PSYCHO-SOCIAL EFFECTS OF VESICO-VAGINAL FISTULA ON WOMEN'S HEALTH AND DEVELOPMENT

A concern To All Women

Written by Victor Usun

Content

• Meaning of Vesico-Vaginal Fistula(VVF)
• Causes of VVF
• Inhibition of VVF
• Psychological effects of VVF on development and wellbeing
• Health centers in Nigeria
• conclusion

 MEANING OF VESICO-VAGINAL FISTULA(VVF)

Vesico-vaginal fistula is a serious disability that can be experienced by women after childbirth. It is defined as a hole that develops between the vagina and the bladder, resulting in uncontrollable leaking of urine through the vagina. The most common cause of vesico-vaginal fistula is obstructed labor, early marriage, poverty, and women's limited control over the use of family resources.

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 CAUSES OF VVF

Abortion

Accidental surgical injury related to pregnancy as well as to crude attempts at induced abortion can as well lead to VVF.

Obstructed labor

Researches have shown that about 90% vvf in Nigeria is from obstructed labor due to cephalopelvic disproportion (misfit between the fetal head and the birth canal). Poor or no antenatal care during pregnancy, lack of transport and poverty (cannot afford caesarean section) are some of the causes of obstructed labor in Nigeria.

Abdominal surgeries and instrumental deliveries

Rupture of the uterus may sometimes be associated with a tear in the bladder especially if the bladder was adherent to a previous caesarean section scar. The bladder may be injured during operative vagina deliveries, caesarean section or caught in sutures during abdominal surgeries leading to fistula formation.

Female genital mutilation

Female genital cuttings are common traditional practices among many communities in Nigeria. These include removal of the clitoris and other forms of female circumcision, “yankan gishiri or angurya”. The latter involves the incision of the vaginal walls in obstructed labor with the hope that the incision would enlarge the birth canals.

Harmful traditional practices

Coital injuries from early marriages and packing the vagina with caustic salts are implicated in the causes of vvf in Nigeria
Pelvic trauma
Penetrating vaginal injuries, pelvic fractures from road traffic accidents and crude attempts at induced abortion causes pelvic injuries that may lead to leakage of urine.

Cancer and radiotherapy

Cancers of the genital tract, bladder and rectum can result into fistulae when advanced. So is irradiation (radiotherapy) from treatment of cancer of the cervix or the vulva.

Infections

Though very rare, lymphogranuloma venereum, a sexual transmitted infection caused by Chlamydia trachomatis may cause leakage of urine in women. During vulval ulceration associated with lymphogranuloma, the urethra may be amputated down to its junction with the bladder leaving a vvf.

 INHIBITION OF VESICO-VAGINAL FISTULA

VVF is the unhidden humiliating indicator of the terrible outcome among women in Nigeria whose prevention involves everybody i.e. government, spirited individuals, private bodies, non-governmental organizations, and religious houses. The prevention and control strategies of vvf are in the headers below:

SAFE MOTHERHOOD INITIATIVE

Vvf tells the untold story of unsafe motherhood. Safe motherhood initiative therefore carves the way for prevention of vvf and maternal death. Safe motherhood means social equity for women, antenatal care for all, emergency obstetrics for those in need, and family planning for the couple. One can also add that there must be strategies to warrant survival of the born children and reduce the temptation of high parity. It can therefore be said without fear of contradiction that VVF from obstructed labor is preventable. This is borne out of the fact that it disappears once the socio-economic circumstances of any community improve.

EDUCATION

Education of the masses is one certain ways of reducing the prevalence of vvf in Nigeria. Education will create awareness in the minds of the patients to utilize the health care facilities that exist and make them deliver in hospitals as opposed to traditional birth attendants. It will also enable the very young adolescents who are the worst victims, to marry much later when they are bigger and more mature to start child bearing.

PROVISION OF BASIC OBSTETRIC CARE

Another way of reducing vvf in Nigeria is by making available basic but quality obstetric care at all levels so that cases at risk can be identified early and referred in time to vvf centres where labor complications can be dealt with. These secondary referral centres must be made accessible and functional with the right staff and equipment.

FAMILY PLANNING

Making family planning available, accessible, and affordable for the couple will allow pregnancy by choice and not by coercion.

LEGISLATION AGAINST CHILD MARRIAGE

Legislation and enforcement of laws will reduce the prevalence of vvf in Nigeria by about 40%. It will make pregnancy safer.

WOMEN EMPOWERMENT

Finally, empowerment through improved agriculture, communication network, and training of medical personnel and trained birth attendants in the skills of management of obstructed labor will ensure an early attainment of this goal. In this regard, cooperation of policy makers, administrators, and health workers in the community would be required.

 PSYCHOLOGICAL EFFECTS OF VVF ON DEVELOPMENT AND WELLBEING

Vvf is not without a social complication but, the social and economic consequences have received scant attention. Fistulae are not only extremely painful but also uncomfortable. It is one of the most dehumanizing afflictions of women. The shame of social isolation can lead to depression, divorce or even suicide. For example, in a study reported from northern Nigeria, the divorce rate following vvf was 65% as women with vvf are deserted by their husbands, relatives consider them as having brought shame to the family. The smell of urine makes them socially unacceptable, coupled with loss of self-esteem. Ultimately, abandoned by husband and rejected by family and sometimes their religion, they then leave their places of abode and become destitute until the fistula is repaired.

Women suffering from pelvic injuries and foot drop have difficulty in completing daily tasks as carrying water or firewood or caring for the children. Consequently, they are viewed as a burden to the family. The women are unable to be sexually active, it must be noted that since young women giving birth for the first time seem rather prone to vvf, they may have no living children due to subsequent complication of infertility.

Women reported many psychological consequences of VVF including depression, feelings of shame, and loneliness. Others reported feeling devalued as a woman and wanting to end their lives.

 VVF Health centers in Nigeria

Family Life Centre Hospital, Mbrebit Itam, Uyo, Akwa- Ibom, Nigeria.
University of Benin Teaching Hospital, Ugbowo, Benin-city, Nigeria.
Ogoja General Hospital, Cross River, Nigeria.
Ebonyi State University Teaching Hospital, Ebonyi, Nigeria.
National Obstetric Fistula Centre, abakaliki, Ebonyi, Nigeria.
Evangel VVF Centre, Jos, Nigeria.
National Obstetric Fistula Centre, Ningi, Bauchi, Nigeria.
Fistula Foundation Nigeria, Kano, Nigeria.
National Obstetric Fistula Centre, Bubbar Ruga, Katsina, Nigeria.
Laure Fistula Centre, Kano, Nigeria.
Kebbi VVF Centre, Birnin Kebbi, Nigeria.
Gesse VVF Centre, BIrnin Kebbi, Kebbi, Nigeria.
Maryam Abacha Women and Children’s Hospital, Sokoto, Nigeria
Faridat Yakubu General Hospital, Zamfara, Nigeria.
Jahun VVF Centre, Jigawa, Nigeria.
Kwara State Specialist Hospital, Sobi, Ilorin, Nigeria.
Adeoye General Hospital, Ibadan, Oyo, Nigeria.
University College Hospital, Ibadan, Oyo, Nigeria.

 CONCLUSION

Vesico-Vaginal Fistula (VVF) is one of the most serial women killers after breast cancer, it’s accompanied with traumas and depression which can even lead to suicide. VVF alongside with female genital mutilation (FGM) is very common in the Northern part of Nigeria, Many sees early-child marriage as a common tradition and thereby depriving the young girls of their right to childhood, education etc.
Children who get married at a very tender age has a poor prognosis or higher chances of getting VVF, VVF is not sexually transmitted, communicable or genetically transmitted. It’s caused by an opening of the bladder or as a hole that develops between the vagina and the bladder which causes urine linkage from the bladder to the vaginal, this as well hinders the woman’s ability to control the movement of urine in her bladder. There are many causes of VVF apart from a woman’s inability to give birth normally, these includes: Abortion, Incomplete or inappropriate surgery, malnutrition and many others.
VVF can be controlled by setting up appropriate rules regarding traditions that allows child-marriage, female genital mutilation or circumcision. Also equipping the health care centers with necessary equipment needed for the operation and treatment of this ailment.
It can also be treated via surgery.

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