A couple of days ago, a charming, well-dressed young girl walked into the outpatient department (OPD) at our hospital to have her report examined. It seems she had first come into the OPD with complaints of pain in the abdomen and had been advised to get an ultrasound done, and it showed that all was all right, thankfully. She looked vaguely familiar though, and I realised then that I had seen her about four years ago when she’d come to me with menstrual problems. She told me that she was much better now, and her menstrual cycle was on schedule and with regular flow. Unthinkingly, and quite foolishly, I ended up asking her if she was married. Annoyed, she replied that she was just 16. “How would I be married?”
Four years ago, she had come to the hospital, clutching her mother’s hand and crying. I remember trying to comfort her, but it had no effect on her tears—she was very scared. Her mother had been worried about the pain she had been experiencing in her lower abdomen for the last three to four months, and being that she was only 12 back then, she hadn’t even started her periods yet.
Following prolonged consoling, the young girl had finally agreed to lie down on the examination bed, and on initial assessment, was found to exhibit normal sexual characteristics for her age, but there was a definite pain on palpitating her abdomen. Further examination revealed that there was an abnormality in her vagina—it was absent, you see—and the ultrasound showed a collection in her uterine cavity. The girl’s vagina had not developed properly, and when she had begun menstruating, unbeknownst to her, the menstrual blood had started accumulating in the uterus because it could not find an outlet, and was causing her pain. Surgery was immediately carried out to reconstruct her vagina and the lower part of her uterus. She was finally discharged, with prayers, because these procedures can often prove unsuccessful or result in complications of their own.
The ultimate aim of the surgery is to grant women the ability to menstruate normally, have a normal sex life, and be able to bear a child. So I was naturally elated to rediscover this young girl after four years, and to see and be told that she was menstruating regularly. I suppose that was where the hasty question about marriage had stemmed from.
A normal menstrual cycle involves a complex interaction between the ovary and brain—technically, the pituitary gland and hypothalamus—axis, and the uterus. Any alteration or hindrances in this interaction can cause cessation of menstruation, what is called ‘amenorrhoea’. There are essentially two kinds of amenorrhoea: Primary amenorrhoea, where the patient has not menstruated at all, and secondary amenorrhoea, where a patient with a normal history of menstruation stops menstruating for a period of at least three months.
Women come for gynecological checkups at the OPD with various issues, ranging from minor problems such as mild lower abdominal pain to more serious conditions such as cancers of the uterus, ovary or cervix, but there are very few who bother to get consultations for menstrual problems. Many cases of primary amenorrhoea therefore go undiagnosed, rooted as they are in confusion and embarrassment on the patient’s part. They are reluctant to go to doctors because of the kind of narrow-mindedness that exists in our society regarding these issues, and end up compounding their conditions by not taking action, leading to various social, psychosexual, martial and infertility problems. Most don’t get married at all.
If you or your daughter sense something is not right with your menstrual cycles, it is important that you consult a doctor immediately, just so you don’t cause yourselves further harm, and are able to remedy the problem when it is still at its initial stage. Don’t let your self-consciousness stand in your way; there are, after all, bigger things out there than the possibility of a little embarrassment.
Dr Singh is Professor of Obstetrics and Gynecology at the TU Teaching Hospital
Posted on: 2013-04-15 10:07