What is female genital schistosomiasis?

Female genital schistosomiasis (FGS) is a disease manifestation of schistosomiasis caused by the Schistosoma haematobium, a waterborne parasite that affects both the urinary and genital tract of infected individuals. It develops over a long period of time (months to years) when girls and women do not have access to treatment. It has been described as one of the most neglected sexual and reproductive health diseases in sub-Saharan Africa, affecting an estimated 56 million women and girls.

Almost 56 million girls and women in sub-Saharan Africa are estimated to be affected by FGS.

FGS occurs in up to 70% of women infected by schistosomiasis.

FGS is underdiagnosed, with serious implications for women’s reproductive health.

FGS leads to infertility and can increased the risk of HIV infection.

Symptoms and complications of FGS

FGS occurs when the parasite eggs cause damage to the reproductive organs, which can result in gynaecological symptoms in women and adolescent girls, such as:

Vaginal discharge
Blood in urine
Abdominal and pelvic pain

If left untreated, women living with FGS can experience a range of complications, including:

Infertility
Abortion or ectopic pregnancy
Genital ulcers
Increased risk of HIV and human papillomavirus infections

Unlimit Health · Female Genital Schistosomiasis (FGS)- the most neglected gynaecological disease

Schistosomiasis and HIV

Farmer rinsing heads of salad in a water point located in her field in Grand-Zattry, Soubré District of Côte d’Ivoire. Image by: Unlimit Health/Aka Aboubakhr Thierry Kouamé

FGS causes open sores, inflammation and exposure to blood, giving easy access for any virus to enter the body. As a result, women and girls with FGS are up to three times more likely to acquire HIV.

Is FGS a sexually transmitted infection?

FGS is not a sexually transmitted infection. FGS develops when someone has schistosomiasis, which is only caught through skin contact with contaminated freshwater sources. It cannot be passed from person to person directly.

How is FGS diagnosed?

FGS can be diagnosed by visual examination of the genitals and colposcopy, which is a procedure to take a closer look at someone’s vagina and cervix. Unfortunately the equipment required for this is expensive and requires lots of medical training, and this is not always available in the health facilities in all affected communities. Another challenge is that health professionals are often not familiar with FGS as it is typically not part of standard medical training. Therefore, it remains underreported, misdiagnosed and largely untreated.

This has serious consequences for women, who not only suffer physical symptoms but also mental health problems due to stigma surrounding infertility and because symptoms are often confused with those of sexually transmitted infections. The World Health Organization’s pocket atlas has been developed to aid healthcare professionals with diagnosis of the disease.

Raising awareness of FGS

Female researcher in Madagascar. Image by: Unlimit Health /The END Fund

It is evident that there are many factors at play, but in order to prevent new cases and reduce the morbidity associated with FGS, appropriate training must be provided to healthcare professionals. Through early diagnosis and regular treatment of schistosomiasis, girls and women will be protected from developing FGS, which in turn can lead to improvements in their quality of life. Increased awareness of the disease and how to prevent it is critical so that communities understand the risks and impact of FGS on individuals, including the stigma that surrounds it.