Lillian’s story is a tragic one. I saw her five years ago. She came to the clinic because she wanted to satisfy her husband sexually. Like many African women in marriage, she was socialised to always make the man happy or suffer the consequences, an absurd mentality but a reality in our cultures.
“I am being impeached from my bedroom doctor,” she said during a phone call. “You better intervene before my marriage breaks!”
Phone calls are never the best for a first-time consultation. The doctor misses the body language, which can be quite telling. Further, physical examination is not possible. We therefore agreed to meet at the clinic the following day.
“So, what is this story of impeachment from the bedroom all about?” I asked when we met.
“Well, I am unable to be sexual. As they say, when it rains it pours, and for me, it is happening literally!” Lillian had a way with the spoken word. I was not sure I understood everything she was talking about in her parables, so I requested that she explain.
“It is my period. They just won’t subside. My husband is very upset and thinks I am pulling one of those strings on him,” she explained.
She had been bleeding continuously for three weeks. This was contrary to her usual menstrual flow, which would normally go for four days. She had no tummy pains, but in the preceding few days, she had noted that the blood was starting to smell.
“But all that is not a problem, I am seriously worried about my husband. He won’t move close to me, he hates blood. I need advice on my sex life. It has been almost a month with no sex, can you imagine?” Lillian explained.
I examined Lillian and found the bleeding to arise from her cervix. There was a friable growth in the cervix which was bleeding easily. The growth seemed to be extending to the pelvis. I feared this growth could be sinister, could it be cancerous?
“So when did you last have a pap smear?” I asked. Pap smear is an important test that every woman should undertake routinely. It detects changes in the cervix that could develop into cancer. Treating those changes in good time averts cancer of the cervix.
“It is not that I do not know about the test doctor,” she explained. “It is just that I have never had the courage to do it, many women I hate it; they say it is uncomfortable.”
Lillian was booked for examination in the theatre under anesthesia to confirm the extent of the growth and also take a biopsy for testing in the laboratory.
Results of the tests were ready a week later. Lillian came with her husband to the clinic to receive them.
“I came to see a doctor because I wanted to make you happy sexually, but this is turning out to be unbearable for me,” she told her husband, tears rolling down her cheeks. I had just explained to them that the test confirmed that she was having cancer of the cervix.
“But, doctor do you mean just bleeding alone is a symptom of the cancer?” Lillian’s husband asked. “My wife has always been fine. What could have caused the cancer?”
Unfortunately, cancer of the cervix never has symptoms until it reaches advanced stages when abnormal vaginal bleeding, sometimes following sex, may occur. Some women may also experience blood-stained, smelly discharge. Pain happens late in the disease. The only way to detect the cancer early is to go through routine screening using a pap smear or other tests.
Because most women do not go for screening, cancer of the cervix is among the commonest cancers in our communities. It is estimated that over half a million cases of the cancer are newly diagnosed globally each year leading to about 280,000 deaths of women. In Kenya, about 2,500 cases are diagnosed each year, leading to about 1,700 deaths. The cancer occurs in women who have had sex at least once. Any woman who has been sexually active, therefore, needs to be screened for it.
For young girls who are yet to be exposed to sex, there is now a vaccine. The vaccine can be administered from the age of nine years. Parents should help their children get the vaccine.
“When you say that it happens in women who have had sex, does it mean that it is sexually transmitted?” Lillian asked.
Lillian underwent a hysterectomy, the removal of the uterus, with the hope of cutting out all the cancer cells from the body. She then underwent radiotherapy. Unfortunately, 10 months later, her kidneys failed. The cancer cells had invaded the urinary system and interfered with the flow of urine, leading to destruction of the kidneys.
Realising that the cancer had advanced to levels beyond repair, Lillian was referred to the hospice for terminal care. She unfortunately passed on a few months later. I hope women will go for routine pap smear. I also hope that their daughters will take the cervical cancer vaccine for prevention. It is painful to see women die from causes that can be prevented. It is an injustice of the highest order if we do not use the scientific knowledge and technology that is available to us to prevent these deaths.
