Reproductive tract infections
in women
Introduction
A unique feature of
reproductive tract infections is that, like no
other infectious diseases, they are inextricably linked to the highly
emotive issue of sexuality. Sexuality is central to intimate personal life.
Gender is a pivotal fact in personal identity, determining both life
experience and options. Sexuality is the mechanism of social survival, hence the
cultural norms and values which regulate it. Of course, expectations and
practice are often very different. Social factors and advertising play a
dramatic role in the spread of STDs and influence attempts to control
reproductive infections. A further feature of reproductive tract infections
(excluding HIV) is that women, in particular, suffer the worst complications.
Thus:
-
Women are less
likely to be able to prevent STD exposure than men. There are no widely
acceptable female-controlled barrier methods of contraception and STD
prevention, (despite the recent development of the "female
condom"). Some female contraceptives, eg the pill, increase
the susceptibility to STD pathogens, although paradoxically it may also
reduce complications. Sexual and economic relationships often limit the freedom of women to negotiate the conditions for sexual intercourse;
-
Following
exposure to STD, anatomy makes women more susceptible. Transmission of
HIV, gonorrhoea, Chlamydia and trichomoniasis (see later) is more
efficient from male to female than the other way around. In women the
abdominal cavity and its organs can be infected by STD agents via
ascending infection through the uterus and Fallopian tubes. Susceptibility
varies with the menstrual cycle;
-
Women are more likely than men
to be asymptomatically infected, and therefore not to seek treatment;
-
If the woman is symptomatic,
there are male-inspired social stigmas against gynaecological examination
in many countries and religions;
-
Diagnosis of STDs is more
difficult in women than men;
-
The
complications of many STDs are more severe in women than in men.
Infertility following STD is commoner in women than in men. Men don't get
ectopic pregnancy or cervical cancer! Nor do they suffer from puerperal
fever, post partum sepsis or septic abortion. The latter are the main
causes of maternal deaths in developing countries.
[MEW] March 2002
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