report of the rapid assessment of vesico-vaginal fistulae in nigeria

CoitusIn the Zaria study, there were six lesions due to sexual intercourse. All the patientswere under 16 years of age, apart from one prostitute who had a lesion due tocoitus at 18 years of age and subsequently she had repeated coital breakdown ofthe lesion after it was repaired twice. There was one suspected case of rape in a 9-year-old child, and one case of a fistula in a single unmarried girl, otherwise theothers were all married. The age of the patients ranging from 10 to 14 isnoteworthy, as well as the fact that all their husbands were polygamous (thereforewith sexual experience at the time of marriage). The main factors in these injuriesappear have been rough coitus and disproportion between the vagina and the penis.In another case, the husband used a cow horn to cut the hymen of his young wifeand this resulted in a rectovaginal fistula.Lawson (19) has noted two cases of laceration of the lower half of the posteriorvaginal wall extending into the rectum in patients with vaginal stenosis followingVVF repair, and a case of anterior vaginal wall laceration following coitusinvolving the bladder, resulting in a VVF, as well as a third degree tear after a firstcoitus.Ikedife (19) in discussing coital injuries in eastern Nigeria has noted that “thecommon factor was the woman’s poor nutritional state, a condition which was verynotable in the area, and soon after the Nigerian civil war. This possibly contributedto the easy traumatisability of their tissues” and subsequent coital injuries.TraumaIn Lawson’s series from Ibadan, (4) there was one case of VVF due to perforationby stick. In the Zaria study, there were six cases due to trauma (other than due tocoitus). The traumatic causes included the passage of calculus per vaginum after aprevious successful repair of a VVF, penetration of vagina with sharp stick after32