Rehabilitative care practices in the management of childbirth-related pelvic fistula: A systematic review

Keyser, Laura; McKinney, Jessica; Hosterman, Lauren; Chen, Grace

doi:10.1007/s00192-021-04845-4

Cited by 3 publications

(2 citation statements)

References 49 publications

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“…Prior studies have reported that rehabilitative practices surrounding fistula repair lack consistency and would benefit greatly from patient-centered care pathways that address specific postoperative complaints. 32 Our findings similarly support the call for increased investment in holistic rehabilitation to improve long-term health and social outcomes. 32 Our findings underscore the need for continued investigation and improvement of functional outcomes alongside anatomic repair, as cited in other literature.…”

Section: Discussionsupporting

confidence: 76%

“…32 Our findings similarly support the call for increased investment in holistic rehabilitation to improve long-term health and social outcomes. 32 Our findings underscore the need for continued investigation and improvement of functional outcomes alongside anatomic repair, as cited in other literature. 33 Another key finding related to decision making about resuming sex postrepair involved the increased risk of acquiring a sexually transmitted disease.…”

Section: Discussionsupporting

confidence: 76%

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Women’s sexual activity and experiences following female genital fistula surgery

Ayadi

Nalubwama

Miller

et al. 2023

The Journal of Sexual Medicine

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Background Surgical repair has been found to have a transformative impact on the lives of women affected by female genital fistula, however, various physical, social, and economic challenges may persist post-repair preventing complete reengagement in relationships and communities. Nuanced investigation of these experiences is needed to inform programming that aligns with women’s reintegration needs. Aim We investigated sexual activity resumption, experiences, and concerns of Ugandan women during the year following genital fistula repair surgery. Methods Women were recruited from Mulago Hospital between December 2014 and June 2015. We collected data at baseline and four times post-surgery about socio-demographic characteristics and physical/psychosocial status; and assessed sexual interest and satisfaction twice. We performed in-depth interviews with a subset of participants. We analyzed quantitative findings descriptively, coded and analyzed qualitative data thematically, and integrated mixed-methods findings in interpretation. Outcomes Sexual activity, pain with sex, sexual interest/disinterest, and sexual satisfaction/dissatisfaction were measured quantitatively whereas sexual readiness, fears, and challenges following surgical repair of female genital fistula were assessed qualitatively. Results Among the 60 participants, 18% were sexually active at baseline, which decreased to 7% post-surgery, and increased to 55% at one year after repair. Dyspareunia was reported by 27% at baseline and 10% at one year, few described leakage during sex or vaginal dryness. Qualitative findings showed wide variance of sexual experiences. Some reported sexual readiness quickly after surgery and some were not ready after one year. For all, fears included fistula recurrence and unwanted pregnancy. Clinical Implications In addition to physical repair, ongoing psychosocial support is needed for comprehensive reintegration and the restoration of desired sexuality. Strengths & Limitations Our mixed-methods findings add nuance and depth to the understanding of women’s postoperative sexual experiences; however, our study would have been strengthened by the inclusion of clinical data and a more detailed sexual dysfunction assessment. Conclusion Post-repair sexual experiences vary widely and intersect meaningfully with marital and social roles following fistula and repair, necessitating attention to physical and psychosocial domains of sexuality among this population.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 76%

Women’s sexual activity and experiences following female genital fistula surgery

Ayadi

Nalubwama

Miller

et al. 2023

The Journal of Sexual Medicine

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Development and Pilot Test of a Multi-Component Intervention to Support Women’s Recovery from Female Genital Fistula

Barageine,

Nalubwama,

Obore

et al. 2024

Int Urogynecol J

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Introduction and hypothesis We evaluated a pilot multi-component reintegration intervention to improve women’s physical and psychosocial quality of life after genital fistula surgery. Methods Twelve women undergoing fistula repair at Mulago Specialized Women and Neonatal Hospital (Kampala, Uganda) anticipated in a 2-week multi-component intervention including health education, psychosocial therapy, physiotherapy, and economic investment. We assessed feasibility through recruitment, retention, and adherence, acceptability through intervention satisfaction, and preliminary effectiveness through reintegration, mental health, physical health, and economic status. We collected quantitative data at enrollment, 6 weeks, 3 months, and 6 months. We conducted in-depth interviews with six participants. Quantitative data are presented descriptively, and qualitative data analyzed thematically. Results Participants had a median age of 34.5 years (25.5–38.0), 50% were married/partnered, 42% were separated, 50$ had completed less than primary education, and 67% were unemployed. Mean number of sessions received was 12 for health education (range 5–15), 8 for counseling (range 8–9), and 6 for physiotherapy (range 4–8). Feasibility was demonstrated by study acceptance among all those eligible (100%); comfort with study measures, data collection frequency and approach; and procedural fidelity. Acceptability was high; all participants reported being very satisfied with the intervention and each of the components. Participant narratives echoed quantitative findings and contributed nuanced perspectives to understanding approach and content. Conclusions Our results suggest that the intervention and associated research were both feasible and acceptable, and suggested certain modifications to the intervention protocol to reduce participant burden. Further research to determine the effectiveness of the intervention above and beyond surgery alone with regard to the health and well-being of women with fistulas is warranted.

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Current Resources for Evidence-Based Practice, January 2022

Bovbjerg¹,

Horan²

2022

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Rehabilitative care practices in the management of childbirth-related pelvic fistula: A systematic review

Cited by 3 publications

References 49 publications

Women’s sexual activity and experiences following female genital fistula surgery

Women’s sexual activity and experiences following female genital fistula surgery

Development and Pilot Test of a Multi-Component Intervention to Support Women’s Recovery from Female Genital Fistula

Current Resources for Evidence-Based Practice, January 2022

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