Doc, can my birth canal be repaired?


The condition has affected my self-esteem

Tuesday October 01 2019

Dr Flo,
I would like to know if my birth canal can be repaired. I gave birth to my first child in 2008 and it was a home delivery. I had a tear from the vagina to the anus. I’ve been married for three years now and it’s really affecting my sex life. Sometimes I can't hold back faeces for long. I can defaecate on myself without my knowledge and it has really affected my self esteem. Can this problem be corrected? If yes, kindly advise me on where I can get help.

Dear Kate,
At the time of pushing out a baby during delivery, the tissues in and around the vagina become thin and stretch to allow the baby to pass through. In the process, it is common to get a tear, especially if there is lack of good support during delivery. The tears are graded depending on how severe they are. A grade one perineal tear affects the skin only and heals quickly without treatment or with a few stitches. Grade 2 involves both skin and muscle and heals within a few weeks after stitching. A grade 3 tear involves the muscles around the vagina and the anus and in grade 4 the tear extends up to the rectum and faeces leak out.
Injury during child birth can also lead to weakness of the perineal muscles affecting the ability to hold back urine and faeces. The vagina may also feel loose, with reduced sensation, which reduces sexual satisfaction for both partners.
It is advisable for you to be reviewed by a gynaecologist to determine the extent of the problem. Reconstructive surgery can be done by a gynaecologist at a county or national referral hospital, or a major private hospital.
In addition, pelvic floor exercises (kegel’s) to strengthen the pelvic muscles around the vagina and anus help to reduce the feeling of looseness and have been found to help with sexual satisfaction. To do these, contract your pelvic muscles as though you are stopping urine from coming out. Do it quickly 10 times, then slowly, tightening the muscles for about 10 seconds before releasing, and repeat 10 times. Repeat this exercise four to six times per day.

Dr Flo,
Each time a gentleman friend has sex with a woman, she develops a musty smell around her. He neither has an STD nor a skin disease. He is hygiene conscious. What is going on? Are there remedies for him? Her?

Dear JKL,
The vagina has a natural mild musky smell. This smell changes with hormonal changes during the menstrual cycle, pregnancy and menopause. Strong smelling foods may also affect the vaginal smell. Sweat and hygiene concerns in and around the vagina and surrounding areas may contribute to the odour.
During and after intercourse, the vaginal smell may change due to use of lubricants and due to interactions between semen and vaginal fluids. If there is a strong, fishy odour immediately after intercourse, it is most likely due to bacterial vaginosis (BV). BV is an infection that occurs due to overgrowth of some bacteria that are naturally found in the vagina due to changes in the internal environment of the vagina. It may also cause an itch or burning sensation and pain during intercourse. Other vaginal infections like candidiasis, trichomoniasis and gonorrhoea can also cause a vaginal odour.
It would be advisable for your friend to have a vaginal swab for analysis and culture tests, and possibly a urine test, even as he is also screened. He should also avoid intercourse until after completion of treatment or use a condom.
She should also avoid wearing tight clothing, avoid douches and perfumed products in and around the vagina. After intercourse, she should urinate immediately afterwards and rinse the vulva and vagina with plain water. She should also avoid sugary foods, wipe front to back, shower and change underwear after sweating or exercise and wear cotton underwear. Adequate hydration is also important.

Dr Flo,
My left eye is noticeably smaller than the right one and this is a major concern. I am short sighted and early last year I suffered from Bell’s Palsy, but after medication and treatment, all was fine. Is the varying size of my eyes an aftermath of Bell’s Palsy? Are my nerves okay? What could be the probable cause?

Dear Maria,
Bell’s Palsy is a paralysis that occurs suddenly, causing temporary weakness of the muscles on one side of the face. It can occur following a viral infection or due to inflammation of the main nerve that serves the face. It makes your face look like it is drooping on one side, with a one-sided smile and an eye that has difficulty closing. You may also have drooling, pain in the jaw or behind the ear on the affected side, headache, sound sensitivity, decrease in the ability to taste and changes in the amount of saliva produced.
In most people, the symptoms go away in six months, but in a few people the symptoms can persist. The damage to the nerve may not reverse completely and the affected eye is not able to close well. In this case, the eye may have excessive dryness and is easily scratched which can damage vision.
Initially, you may also have had changes in the eyelids and brow, and later, contracting of the facial muscles which can make your eye look smaller. Other long term complications, include tearing when chewing, abnormal facial muscle movement and even facial disfigurement.
It would be advisable to be reviewed by a nerve specialist (neurologist) and also continue with the physical exercises you were doing during treatment.

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