will produce findings that are robust enough to offer meaningful programmatic and policy responses, say Jejeebhoy, Koenig, and Elias. Source See Also
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