Reproductive Tract Infections

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Reproductive tract infections, including sexually transmitted diseases (STDs) are a major cause of infertility, genital cancers, pelvic inflammatory disease, ectopic pregnancy, poor pregnancy outcomes, and infections in neonates, and are often less symptomatic, more easily contracted, and have more serious and life-threatening consequences for women than for men. For example, chlamydia infection is a common STD with serious consequences for women's health including increasing risk of ectopic pregnancies, infertility, and neonatal morbidity (Millar, 1987). Human papilloma virus, the causative agent of genital warts, is associated with cervical cancer. STDs are socially influenced by such factors as the number of sexual partners, use of contraceptives, sexual behaviors, and general health care practices. Beliefs and meanings surrounding gender and sexuality, fertility, STDs, hygiene, and health care are all crucial to developing prevention strategies and reducing the impact of STDs, along with studies of the psychosocial consequences of infection and its economic consequences.

There is a relatively small literature relating to reproductive tract infections in men and women. In part this is because these topics are extremely sensitive and in many cultures associated with shame and social stigma. While the incidence of reproductive tract infections and other conditions in developing countries is substantial, many women do not seek treatment from the formal health sector for these problems, or else postpone treatment until the condition is acute. Work conducted in Vietnam (Gammeltoft, 1999; Whittaker, 2002), in Thailand (Boonmongkon Nichter & Pylypa, 2001; Whittaker, 2000), and among Vietnamese migrants (Kendall, 1987), concentrates upon the ethnophysiology of vaginal discharge and its relationship to ideas of strength, humoral balance, and cleanliness. The presence of vaginal discharge may be associated with a "dirty" womb and may be believed to indicate a transgression against the moral order. Sobo's (1993a, 1993b) study of

Jamaican ethnophysiology explores how the body and culturally constructed idioms of health and sickness serve as metaphors for the social and moral order. In Thailand, understandings of the causation and detection of cervical cancers are linked to ideas about the strength of the womb, its cleanliness and dryness, and the presence of an injury or infection which is understood to develop into an ulcer (Boonmongkon et al., 2001). Such understandings have public health ramifications for cervical cancer screening programs and notions of risk (Chavez, Hubbell, McMullin, Martinez, & Mishra, 1995). In South Africa, pap smears to check for cervical cancer are believed to be a preventive measure to clean the womb (Wood, Jewkes, & Abrahams, 1997). In Northeastern Brazil, campaign messages linking cervical cancer with sexual activity are interpreted by many women to mean that once a woman is no longer sexually active she need not continue to be screened (Gregg, 2000).

There remains little anthropological research on male reproductive health. Apart from early studies on ritual or informal couvades (Browner, 1983; Riviere, 1974) and male initiation, there has been little attention paid to male ethnophysiology, attitudes toward infertility, their roles in sexual negotiation, and reproductive decision-making (Rosen & Benson, 1982; Whiteford & Sharinus, 1988), roles in birth (Ebin, 1994), experience of paternity (Katz & Konner, 1981), and practices surrounding STDs. For example, Nichter describes men's use of self-medication for the treatment of suspected STDs (Nichter, 1996c) and prophylactic practices to avoid infection, such as washing the penis in disinfectives and the consumption of purges. Recent programs promoting male involvement in family planning and HIV/AIDS programs have encouraged research in these fields.

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