ABSTRACT
Background: Women with mental illness (WMI) are more likely to experience unreported sexual and reproductive health (SRH) problems. Mixed-method research studies with the strengths of quantitative and qualitative approaches provide deeper insight into SRH issues of WMI. Methods: A sequential explanatory mixed-method design was used to understand better the SRH problems of WMI attending tertiary care psychiatry hospital. In phase 1, a survey was conducted to identify if they have SRH problems. Women who were identified to have SRH problems were part of Phase II. In this phase, in-depth interview was conducted to explore their lived-in experiences. Integration at the method level was adopted by connection through sampling. Using a narrative approach, integration was accomplished at the level of interpretation and reporting. Results: Among the users, 261 (64.6%) female sterilization, 244 (93%) was the most common, and the other methods like coitus interruptus, male condoms, and intrauterine devices were reported less. Of the non-users, 137 (33.9%) WMI 100 (73%) were unaware of the best family planning approach. Most of them, 377 (93.3%), were ignorant about sexually transmitted infection (STI) symptoms. WMI reported 62 (15.3%) unusual foul-smelling vaginal discharge and 58 (14.4%) genital ulcers, with poor treatment-seeking behavior. Sexual dysfunction in desire, arousal, lubrication, orgasm, satisfaction, and pain were also reported. The findings were described in a single report based on the quantitative data followed by themes obtained from qualitative interviews using weaving techniques under the headings of contraceptive use and its awareness, prevalence of STI symptoms and its treatment, and sexual health experiences. Conclusion: Data integration demonstrated that one-fourth of WMI had inadequate awareness of contraceptive use, were ignorant of STI symptoms, and experienced sexual dysfunction.
ABSTRACT
BACKGROUND: Women with mental illness (WMI) experience considerable disparities in sexual and reproductive health (SRH) when compared to the general population. Due to their restricted access to SRH services, they have unmet contraceptive needs, a greater prevalence of sexually transmitted infections (STIs), and sexual dysfunction. The study aimed to explore the SRH issues of WMI in a tertiary care psychiatric outpatient clinic in Bengaluru, India. MATERIALS AND METHOD: A qualitative hermeneutic phenomenological approach was used. A reproductive age group (18-49 years) WMI (n = 32) was selected by purposive sampling technique. The period of data collection was from January 2021 to September 2021. An in-depth face-to-face interview was conducted using a validated interview schedule. Hycner's explicitation process was used to investigate the constituents of a phenomenon. RESULT: The codes revealed potential themes and subthemes. SRH issues faced by WMI were organized under three main themes, namely, (1) factors responsible for sexual dysfunction, (2) symptoms of STI and treatment adherence, and (3) use of contraception and its barrier. CONCLUSIONS: Sexual dysfunction among WMI is contributed by numerous factors. Women were exhibited limited knowledge of STI symptoms and treatment compliance. Such women experience issues with current method of contraception and are unaware of the alternatives. The findings of this study may be helpful for clinical nurses in drawing attention to and increasing knowledge of the reproductive health issues that women with psychiatric disorders face, taking the required precautions, and devising strategies for minimizing harm.
ABSTRACT
Objectives: Sexual and reproductive health (SRH) is a vital concern among women with mental illness (WMI) due to the increased risk for unplanned pregnancy, sexually transmitted infections (STIs), and poor obstetric outcomes. Objective of the study was to explore the current use of family planning (FP) methods, symptoms of STIs and sexual dysfunction among WMI. Materials and Methods: This descriptive study involved 404 WMI of reproductive age (18-49 years) attending tertiary care psychiatric outpatient clinics in India. During face-to-face interviews, centers for disease control and prevention (CDC)-reproductive health assessment toolkit-FP questionnaire, STI questionnaire and Female sexual function index (FSFI) were used to collect the data. Results: Of 404 WMI, 261(64.6%) were users, and 137 (33.9%) were non-users of FP methods. About 6(1.5%) WMI did not respond FP methods question. Female sterilization was the highest among the users, 244(93%). Among non-users, 100 (73%) were unaware of choosing the effective method of FP. Most of the WMI, 377(93.3%), were unaware of STIs. The symptoms of STI reported include unusual genital discharge 62(15.3%) and genital ulcers/ sores 58(14.4 %). Most of them, 76(63.3%), were not on any treatment. The most common reason for not taking treatment was feeling ashamed 70(92.1%). Female sexual dysfunction was reported in 176(43.6%). Most of the WMI had difficulties in the arousal domain 288(71.3%), followed by low desire 233(57.7%) and dissatisfaction 186(46%). Conclusion: Most WMI underwent sterilization. Non-users of FP methods were not aware of choosing the effective method. Awareness about STIs was poor, and feeling ashamed was the primary reason for not availing of medical help. Nearly half of the WMI reported sexual dysfunction, among which arousal difficulties, low desire and dissatisfaction were common. Health professionals need to increase awareness about FP methods and symptoms of STIs among WMIs. Women require appropriate counselling regarding SRH and treatment for sexual dysfunction.
