As many as 45 million women in the world, most of them in sub-Saharan Africa [1], suffer from a painful sexual health condition. This scourge of women’s health may cause bleeding and pain (especially during sexual intercourse) [2], decrease fertility [3], and make women more susceptible to STDs [4,5]. The lesions, often acquired in childhood, can and do persist through adult life [6, 7]. Yet this condition is fully preventable: all we need is a cultural shift towards valuing women’s lives everywhere in the world.

You may be surprised to learn that I am not talking about female genital mutilation (FGM) [a]. FGM has received plenty of attention in mainstream media in the last few years, leading to a number of global campaigns pledging to stop this practice [8, 9, 10]. The problem I am talking about is female genital schistosomiasis (FGS), and you are very unlikely to have heard of it in the mainstream media. For example, whereas a quick search in The Guardian returns about 382,000 results on FGM, there isn’t a single article mentioning FGS.

While it is true that ending FGM mainly requires a shift in local traditions and views of women, this is by no means easy to achieve [11]. In contrast, wherever we are, we can all work on the cultural shift needed to end FGS. What we need is to value all human lives equally, and act in accordance – both individually, through giving, and politically, through campaigning for global justice.

And you should care about ending FGS, even if it is the first time you’ve heard about it. Here is why:

  1. It reduces quality of life

    Female Genital Schistosomiasis is caused by infection with the S. haematobium, a parasite which infects people exposed to affected water. It is often contracted in childhood, with serious symptoms observed in girls as young as 3. [12] This parasite then continues its life cycle inside the human body. When its eggs lodge in the female reproductive system, the body’s reaction leads to a host of unpleasant lesions. [13, 14]

    The most characteristic ones are ‘sandy patches’ (thickening and scarring of tissue), breaches and open wounds in the mucosal surface and skin. [13, 14] Scars in tissue are a lifelong condition once contracted. [6, 7] Other associated symptoms are stress incontinence [15], irregular bleeding [16] , discharge [4], and pain during intercourse [2]. It may also be associated with infertility [3] and severe acute diseases such as ectopic pregnancy [17].

  2. It can lead to cancer and death at a young age

    The internal injuries I mentioned above are not only painful, but they also facilitate the implementation of HPV [4, 5], which can lead to cervical cancer. As FGS favours a rapid propagation of the virus and eases the spread of malignant cells, it contributes to a higher chance of developing cancer more quickly.[18, 19]

    Because girls often contract FGS at a young age, this type of cancer occurs shockingly early in sub-Saharan Africa. For example, a study in Tanzania found that 18% of women with FGS and cancer were younger than 25, whereas only 5% of women with cervical cancer and without FGS were in the same age group. [20]

    There is evidence that what applies to HPV also applies to other STDs: FGS makes it far easier to contract them. This means that STDs will spread more where more women have FGS, worsening the sexual health of the whole population.

  3. It makes HIV transmission much more likely

    FGS is associated with a 3-4 fold increase in acquiring HIV/AIDS during sexual intercourse, which means that FGS may be one of the most important co-factors in HIV transmission in Sub-Saharan Africa’s HIV epidemic. It has been estimated that 16 million women will acquire FGS and that, if cured, 120 000 new cases of HIV could be averted through regular FGS treatments in the next decade [21, 22, 23]

    More research needs to be done on the topic, but we now know that FGS causally contributes to HIV transmission by increasing the number of HIV-receptive cells in a woman’s reproductive system. A woman infected with both diseases poses an additional risk of infecting her partners, as the dual infection leads to increased HIV levels in genital ulcers. [23]

    Finally, HIV in a woman with FGS is very likely to have a fast progression to AIDS. As with HPV, this is because FGS facilitates virus replication. All of this tends to happen at a very young age, because FGS is often contracted before women become sexually active.

    You can read more about some recent research on the HIV-Schistosomiasis interaction here.

  4. It is a factor in gender inequality, poverty and social exclusion

    It should be no surprise that suffering from disruptive symptoms since childhood, with a higher risk of contracting life-threatening illnesses, contributes to staying in poverty. But there is more to FGS than the health problems mentioned above.

    Though men also contract schistosomiasis, these infections have a disproportionate impact on women’s quality of life through FGS symptoms. This is compounded by the social stigma associated to the disease, by other disruptive symptoms of schistosomiasis [24], and by the association between schistosomiasis and being unable to go to school or to work [25]. All together, suffering from FGS compromises women’s agency and makes it very difficult to escape poverty.

  5. You can make a difference

    Here is the happy ending to this post: there is effective treatment for schistosomiasis ( praziquantel), and it is given for free by pharmaceutical companies in a program coordinated by the World Health Organization (http://www.who.int/schistosomiasis/strategy/en/). If we add the cost of organizing and monitoring distribution, we get the result that treating a child costs US$1.23 (through the Schistosomiasis Control Initiative, one of Giving What We Can’s and Give Well’s recommended charities). What are you waiting for?

References

  1. [](http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

  2. <a href=)

  3. [Morice, P. et al. (1996) [Genital bilharziasis and female infertility.Review of the literature and three case reports]. Contracept. Fertil. Sex24, 56–61](http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

  4. <a href=)

  5. [Kjetland, E.F. et al. (2008) Female genital schistosomiasis – adifferential diagnosis to sexually transmitted disease: genital itchand vaginal discharge as indicators of genital S. haematobiummorbidity in a cross-sectional study in endemic rural Zimbabwe.Trop. Med. Int. Health 13, 1509–1517](http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

  6. <a href=)

  7. [Mosunjac, M.B. et al. (2003) Cervical schistosomiasis, humanpapilloma virus (HPV), and human immunodeficiency virus (HIV): adangerous coexistence or coincidence? Gynecol. Oncol. 90, 211–214](http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

  8. <a href=)

  9. [Kjetland, E.F. et al. (2008) Prevention of gynecologic contact bleedingand genital sandy patches by childhood anti-schistosomal treatment.Am. J. Trop. Med. Hyg. 79, 79–83](http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

  10. <a href=)

  11. [Silva, I.M. et al. (2005) Therapeutic failure of praziquantel in thetreatment of Schistosoma haematobium infection in Braziliansreturning from Africa. Mem. Inst. Oswaldo Cruz 100, 445–449

    [a] Interestingly, the two may be historically related. A recent paper (https://www.researchgate.net/publication/236052203_Female_genital_mutilation_and_female_genital_schistosomiasis-bourouwel_the_worm_Traditional_belief_or_medical_explanation_for_a_cruel_practice) suggests that FGM may have started as a misguided attempt to cure visible symptoms of FGS. In fact, the areas with high prevalence of FGS and of FGM overlap.

    ](http://www.who.int/neglected_diseases/integrated_media_urogenital_schistosomiasis/en/

  12. <a href=)

  13. Stop FGM Now

  14. UNFPA

  15. End FGM

  16. WHO: Effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting

  17. El-Adnani, M.S., Saleh, K.M., 1982. Extraurinary schistosomiasisin Southern Iraq. Histopathology 6, 747–752

  18. Poggensee, G., Feldmeier, H. (2001) Female genital schistosomiasis: facts and hypotheses. Acta Tropica 79, 193-210

  19. Eyrun F. Kjetland, E. F, Leutscher, P. D. C., Ndhlov, P.D.(2002) A review of female genital schistosomiasis. Trends in Parasitology Vol. 28, No. 2, 58-65

  20. Kjetland, E.F. et al. (2005) Simple clinical manifestations of genitalSchistosoma haematobium infection in rural Zimbabwean women. Am.J. Trop. Med. Hyg. 72, 311–319

  21. Bland, K.G. and Gelfand, M. (1970) The effects of schistosomiasis onthe cervix uteri in the African female. J. Obstet. Gynaecol. Br.Commonw. 77, 1127–1131

  22. Ville, Y. et al. (1991) Tubal schistosomiasis as a cause of ectopicpregnancy in endemic areas? A report of three cases. Eur. J. Obstet.Gynaecol. Rep. Biol. 42, 77–79

  23. Moubayed, P., Ziehe, A., Peters, J., Mwakyoma, H., Schmidt,D., 1995. Carcinoma of the uterine cervix associated withschistosomiasis and induced by human papillomaviruses.Int. J. Gynaecol. Obstet. 49, 175–179.

  24. Ylitalo, N., Sorensen, P., Josefsson, A.M., Magnusson,P.K.E., Andersen, P.K., Ponte´n, J., Adami, H.O., Gyllensetein,U.B., Melbyl, M., 2000. Consistent high viralload of human papillomavirus 16 and risk of cervicalcarcinoma in situ: a nested case-control study. Lancet 355,2194–2198.

  25. Moubayed, P., Lepere, J.F., Mwakyoma, H., Neuvians, D.,1994. Carcinoma of the uterine cervix and schistosomiasis.Int. J. Gynaecol. Obstet. 45, 133–139.

  26. Hotez, P.J. et al. (2009) Africa’s 32 cents solution for HIV/AIDS. PLoSNegl. Trop. Dis. 3, e430

  27. Feldmeier, H. et al. (1994) Female genital schistosomiasis as a riskfactorfor the transmission of HIV. AIDS 5, 368–372

  28. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001396

  29. King, C.H. and Dangerfield-Cha, M. (2008) The unacknowledgedimpact of chronic schistosomiasis. Chronic Illn. 4, 65–79

  30. Givewell: deworming

  31. Givewell: SCI