Vesicovaginal Fistula: Psychosocial problems of VVF in rural areas of Pakistan

Abstract

Vesicovaginal fistulas (VVF) are the most commonly acquired genital fistulas that are associated with numerous physical, social, psychological and sexual problems in affected individuals. The prevalence of VVF in women is found to be 2 million approximately in Sub-Saharan Africa and South Asia with an increasing number of 50 – 100 thousands cases every year. ¹

VVF, also known as the obstetric fistulas, is a serious complication of child birth caused by obstructed or prolonged labour. It is an abnormal communication between the bladder and vagina resulting in the continuous leakage of urine from the vagina. ² In developing countries, VVF commonly affects young pregnant women with prolonged obstructed labour, without on time medical or surgical intervention. Conversely, it is very uncommon in western or developed parts of the world after the mid of last century but still poses a major problem in developing countries especially in African and Asian countries. ³

Women affected by the VVF have the physical discomfort that increases the anxiety, worry and stress. Apart from the physical discomfort it also causes dermatological infections leading to fever and constant pain.⁴  These problems not only  increases the suffering but also affects the everyday life of the affected individuals. Due to continuous uncontrolled urinary incontinence in the patients of VVF, their social stigma damaged and therefore leading to psychosocial trauma that lowers their self-esteem and continuous stress⁵  results in the detoriation of their mental health.  Women with VVF are the vulnerable and the most impoverished members of the society, as they are unable to work and ostracized by society.  They neglected by their families and family members do not like to spend time with them, even do not like to eat food cooked by them due to lack of cleanliness and offensive odours. ⁶  The relationship of VVF affected women with their husbands is also the major concern due to sexual and relationship problems. They are often abandoned by their husbands.