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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 36  |  Issue : 3  |  Page : 472-473

Once treated, twice harmed: A case report of acquired gynatresia following vaginal insertion of herbs


1 Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
2 Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex; Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria

Date of Submission11-Apr-2019
Date of Decision09-Dec-2019
Date of Acceptance07-Nov-2019
Date of Web Publication22-Jan-2020

Correspondence Address:
Dr. Olusegun O Badejoko
Department of Obstetrics, Gynecology, and Perinatology, Obafemi Awolowo University, Ile-Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TJOG.TJOG_101_19

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  Abstract 


Gynatresia is the narrowing or complete occlusion of the vagina, which may be congenital or acquired. In Nigeria, acquired gynatresia is more common, usually resulting from the use of herbal pessaries. Its mere occurrence is indeed one social calamity to many. We present a case of a 37-year-old P0+1 with acquired gynatresia following insertion of herbal pessaries at a trado medical center. This was in an attempt to treat cryptomenorrhea which had developed following an abortion complicated by uterine perforation at a private hospital 20 years prior. Poor quality of medical care may push women to seek unsafe alternatives, resulting in even more harm.

Keywords: Alternative medicine; amenorrhea; apareunia; dyspareunia; gynatresia; patient safety.


How to cite this article:
Allen OO, Badejoko OO. Once treated, twice harmed: A case report of acquired gynatresia following vaginal insertion of herbs. Trop J Obstet Gynaecol 2019;36:472-3

How to cite this URL:
Allen OO, Badejoko OO. Once treated, twice harmed: A case report of acquired gynatresia following vaginal insertion of herbs. Trop J Obstet Gynaecol [serial online] 2019 [cited 2020 Jul 6];36:472-3. Available from: http://www.tjogonline.com/text.asp?2019/36/3/472/276431




  Introduction Top


Gynatresia, also known as vaginal stenosis, is the narrowing or complete occlusion of the vagina, which may be congenital or acquired.[1] In the developed world, congenital causes account for most cases, while acquired gynatresia is rare, usually resulting from surgery or radiotherapy. In developing countries, such as in Nigeria, acquired gynatresia is more common, occurring from the use of herbal pessaries for the treatment of uterine fibroids, infertility, and uterovaginal prolapse, or in an attempt to terminate an unwanted pregnancy.[2],[3] This seemingly simple act often leads to years of physical, psychological, social, and financial distress to affected women. Its mere occurrence is indeed one social calamity to many. Herein, we report a case of a young woman with acquired gynatresia following a cascade of events that could have been prevented by appropriate healthcare.


  Case Report Top


A 37-year old P 0+1, presented with a 20-year history of secondary amenorrhea and 1 year of apareunia due to a “closed vagina”. She had a botched abortion 20 years ago, complicated by uterine perforation and sepsis at a private hospital. She subsequently had a laparotomy, which was further complicated by wound breakdown. Since then, she had been amenorrheic however, had cyclical lower abdominal pain and premenstrual symptoms. This persisted until 4 years ago when she visited another private hospital in an attempt to cure her symptoms. A pelvic scan was done, which revealed hematometra. She then had transvaginal drainage with transient relief of her symptoms but the cryptomenorrhea recurred soon after. One year ago, she visited a trado medical center, where she had herbal pessaries inserted. These were later expelled, with associated pain, vaginal bleeding, and severe dyspareunia. She soon became apareunic, and noticed a complete occlusion of the vagina which made coitus impossible. Clinical examination revealed an anxious-looking young woman who generally appeared healthy. She had a wide, fibrotic, midline infra-umbilical scar but there was no palpable abdominopelvic mass. Vaginal examination revealed healthy vaginal mucosa of 3 cm from the introitus, beyond which a fibrotic band obstructed the vagina completely. A diagnosis of acquired gynatresia resulting from chemical vaginitis was made. She was educated about the diagnosis and counseled on the need for surgery. She is being worked-up for vaginoplasty in conjunction with the plastic surgeons.


  Discussion Top


Acquired gynatresia is a preventable gynecological disorder of public health importance due to its significant impact on the quality of life of affected women. Arowojolu et al. reported an incidence of 7/1000 women in Ibadan.[4] Vaginal insertion of herbal pessaries has been found to be the most common cause of acquired gynatresia in African countries, especially Nigeria. Other causes include female genital mutilation and birth injuries. In other regions of the world, postpartum vaginal insertion of rock salts is practiced to achieve vaginal “tightening”.[3],[5] Herbal pessaries may contain a mixture of substances such as herbs, potassium permanganate, and calcium carbonate.[2],[5] These substances are corrosive and cause irritation and inflammation of the vaginal mucosa. In the immediate period, the patient experiences severe pain or burning, with bleeding, and/or infection. As healing occurs, there is apposition of the vaginal walls, with scarring, and subsequent complete or partial vaginal occlusion.[2],[6] This may lead to dyspareunia, and eventual loss of sexual function, as occurred in our patient. There may also be secondary amenorrhea, dysmenorrhea, or cryptomenorrhea.

The peculiarity of this case is that gynatresia occurred in our patient as an unfortunate complication of her attempt to cure a problem that had plagued her for two decades. She had received inadequate care at two private hospitals; first 20 years ago, where she had an abortion complicated by uterine perforation and sepsis following which she first developed cryptomenorrhea; and then 4 years ago, where she had drainage of the hematomata. This inability of the health system to provide her with satisfactory care led her to a traditional practitioner who inserted the herbal pessaries. This raises concerns regarding patient safety, especially in countries like Nigeria where potentially harmful traditional and cultural practices still abound.

Each year, a significant number of patients suffer avoidable injuries, or death, as a result of poor quality healthcare.[7] The concept of patient safety emphasizes the prevention and reduction of medical errors that may cause preventable injury in patients. These errors may include wrong diagnosis, use of substandard medications, surgical adverse events, nosocomial infections, and others.[8] Poor quality of health services compromise the health of patients, and may lead to lack of trust in the healthcare system, pushing them to seek care from unqualified personnel, such as occurred in our patient.[7] Proposed mechanisms to improve patient safety culture include good leadership, teamwork, evidence-based care, communication, learning from mistakes, cultivating a just culture, and patient-centered care.[9]

In conclusion, acquired gynatresia due to herbal pessaries still occurs in present-day Nigeria. Poor medical care may push women to seek unsafe alternative remedies, resulting in even more harm. Efforts to ensure patient safety in our health facilities may prevent this occurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Park Y, Im E. Postpartum gynetresia. Perinatology 2019;30:36-9.  Back to cited text no. 1
    
2.
Anzaku SA, Ahmadu D, Mikah S, Didamson GD. Cryptomenorrhea due to acquired mid-vaginal atresia: A case report treated by vaginoplasty and serial vaginal dilatation. J Gynecol Infertility 2017;1:1.  Back to cited text no. 2
    
3.
Kunwar S, Khan T, Gupta H. Case report: Acquired gynatresia. BMJ Case Rep 2014;2014: bcr2014203529.  Back to cited text no. 3
    
4.
Arowojolu MO, AO Adekunle, AO Ilesanmi, A. Three decades of acquired gynaetresia in Ibadan: clinical presentation and management. J Obstet Gynaecol 2001;21:375-8.  Back to cited text no. 4
    
5.
Kaur G, Sinha M, Gupta R. Postpartum vaginal stenosis due to chemical vaginitis. J ClinDiagn Res: JCDR 2016;10:QD03.  Back to cited text no. 5
    
6.
Nakhal RS, Williams CE, Creighton SM. Chemical vaginitis: Implications and management. J Low Genit Tract Dis 2013;17:95-8.  Back to cited text no. 6
    
7.
Patient Safety: Making Health Care Safer. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.  Back to cited text no. 7
    
8.
Jha AK, Prasopa-Plaizier N, Larizgoitia IA, Bates DW. Patient safety research: An overview of the global evidence. Qual Saf Health Care 2010;19:42-7.  Back to cited text no. 8
    
9.
Sammer CE, Lykens K, Singh KP, Mains DA, Lackan NA. What is patient safety culture? A review of the literature. J NursScholarsh 2010;42:156-65.  Back to cited text no. 9
    




 

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