Repairing a Vaginal Fistula in Malawi

In third-world countries, women suffer terribly if they get a vaginal fistula. A fistula is a hole that forms when an injury does not heal properly, often after childbirth when medical services are not available. The fistula may be between the vagina and urinary system, so that a woman drips urine all of the time through her vagina, or between the vagina and the anus, so that stool leaks from the vagina. Women in poor countries do not have a way to deal with the leakage, so that odor and incontinence makes them social outcasts. A fistula may also happen after a brutal rape or when female genital mutilation in childhood complicates later childbirth. We also occasionally see them in Western countries after surgery or radiation therapy for pelvic cancer, despite excellent care.

A fistula can be repaired with surgery, but most third world women cannot afford medical care. Centers offering repair are often funded by charitable donations or grants. As I described in a previous post, The Challenge of Living with Cancer for Women in Rural Africa, Baylor College of Medicine has a hospital in the African country, Malawi that offers care to women in rural villages.  Rachel Pope, MD, an ob/gyn and Global Fellow in their program is leaving for a 2-year stint in the clinic, where she will try to get a better understanding of how fistula repairs affect women’s lives. One problem is that the scar tissue is often so dense that even after a repair, a woman may not have a vagina that can stretch enough for comfortable sexual intercourse. We are wondering if teaching women to stretch the vagina once healing has begun could help.

A vaginal dilator is an excellent way to stretch vaginal tissue and to teach women to control muscles around the vaginal entrance.  After experiences of painful penetration, women often tense up when anything gets close to the vaginal entrance, without realizing it. Women can start with a small dilator and work up to one similar in size to an erect penis, before trying intercourse with a partner.

Many years ago, I was frustrated with the types of vaginal dilators available for women. Some gynecologists used test-tubes of varying size, but that is dangerous because glass can break. Medical device dilators were made of stiff materials and were shaped like a penis. The most common set we used were also black. Women took one look at them, and I knew they would end up on the closet shelf. I wrote to a company that made sex toys and was into women-centered products. I told them we needed dilators in pastel colors, not shaped like a penis, not rock hard, and easy to clean. I never heard back from them, but years later, I heard about Soulsource dilators. Whether or not they ever saw my letter, they had created just what I imagined. I sent their flyer to one of our gynecologists at UT MD Anderson’s Gynecologic Oncology Care Center, and we have stocked them ever since. A new owner, Jane Silverstein, took over the company and has made some helpful innovations in their products. When I met Rachel, I asked Jane if she could donate some dilators for the project in Malawi. The photo at the top of this post shows the stash that Rachel is bringing to Africa. She is a little worried about how she will explain them if customs inspects her bags! Thanks to Rachel and to Jane for helping to improve women’s lives.

This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.

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