LOOSE VAGINA AFTER DELIVERY

After my third baby a few months ago, I discovered that my vagina is loose and not as tight as before. I no longer enjoy mating with my husband. Is there anything that can be done? -Salome, Abuja. This is not uncommon after deliveries. This is usually due to a relaxation in pelvic muscles and other structures because of stretching during pregnancy and deliveries. Pushing before full cervical dilatation and difficult vaginal deliveries increases the risk. It is also a common occurrence in patients with uterovaginal prolapse. It could also occur due to the inherent weakness in the pelvic structures and also part of the ageing process.

To minimize the incidence we avoid pushing before the 2nd stage and avoiding difficult vaginal deliveries.

The treatment includes Kegel exercises. This is a pelvic floor muscles exercise. It helps to return the tone of the pelvic floor muscles and thereby return sexual satisfaction. Most postpartum (after deliveries) pelvic floor muscle relaxation will return to normal with this. For the technique of kegel exercises, kindly contact a physiotherapist or your gym instructor.

Where necessary, surgery may be done to correct pelvic floor muscles and supporting structure relaxation. Mainly colpoperineorraphy with or without other associated surgery may be done for the restoration of anatomical structure and sexual satisfaction.

I will suggest you see a gynaecologist.

NO NIPPLE AT SEVENTEEN

I am a 17-year-old young lady and I do not have nipples. My friends say until I am pregnant before I can have them. Is this true? I am worried, please help.

-Bola Kaduna

Breast development starts from fetal life (while still in the womb), but become more pronounced during puberty. Nipple development does not wait till the first pregnancy; it comes as part of pubertal development. Firstly, one has to be sure, is it that there is no nipple at all; not well developed or developed but not pronounced? Sometimes it could also be a retracted nipple, in which case it is developed.

There are so many questions that need to be answered before one can give objective advice. Are your pubertal changes normal? Have you started menstruating? What Tanner stage is your breast development?

Do not fall into the temptation of getting pregnant just to have a nipple or breast. I know as a girl this will be a source of psychological disturbance and anxiety. But beware of peer pressure.

I will suggest your mum takes you to see the family physician or the gynaecologist for an examination.

FIBROIDS IN LATE TWENTIES

I am a 28-year-old lady. I was told I had fibroids at the hospital. Please, is it possible at my age to have fibroids? What do I do?

-Zainab, Damaturu

Yes, it is possible. At your age, fibroids could be diagnosed and could be of a large size. We have operated on several cases of fibroid at that age that could be as big as seven to six months pregnancy size. The fibroid is not common in teenagers, only a few instances have been recorded in scientific literature. A fibroid is more common in people who have delayed childbirth.

Usually, a lot of factors are considered before one determine what to do when fibroids are diagnosed. A lot of time it may be left alone, one could remove the fibroids – myomectomy, or remove the whole uterus – hysterectomy, especially for people who have completed their family size. Factors to consider whether to operate fibroids include the size of the uterine fibroids; whether it is symptomatic or not like menorragia (excessive menses) or pains; unexplained infertility with uterine fibroid among others.

About the use of drugs to treat uterine fibroids, please it has its role but it is limited. We use drugs like goserelin to reduce the size of fibroid before surgery or for women who are around menopause. Please beware of wasting your money and time on acclaimed oral medications to ‘cure’ fibroids they are deceitful. More dangerous is the insertion of herbal materials into the vaginal to ‘treat’ fibroids, many have come down with gynaetresia ‘stenosed or narrow’ genital tract with its complications

ASTHMA IN EARLY PREGNANCY

What drugs can I use as an asthmatic patient? I am six weeks pregnant. Is it safe for me to use the inhaler?

-Nancy, Nyanya, Abuja

Most of the drugs used in the management of asthma are safe in pregnancy. The inhaler, salbutamol tabs and if necessary aminophylline injection can be used. Most importantly, ensure you always have your inhaler with you so that when you start to experience the symptoms you can use it. Avoiding predisposing factors is also critical in management. I will advise that you book early for antenatal under an obstetrician