Mary walked into the consultation room with her husband James and before I could usher them to take their seats, declared that she was not sick. “I just have a question that has been bothering me and which I think you are best placed to answer,” she smiled shyly.
We are used to people declaring that they are not sick the first time they visit the Sexology Clinic. This is because most people do not consider sex related concerns medical problems. I leaned forward to encourage Mary to pour out her heart out.
“I actually forced James to come with me because he is the one having a problem and he can never own up,” she continued, staring at James who seemed least interested in the discussion.
A number of things ran through my mind; it had been a week tending to umpteen complaints of premature ejaculation and erectile dysfunctions. Could this be yet another? But why would Mary be the one leading the discussion? “Doctor, my husband is ejaculating blood,” Mary dropped the bombshell.
“No it is not true,” James protested. He said his wife had formed a habit of accusing him of anything that went wrong sexually and that he had decided he would no longer accept such accusations. I had to intervene so as to get the truth of the matter.
This couple had been married for eight years. Mary was 36 while James was 37 years old. They had two children. Their complaint was that Mary had been seeing fresh blood from her birth canal immediately after sex. She did not have pain during or after sex. Both she and her husband reported that they actually enjoyed having sex and that they did not feel that it was rough.
“So do you not see what I mean? I am fine, no pain, nothing to complain about except the blood,” said Mary, “and so my question is, where is the blood coming from if it is not James?”
I took to explaining a few basic facts. When a woman sees blood after sex, there is definitely a raw wound somewhere in the vaginal canal or in the cervix. Some of these could be mild infections. What is more worrying though is if there is a growth, especially in the cervix. The cervix is the entrance of the uterus and is placed somewhere up in the vagina. It is notorious for developing cancer and bleeding after sex is one of the symptoms.
I examined Mary. Everything looked normal until I reached her cervix. It had a growth that bled easily on touch. “Anything is possible here and I would like to book you for a biopsy to explain the nature of the growth,” I said.
I realised that Mary had actually never had a Pap smear, the test that is usually done to women to detect if they have cancer cells. In countries where women go for routine Pap Smears, cancer of the cervix has been eradicated.
The examination showed that Mary’s growth had already spread beyond the uterus. The biopsy showed a highly malignant cancer of the cervix. Mary needed to be put on treatment as a matter of urgency.
Mary underwent extensive surgery in which her uterus was removed. She was then put on a mixture of radiotherapy and chemotherapy. It was a difficult experience for her. She lost weight, her hair fell off, and her body image changed. She was a strong lady and took everything positively.
This was yet another reminder that vaginal bleeding after sex should not be taken lightly. “Advise all your friends to go for Pap smears so that if there are early signs of cancer, treatment can be given to prevent the development of full blown cancer which is hard to treat,” I concluded the last time I saw James and Mary.