By Francesca Hangeior
After proper surgical repair, women who have a vesicovaginal fistula, an abnormal opening between the bladder and the vaginal wall, leading to urine leakage and other complications, can have a pleasurable sexual life, gynaecologists have assured.
They advised such women to wait until 12 weeks after the surgery to allow complete healing and recovery before resuming sexual activities.
The maternal experts, however, stated that the return to normal sexual life depended on the delays before the repair was done and the scarred tissues that were formed, stating that some of the women might experience vagina tightness and pain during sex.
The fertility experts further emphasised the need for counselling and psychotherapy before resuming sexual activity, to ensure that the fear, anxiety, and emotional trauma related to sex and pregnancy were overcome.
According to the seasoned obstetric gynaecologists, women with repaired VVF, who desired more children, could become pregnant and have more babies.
However, they stressed that such delivery must be through a caesarean section and done in a conventional health facility.
VVF is a complication of obstructed labour during delivery. According to the United Nations Population Fund, VVF is a major public health problem with over two million cases, globally.
In Nigeria, there are about 150,000 cases with 12,000 new cases recorded every year.
Many women with VVF in Nigeria battle with stigma, leading to social ostracisation, abandonment, and psychological distress.
Also, a professor of Obstetrics and Gynaecology at the Usmanu Danfodiyo University, Abubakar Panti, stated that after the successful closure of the fistula and complete healing after surgery, normal sexual activity could be restored.
He further stated that to ensure proper healing and recovery time, the recommendation was to avoid sexual activity for at least three months, which is 12 weeks post-surgery to allow complete healing.
The don also stated that before resuming sexual activity, the strength of the pelvic floor must be assessed, as some women may experience vaginal tightness or weakness after prolonged fistula, which could affect sexual comfort.
To resolve this, Panti advised the women to do some pelvic floor exercises, noting that sometimes the help of a physiotherapist was needed.
“When women have lived with VVF for a long time, they know what caused it, they know it’s a pregnancy that caused it, so they may experience fear, anxiety or some form of emotional trauma related to sex, because they would think sex is what brought it in the first place, so they need a lot of counselling or therapy, in that instance psychotherapy may be beneficial.
“Some of these women used to have a lot of terrible experiences, sometimes they are abandoned by their husbands, divorced and other things, so they think every man may be like that.
“The last one probably would be the presence of scarring or vaginal shortening. If extensive damage occurred before repair, some women may have vaginal scarring and then sometimes there will be dryness of the vagina or reduced elasticity.
“Usually, the vagina distends to accommodate, irrespective of the size of the penis that comes into it, so if there is scarring, that distension will not be there, and there will be tightness, so this can also affect comfort during sex. Most of the time we just tell them to apply lubricants and sometimes medical interventions may help,” the fertility expert said.
Panti asserted that with successful surgery, proper healing and emotional support, many women regained a satisfying sexual life.
He advised the women to whenever they had concerns or difficulties, consult their gynaecologist, who would give them tips regarding the repair, sexual health and resuming sexual activity.
Panti emphasised the need for counselling the woman and her husband, “because it needs a lot of patience from the partner, that he has to start slow and of course, he has to listen to her or look at her body language if she’s in any discomfort or experiencing pain so that he can stop, rest and try again.”
The don advised the women to watch out for symptoms like leakage of urine and consult with the gynae if there’s discomfort during sex.
The consultant gynaecologist urged them to focus on their overall wellness by eating well and preventing urinary tract infections.
“With proper healing, patience and emotional support, most of them regain their full sexual life after VVF repair, the key is to slow down, communicate with your partner and seek medical advice where needed,” Panti said.
He further stated subsequent delivery after VVF must be by caesarean section, to prevent a reopening of the repair.