We demonstrated that Pelvic Organ prolapse is a common, but under-reported condition in our settings (papers iv and v) and it has a significant negative impact on the quality of life of the sufferers. Very few surveys exist in the developing world, especially Nigeria regarding the use of mechanical device (i.e., vaginal Pessary) in the conservative management of pelvic organ prolapse (paper xxvi).We described the feasibility of Pessary use in the conservative management of symptomatic pelvic organ prolapse in developing countries (paper xxvi). This method has not been fully utilized in our settings and most gynaecologists easily resort to surgical management thereby presenting limited options to patients. With careful patient selection, morbidities associated with vaginal pessary are reduced with significant patient satisfaction. This method of treatment should be considered before settling down for surgery considering morbidities associated with surgical options (papers v and xxvi).

Another aspect of urogynaecology that we focused on was the care of patients suffering from genital tract fistula (Vesico-vaginal fistula). We studied the burden of vesico-vaginal fistula (VVF) in Ile-Ife (paper xvii), and consider the medico-social consequences of Obstetric fistula in Ilesha, Nigeria (paper xxiii and xxxiii). These studies revealed the debilitating effects of obstetric fistula on women in resource-poor settings. They revealed that this condition is predominant in our area and are strongly associated with difficult deliveries especially prolonged obstructed labour at home, mission houses and in Traditional birth attendants (TBAs)centres (papers xviii, xxii and xix). These studies emphasize the need to equip our health facilities with appropriate resources and health-educate pregnant women and their families on the importance of hospital delivery. Our studies underscore the need for advocacy for family planning, advocacy against early child marriage,and early sexual debut (paper i, ix, xiii, and xx). We also advocate for appropriate adolescent-parental communication about safe sexual behaviours (paper xxix).  These efforts will prevent teenage pregnancy which is a major pathway to the development of obstetric fistula (papers i, ix, x, xiii, xx, and xxix). Patients’ experiences during labour and child bearing in the studied healthcare facility was “disrespectful” (paper xii). This was reported as another reason why many pregnant women patronize TBAs with its negative sequelae like VVF and maternal mortality in Nigeria. There is the need to emphasize patient-centred care and inculcate compassionate care into orthodox healthcare delivery in Nigeria to improve its utilization by pregnant women.