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The striking prevalence of gynecological problems among homeless women underscores the need for accessible gynecological services for these women, according to the authors of a recent study. The fact that one-fourth of the homeless women studied were either pregnant at the time of the study or had been pregnant during the preceding year suggests they need more accessible obstetrical and prenatal care as well, says Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles, School of Medicine.
In a study supported by the Agency for Healthcare Research and Quality (HS08323), Dr. Gelberg and colleagues found that of nearly 1,000 Los Angeles County homeless women of reproductive age (15-44 years) they interviewed, two-thirds reported gynecological symptoms during the previous year. Their symptoms ranged from abnormal vaginal discharge, severe pelvic pain, and skipped periods (the most common symptom) to breast lumps and burning during urination. Four factors increased the likelihood that homeless women would have gynecological problems: a current pregnancy or a pregnancy completed during the past year; drug dependence; more episodes of homelessness, which probably make it difficult to maintain good hygiene and other preventive behaviors; and general physical health symptoms.
Of the women who experienced at least one symptom, 71 percent sought care for at least one of their problems. Homeless women with gynecological symptoms, younger age, better perceived health, and insurance coverage received more health care (more doctor visits) than other women, while women reporting recent drug use and rape received less care. Women who have been raped often have trauma-like responses during gynecological exams, which may explain their reluctance to seek gynecological care. These findings underscore the need for accessible health care and substance abuse treatment services for homeless women, conclude the authors.
For more details, see "Homeless women's gynecological symptoms and use of medical care," by Suzanne L. Wenzel, Ph.D., Ronald M. Andersen, Ph.D., Deidre S. Gifford, M.D., M.P.H., and Dr. Gelberg, in the Journal of Health Care for the Poor and Underserved 12(3), pp. 323-341, 2001.
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