title: Listening to "felt needs": investigating genital prolapse in western Nepal.
abstract: The global prevalence of genital prolapse is estimated to be 2-20% in women under age 45. In Nepal, genital prolapse appears to be widespread, but little published evidence exists to buttress this claim. This paper presents findings of two studies, one ethnographic and one clinic-based, in western Nepal. The ethnographic study involved 16 focus group discussions with 120 community members and key informants, and covered community perceptions and women's experience of prolapse and its perceived causes and consequences. The clinic-based study was conducted among 2,072 women who presented with gynaecological complaints and received a diagnosis. One in four of them had genital prolapse, of whom 95% had self-reported the prolapse. The most commonly perceived causes of prolapse were lifting heavy loads, including in the post-partum period. The adverse effects reported included difficulty urinating, abdominal pain, backache, painful intercourse, burning upon urination, white watery discharge, foul-smelling discharge, itching, and difficulty lifting, sitting, walking and standing. The results confirm prolapse as a significant public health problem in western Nepal. We strongly recommend developing systematic, rotational gynaecological clinics in rural districts, the use of a screening checklist and counselling for prevention and early management of genital prolapse by district health workers for family planning and antenatal patients.
authors.affiliation: Health Sector Support Programme, German Agency for Technical Cooperation (GTZ), Nepal.
authors.forename: Tiphaine Ravenel
authors.initials: TR
authors.lastname: Bonetti
authors.forename: Anne
authors.initials: A
authors.lastname: Erpelding
authors.forename: Laxmi Raj
authors.initials: LR
authors.lastname: Pathak
mesh_terms: D000328:Adult; D000739:Anecdotes as Topic; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology*; D006266:Health Education / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D017773:Pelvic Floor / Q000503:physiopathology; D011788:Quality of Life; D012307:Risk Factors; D012423:Rural Health; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology*; D014596:Uterine Prolapse / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D016387:Women's Health