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

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.