title: The psychological and social contexts of complaints of abnormal vaginal discharge: a study of illness narratives in India.
abstract: OBJECTIVE
  Epidemiological studies have reported strong associations between psychosocial adversity and complaints of abnormal vaginal discharge (AVD) in South Asia. We aimed to explore the mechanism of these associations through qualitative research.
  
  
  METHODS
  We carried out serial in-depth interviews with 42 married women with the complaint of AVD who were purposively selected from a sample of 2494 women recruited into a population-based cohort study in Goa, India. The interviews elicited illness narratives of their complaint, focusing on causal attributions and help-seeking behaviors.
  
  
  RESULTS
  Women explicitly link their personal experiences of social adversity and stress (such as marital problems and heavy workloads) with their complaints of AVD. The complaint of tiredness, a core feature of depressive and somatoform disorders, and complaint of "tension" were commonly associated with AVD through bidirectional causal interpretations. Reproductive events, particularly related to the menstrual cycle and contraception, comprise another set of causal attributions. Many women hold multiple causal attributions. Most women sought health care, both biomedical and traditional, and their narratives indicate reinforcement of their causal attributions by health care providers. However, treatments were often discontinued or changed due to lack of symptomatic relief, side effects, or costs.
  
  
  CONCLUSIONS
  Reproductive health policy and practice must explicitly acknowledge and integrate research findings on psychosocial associations of AVD to promote a holistic and evidence-based approach for this common complaint in women in South Asia.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom. vikram.patel@lshtm.ac.uk
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.forename: Gracy
authors.initials: G
authors.lastname: Andrew
authors.forename: Pertti J
authors.initials: PJ
authors.lastname: Pelto
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007194:India; D008875:Middle Aged; D033262:Narration; D010342:Patient Acceptance of Health Care; D012054:Reinforcement, Psychology; D012803:Sick Role; D012931:Social Environment; D019522:Vaginal Discharge / Q000175:diagnosis* / Q000523:psychology*