Gynecologic conditions in the context of incarceration: A scoping review.

Abstract

<h4>Background</h4>More than 740 000 people identified as female at intake were incarcerated globally as of 2022, reflecting a 60% global increase since the year 2000, with a concomitant increase in gynecologic conditions experienced behind bars.<h4>Objectives</h4>The purpose of this scoping review was to examine the breadth of benign and malignant gynecologic conditions experienced during incarceration, including the prevalence, special management considerations, access to services, and the patient experience.<h4>Method</h4>The search strategy included a combination of keywords and subject headings for incarceration and benign or malignant gynecologic conditions with no language or date limits. Studies were eligible for the review if they: (i) discussed a benign or malignant gynecologic condition; (ii) included a population of people experiencing incarceration; and (iii) answered one or more of the four key questions identified prior to the search. One researcher independently screened each reference title and abstract for eligibility, and two reviewers independently screened each full text reference. One researcher extracted data from each study using a data extraction template, with verification and consensus by the primary and senior investigators.<h4>Results</h4>After screening, 135 studies corresponding to 137 reports from 38 countries were included in the review. Included studies focused on cervical dysplasia and human papilloma virus (56), normal menstruation (38), vaginitis (36), routine gynecologic care (23), abnormal bleeding (17), pelvic pain (13), menopause (8), urinary incontinence (7), and gynecologic malignancy (5) during incarceration.<h4>Conclusion</h4>The included studies demonstrate that across the globe, gynecologic conditions in carceral settings are common and can be exacerbated by the physical and emotional stress of incarceration, trauma histories, lack of access to care, and conditions of confinement in these settings. Gaps in the published literature exist on health education and interventions to address gynecologic health disparities and the gynecologic health needs of aging and older adults. There is a pressing need for parallel efforts at global de-carceration and policy interventions to provide for basic gynecologic needs, decrease intersectional stigma, and improve the conditions of confinement.