The importance of gynaecological morbidity resulting from reproductive tract infections among diverse populations of women in developing countries is well documented (Cates, Farley and Rowe, 1985; Koenig et al., 1998; Schulz, Cates and O'Mara, 1987; Wasserheit, 1989). Less well researched, but of growing concern, is the problem of infection-related reproductive tract morbidity among men, which is discussed in Chapter 4. Despite a growing consensus that reproductive tract infections are an important health issue, a perplexing array of problems faces those who seek to describe the extent of these conditions. The literature reveals tremendous variability in the reported prevalence of specific infections, some of which undoubtedly arises from real differences in the underlying epidemiology. Of equal importance, however, may be differences in the clinical definitions used to classify and describe various types of gynaecological morbidity, the training of the health care providers who elicit symptoms and record clinical observations, and the thoroughness with which a practitioner examines any client.

This chapter discusses the limitations of defining and observing reproductive tract morbidity in community-based research, and makes recommendations for future practice. We begin by discussing definitions of ‘normality’ and ‘abnormality’ as they apply to gynaecological morbidity, using cervical ectopy as an example. We then illustrate the problems of differences in diagnostic criteria between studies and inter-observer variation. Investigators are urged to use standardized definitions of clinically diagnosed morbidity that are both well-supported by evidence from the literature and easily applied in clinical practice