INTRODUCTION:
female genital schistosomiasis (FGS) is a neglected gynaecological condition affecting millions of women in endemic settings, yet it remains largely unrecognised within biomedical health systems1. In many affected communities, symptoms suggestive of FGS are interpreted through indigenous explanatory frameworks2. However, cultural interpretations of these symptoms and treatment-seeking pathways within traditional healing systems remain poorly documented. This study explored cultural interpretations and health-seeking pathways for symptoms suggestive of FGS in rural kwazulu-natal, south africa.

METHODS:
embedded within a broader mixed-methods study, this qualitative component was conducted in the Ilembe district. In-depth interviews were undertaken with traditional healers and women at risk of FGS, alongside focus group discussions with community members. Data were analysed thematically using an inductive approach.

RESULTS:
preliminary findings indicate that genital symptoms suggestive of FGS are commonly interpreted through indigenous lenses, including intentional harm and spiritual imbalance. Treatments prescribed by traditional healers are frequently informed by ancestral guidance and include izimbiza, defined as mixtures of boiled herbs prepared for healing, cleansing, or protection, as well as other herbal preparations. These interpretations strongly shape health-seeking pathways, with traditional healers often serving as the first point of care. In some cases, biomedical and traditional care are pursued concurrently when initial treatments are perceived as insufficient. Pathways to care are further influenced by gendered social norms, healer characteristics, and levels of community trust in different health systems.

CONCLUSIONS:
recognising indigenous interpretations of symptoms suggestive of FGS is important for improving case recognition, reducing stigma, and advancing women’s reproductive health rights. These findings provide context-specific evidence to inform schistosomiasis control programmes, primary health care implementers, and sexual and reproductive health policy frameworks. Integrating traditional healers into culturally responsive community-level health promotion and referral guidelines may strengthen the detection of FGS, treatment uptake, and rights-based women’s health interventions in endemic settings.