{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:06:48Z","timestamp":1792786008493,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R00HD086232"],"award-info":[{"award-number":["R00HD086232"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"US National Institutes of Health","doi-asserted-by":"publisher","award":["R21HD075008"],"award-info":[{"award-number":["R21HD075008"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001622","name":"Fistula Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001622","id-type":"DOI","asserted-by":"publisher"}]},{"name":"US Agency for International Development via the Fistula Care Plus Project"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical repair has a transformative impact on the lives of women affected by female genital fistula; however, various physical, social, and economic challenges may persist postrepair and prevent complete reengagement in relationships and communities. Nuanced investigation of these experiences is needed to inform programming that aligns with women\u2019s reintegration needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We investigated the sexual activity resumption, experiences, and concerns of women in Uganda during the year following genital fistula repair surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women were recruited from Mulago Hospital between December 2014 and June 2015. We collected data at baseline and 4 times postsurgery about sociodemographic characteristics and physical\/psychosocial status; we also assessed sexual interest and satisfaction twice. We performed in-depth interviews with a subset of participants. We analyzed quantitative findings via univariate analyses, and qualitative findings were coded and analyzed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>We assessed sexual readiness, fears, and challenges following surgical repair of female genital fistula using quantitative and qualitative measures of sexual activity, pain with sex, sexual interest\/disinterest, and sexual satisfaction\/dissatisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 60 participants, 18% were sexually active at baseline, which decreased to 7% postsurgery and increased to 55% at 1 year after repair. Dyspareunia was reported by 27% at baseline and 10% at 1 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 1 year. For all, fears included fistula recurrence and unwanted pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that postrepair sexual experiences vary widely and intersect meaningfully with marital and social roles following fistula and repair. In addition to physical repair, ongoing psychosocial support is needed for comprehensive reintegration and the restoration of desired sexuality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdad010","type":"journal-article","created":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T07:08:41Z","timestamp":1678345721000},"page":"633-644","source":"Crossref","is-referenced-by-count":5,"title":["Women\u2019s sexual activity and experiences following female genital fistula surgery"],"prefix":"10.1093","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2674-4887","authenticated-orcid":false,"given":"Alison M","family":"El Ayadi","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco , San Francisco, CA 94158 , United States"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco , San Francisco, CA 94158 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadija","family":"Nalubwama","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suellen","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco , San Francisco, CA 94158 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, University of California , San Francisco, San Francisco, CA 94158 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abner P","family":"Korn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco , San Francisco, CA 94158 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Chiung Grace","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University , Baltimore, MD 21218 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josaphat","family":"Byamugisha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlyn","family":"Painter","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco , San Francisco, CA 94158 , United States"},{"name":"Urogynecology Division, Department of Obstetrics and Gynecology, Kaiser Permanente , Oakland, CA 94611 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Obore","sequence":"additional","affiliation":[{"name":"Urogynecology Division, Mulago National Referral and Teaching Hospital , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justus K","family":"Barageine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University , Kampala , Uganda"},{"name":"Urogynecology Division, Mulago National Referral and Teaching Hospital , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"issue":"suppl 1","key":"2023050103300615900_ref1","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1016\/j.ijgo.2007.06.032","article-title":"Obstetric fistula: guiding principles for clinical management and programme development, a new WHO guideline","volume":"99","author":"de Bernis","year":"2007","journal-title":"Int J Gynaecol Obstet"},{"issue":"1","key":"2023050103300615900_ref2","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/1471-2393-13-246","article-title":"Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis","volume":"13","author":"Adler","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"2023050103300615900_ref3","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s12905-015-0267-1","article-title":"Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania","volume":"15","author":"Mselle","year":"2015","journal-title":"BMC Womens Health"},{"issue":"suppl 1","key":"2023050103300615900_ref4","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1016\/j.ijgo.2007.06.011","article-title":"Social and economic consequences of obstetric fistula: life changed forever?","volume":"99","author":"Ahmed","year":"2007","journal-title":"Int J Gynaecol Obstet."},{"issue":"1","key":"2023050103300615900_ref5","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/j.1464-410X.2011.10630.x","article-title":"Urogenital fistula in the UK: a personal case series managed over 25 years","volume":"110","author":"Hilton","year":"2012","journal-title":"BJU Int"},{"issue":"1","key":"2023050103300615900_ref6","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/1471-2393-13-164","article-title":"Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease","volume":"13","author":"Tayler-Smith","year":"2013","journal-title":"BMC Pregnancy Childbirth."},{"issue":"3","key":"2023050103300615900_ref7","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.ajog.2004.02.020","article-title":"The immediate management of fresh obstetric fistulas","volume":"191","author":"Waaldijk","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"2023050103300615900_ref8","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ajog.2012.02.006","article-title":"Factors influencing urinary fistula repair outcomes in developing countries: a systematic review","volume":"207","author":"Frajzyngier","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"2023050103300615900_ref9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/tmi.13178","article-title":"Trajectories of women\u2019s physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study","volume":"24","author":"El Ayadi","year":"2018","journal-title":"Tropical Med Int Health"},{"key":"2023050103300615900_ref10","doi-asserted-by":"crossref","first-page":"5250843","DOI":"10.1155\/2018\/5250843","article-title":"The experience of women with obstetric fistula following corrective surgery: a qualitative study in Benadir and Mudug regions, Somalia","volume":"2018","author":"Mohamed","year":"2018","journal-title":"Obstet Gynecol Int"},{"issue":"1","key":"2023050103300615900_ref11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12884-015-0755-1","article-title":"Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study","volume":"16","author":"Drew","year":"2016","journal-title":"BMC Pregnancy Childbirth."},{"issue":"11","key":"2023050103300615900_ref12","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1111\/tmi.12771","article-title":"Pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa: scoping review","volume":"21","author":"Delamou","year":"2016","journal-title":"Tropical Med Int Health"},{"issue":"7","key":"2023050103300615900_ref13","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1007\/s00192-019-03896-y","article-title":"Reintegration needs of young women following genitourinary fistula surgery in Uganda","volume":"30","author":"Emasu","year":"2019","journal-title":"Int Urogynecol J"},{"issue":"10","key":"2023050103300615900_ref14","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/S1701-2163(16)35406-8","article-title":"\u201cHoping for a normal life again\u201d: reintegration after fistula repair in rural Tanzania","volume":"34","author":"Teddy Mselle","year":"2012","journal-title":"J Obstet Gynaecol Can"},{"issue":"(8)","key":"2023050103300615900_ref15","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.jsxm.2018.06.006","article-title":"Sexual function before and after vesicovaginal fistula repair","volume":"15","author":"Pope","year":"2018","journal-title":"J Sex Med"},{"issue":"5","key":"2023050103300615900_ref16","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/tmi.12469","article-title":"Rehabilitation experiences after obstetric fistula repair: systematic review of qualitative studies","volume":"20","author":"Lombard","year":"2015","journal-title":"Tropical Med Int Health"},{"key":"2023050103300615900_ref17","volume-title":"Counseling the Obstetric Fistula Client: A Training Curriculum","author":"Care","year":"2012"},{"issue":"7","key":"2023050103300615900_ref18","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1007\/s00192-020-04239-y","article-title":"Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial","volume":"31","author":"Arunachalam","year":"2020","journal-title":"Int Urogynecol J"},{"issue":"3","key":"2023050103300615900_ref19","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1111\/jsm.12070","article-title":"Pelvic floor dysfunction: women\u2019s sexual concerns unraveled","volume":"11","author":"Roos","year":"2014","journal-title":"J Sex Med"},{"issue":"2","key":"2023050103300615900_ref20","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1080\/13691058.2014.964320","article-title":"Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming","volume":"17","author":"Donnelly","year":"2015","journal-title":"Cult Health Sex"},{"issue":"1","key":"2023050103300615900_ref21","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12905-015-0232-z","article-title":"\u201cI am alone and isolated\u201d: a qualitative study of experiences of women living with genital fistula in Uganda","volume":"15","author":"Barageine","year":"2015","journal-title":"BMC Womens Health"},{"issue":"2","key":"2023050103300615900_ref22","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1002\/ijgo.13106","article-title":"Physical etiology of sexual dysfunction in obstetric fistula patients: a prospective study","volume":"149","author":"Mernoff","year":"2020","journal-title":"Int J Gynaecol Obstet."},{"issue":"12","key":"2023050103300615900_ref23","doi-asserted-by":"crossref","first-page":"877","DOI":"10.2471\/BLT.10.011210","article-title":"Mother or nothing: the agony of infertility","volume":"88","author":"Cui","year":"2010","journal-title":"Bull World Health Organ"},{"issue":"1","key":"2023050103300615900_ref24","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12978-015-0100-1","article-title":"Beyond repair\u2014family and community reintegration after obstetric fistula surgery: study protocol","volume":"12","author":"Byamugisha","year":"2015","journal-title":"Reprod Health"},{"key":"2023050103300615900_ref25","volume-title":"The WHOQOL BREF Questionnaire in Luganda: Validation with a Sample Including People Living With HIV in Uganda","author":"Martin","year":"2013"},{"issue":"6","key":"2023050103300615900_ref26","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s00127-004-0763-3","article-title":"Assessment of depression prevalence in rural Uganda using symptom and function criteria","volume":"39","author":"Bolton","year":"2004","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"1","key":"2023050103300615900_ref27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/bs.3830190102","article-title":"The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory","volume":"19","author":"Derogatis","year":"1974","journal-title":"Behav Sci"},{"issue":"1","key":"2023050103300615900_ref28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/ijgo.12083","article-title":"Sexual activity among Nigerian women following successful obstetric fistula repair","volume":"137","author":"Anzaku","year":"2017","journal-title":"Int J Gynaecol Obstet."},{"issue":"40","key":"2023050103300615900_ref29","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0968-8080(12)40661-9","article-title":"Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot","volume":"20","author":"Khisa","year":"2012","journal-title":"Reprod Health Matters"},{"issue":"3","key":"2023050103300615900_ref30","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1080\/13691058.2019.1600721","article-title":"Women\u2019s experiences of fistula-related stigma in Uganda: a conceptual framework to inform stigma-reduction interventions","volume":"22","author":"El Ayadi","year":"2020","journal-title":"Cult Health Sex"},{"issue":"1","key":"2023050103300615900_ref31","doi-asserted-by":"crossref","first-page":"74.e1","DOI":"10.1016\/j.ajog.2014.02.011","article-title":"Sexual function after vaginal and abdominal fistula repair","volume":"211","author":"Mohr","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"9","key":"2023050103300615900_ref32","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1007\/s00192-021-04845-4","article-title":"Rehabilitative care practices in the management of childbirth-related pelvic fistula: a systematic review","volume":"32","author":"Keyser","year":"2021","journal-title":"Int Urogynecol J"},{"issue":"4","key":"2023050103300615900_ref33","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.sxmr.2019.05.007","article-title":"Pelvic floor dysfunction and its effect on quality of sexual life","volume":"7","author":"Verbeek","year":"2019","journal-title":"Sex Med Rev"},{"key":"2023050103300615900_ref34","volume-title":"Factors Influencing Timing of Sexual Resumption Among Postnatal Women Attendign Mulago Hospital, Uganda","author":"Alum","year":"2015"},{"key":"2023050103300615900_ref35","doi-asserted-by":"crossref","first-page":"2333393617714927","DOI":"10.1177\/2333393617714927","article-title":"Reintegration of women post obstetric fistula repair: experience of family caregivers","volume":"4","author":"Jarvis","year":"2017","journal-title":"Glob Qual Nurs Res"},{"key":"2023050103300615900_ref36","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.urology.2020.08.019","article-title":"Optimizing women\u2019s sexual function and sexual experience after radical cystectomy","volume":"151","author":"Avulova","year":"2021","journal-title":"Urology"},{"issue":"7","key":"2023050103300615900_ref37","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.jsxm.2016.04.072","article-title":"A qualitative study on experiences after vulvar surgery in women with lichen sclerosus and sexual pain","volume":"13","author":"Brauer","year":"2016","journal-title":"J Sex Med"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/20\/5\/633\/50118646\/qdad010.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/20\/5\/633\/50118646\/qdad010.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T21:47:52Z","timestamp":1729028872000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/20\/5\/633\/7058850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,27]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,2,27]]},"published-print":{"date-parts":[[2023,4,27]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdad010","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5]]},"published":{"date-parts":[[2023,2,27]]}}}