Premarital classes at the sexology clinic are fun to facilitate. While some couples express genuine ignorance about their sexuality, a number describe out-of-the-world fantasies that they fear marriage might not fulfil. Traditionally couples follow up the sessions with private consultations so that by the time they get married, they are fully skilled on matters of bedroom importance.
It was therefore not surprising when Rose and her fiancé followed me to the consultation room for what they called a private chat.
“It is about me and I already mentioned it to Tom,” she started as Tom, her fiancé, rubbed her shoulders tenderly.
“I am a survivor of rape but I was counselled and overcame the trauma.”
She said that she had resolved not to be bogged down by the rape which happened in her teenage years. It had been ten years after the incident and she had moved on. She said Tom was supportive and loving and was committed to accommodating her dark past.
“I just want you to know this in case you need this history in future; you never know what marriage holds for us and we will definitely be seeing you for advice now and again.”
With that they shook my hand and walked away leaving me puzzled as I tried to fathom what all that was about.
Last Friday, a year the encounter, they came back to see me at the clinic.
“Now I trust your word that you would be consulting now and again,” I said to break the ice.
“We are not here for sex lessons; I get pain during sex but I can live with that,” Rose said looking rather unhappy, “my problem is that a year after our wedding, I have not conceived.”
I examined Rose and ordered for a battery of tests as is characteristic in diagnosing causes of infertility. Tests showed that Rose had blocked fallopian tubes (the channels that transport eggs from the ovaries to the uterus). Under the circumstances, sperms and eggs could not meet to fertilise and form a baby and the result was infertility.
Fallopian tubes get damaged and blocked when they get infected with bacteria. This can happen at any point in life. With a history of rape, pain during sex and damaged tubes, I could only think of one common, but rather ignored sexually transmitted infection: chlamydia.
This bacterial infection is dangerous because 75 per cent of women who have it will not get symptoms, yet it continues to ravage the uterus and tubes and leads to irreparable damage. Half of the men who have the infection also do not have symptoms. Lucky women may get a foul-smelling vaginal discharge when they get chlamydia, while men may get a burning sensation while passing urine.
This is however the exception rather than the norm; there are so many infected people who have no symptoms. In essence, the infection is a quiet epidemic that is rarely talked about.
“So what you mean is that the rapist infected me?” Rose asked sobbing.
In most cases the infection is transmitted during consensual unprotected sex. In fact it is recommended that all women who are sexually active below the age of 25 years, whether with one or multiple partners, undergo annual screening for chlamydia. This is the time when most infections happen and if discovered in good time, treatment is given and the possible damage to the reproductive organs is averted.
Unfortunately almost no woman goes for this screening test so we have had an epidemic of infertility due to damaged fallopian tubes. Men who harbour the infection usually get no damage to their reproductive organs, but a few may have pain in the testes and related organs. After the age of 25 years, it is recommended that women are screened when they get a new sex partner and especially if they have multiple sex partners.
“So what else can we expect from this infection? Do we have a future? Am I also infected? Is there medicine for it?” a distressed Tom asked a battery of questions in quick succession.
A number of women who are infected with chlamydia sometimes also get ectopic pregnancy. This happens if the fallopian tubes are not fully damaged and the eggs and sperms manage to manoeuvre their way and fertilise. If an infected woman conceives and does not get ectopic pregnancy, she has a higher chance of premature delivery. In addition the baby can get infected, normally in the eyes and the lungs and in severe cases chlamydia leads to blindness and/or severe pneumonia in the newborn.
If detected in good time, chlamydia is totally treatable with no recurrence.
To reduce the risk of infection, abstinence, sticking to one uninfected partner and consistent and proper use of condoms is recommended.
“Well, that is now water under the bridge, time for prevention is over; tell me, do I have a future?” Rose asked.
Rose and her husband got a course of antibiotic treatment after which she was referred for in vitro fertilisation (IVF), the best option to get a baby in cases of blocked fallopian tubes.