Thursday, July 7, 2011

Loose Vaginas and Other Worries

“My vagina is loose,” she complained. The young lady sitting across the consulting table was serious. Here was a beautifully manicured, Cameroonian student, age 22, complaining that her ‘vagina was loose’!

Ms. Quinta (not her real name) was the icon of style. Here hair was plaited in locks of crimped yet fluffy black curls that added 2 inches to her already tall frame. She wore a light blue dress with a bejeweled, wide belt that accented her curvy hips. Her flashy necklaces balanced the upper portion of her figure. With her shiny lip-gloss, color-coordinated eye shadow, high heels, and pearly white smile, she was the picture of fashion. I swear the fashion industry is really missing out when I look at all the examples of slender but curvaceous and healthy figures parading around the university on a daily basis.

When Ms. Quinta stated her complaint, I must admit that I was a little shocked. As a physician, I have seen and heard many things – as you might imagine. This was the first time I’ve had anyone complain about their female anatomy using these words. Trying to maintain my professional demeanor but not really succeeding, I said, “What? Can you explain that again? I’m not sure I understand you.”

“You’re a gynecologist, right?” she queried.

“Yes,” I replied. [Here in Africa with my Family Medicine specialization, I can be a pediatrician or a gynecologist or a gerontologist depending on who asks!]

Apparently satisfied with my affirmation as a female anatomy expert, she continued her explanation. “Recently, doctor, I’ve been noticing that my vagina is loose. I want to know if there is some medicine I can take that can tighten it. You know, maybe some cream that I can rub there?” she trailed off.

“Well – “, I paused. “There are different reasons for a loose vagina. Tell me what you mean by a loose vagina. Why is it a problem for you?” I was really stalling for time. I was a bit stumped by what to tell her about loose vaginas.

“Are you having other problems down there?” I queried.

“I used to have ‘sugar sugar’ [This is Pidgin for Candidiasis vulvovaginitis. It is a condition where yeast cells proliferate beyond normal levels and cause characteristic itching and discharge]. The pharmacist gave me some cream that is helping.”

“Oh, I see,” I say. “ So you had some vaginal itching and discharge that is better now? No more itching?”

“No more itching,” she affirmed. “I also have problems with my menses. They are irregular.”

“How are they irregular?” I asked. I jumped at this opportunity to turn the topic of conversation to a medical diagnosis I had actually studied about in medical school! “Can you tell me the dates of your last menses for June, May, and April?”

Ms. Quinta popped out her cellular phone from her large, fashionable purse. She started pressing buttons. As she looked at her cellular calendar, my high-tech patient rattled off the dates of her last few periods. “June 28, April 30, March 26…Oh, I forgot May. May 26.”

“Excellent!” I congratulated her on her organizational skills. “So, it looks like your having a period every month but it doesn’t always come on the same day every month. Is that correct?”

“Uh-huh,” she nods.

“I see,” I answer. Actually I really don’t see. She has a period every month. Generally they are coming around the same time of the month. I think I’m missing something. What is her real worry? My instinct is that she is rather naïve in certain areas. A lot of women worry that if their menstruation does not come monthly at the exact, predicted day, they have fertility problems. Some younger girls start complaining about irregular menses when they really mean a missed menstrual period and the potential of a pregnancy.

I delve into the details of this young lady’s worries. I try to find the clues for the real reason she paid to see a gynecologist. I ask a lot more questions and she reveals to me more hidden messages in her various answers. Gradually we come to understand each other. I try to educate her about quite a few topics in the gynecologic realm. I am able to give her advice about contraception, sexually transmitted infections, and other need-to-know topics for a girl that’s got at least one boyfriend. She leaves my office seemingly satisfied. She has a prescription for birth control. She has the assurance of a reputable health professional about what is normal or not normal in regards to female anatomy and monthly cycles. She knows how sexually transmitted infections including HIV are transmitted and prevented. Her true reason for coming to the doctor was for trusted advice and the means to control her menstrual cycle and prevent unwanted pregnancy.

After her departure, I can’t help laughing at the interesting complaints patients have in Africa! Who would imagine that I would need to know about ‘loose vaginas’ in addition to tropical ulcers, malaria, typhoid, and diabetes management! The possibilities of patient problems here in Buea are endless. Here there are rich and poor, educated and uneducated, foreigners and locals, naïve and experienced. Ms. Quinta reminded me of an underlying principle taught throughout medical school and residency. The real test of a physician’s medical acumen is not just in compiling symptoms into a diagnosis; but in searching out the underlying reason his or her patient has sought medical advice.