Aspects of psychosocial problems of patients with vesico-vaginal fistula.

Our objective was to evaluate psychosocial problems among patients presenting with vesico-vaginal fistula (VVF), and their close relatives. All patients presenting with VVF and their spouses or attendant close relatives were administered a structured questionnaire followed by an in-depth interview. A total of 20 patients and 10 attendant relatives were interviewed. The average age of patients was 24.7 years, range 16-38 years. A total of 11 patients (55%) had their first marriage between the ages of 15-20 years, with one nulliparous, unmarried patient, who acquired VVF following infertility treatment with herbs. Of the interviewed respondents, 19 affirmed that prolonged labour was the cause of VVF, while four patients developed VVF sequel to unsupervised vaginal birth after a previous caesarean section. Reported medical problems were dermatitis (20%), foul smell of urine (15%), recurrent UTI (10%), infertility (5%), amenorrhoea (5%), in that order. Socially, 45% felt ostracised and 50% were economically impoverished by job loss. The divorce rate was 25%, with one case of remarriage and childbirth with an unrepaired VVF. Some 56.6% respondents suggested hospital delivery was a preventive measure, while 33.3% felt avoidance of premarital sex and early marriage would prevent VVF. VVF is still a major social and reproductive health problem and most patients and relatives understand the place of difficult childbirth in VVF formation. The need to empower patients to timely access standard maternity and emergency obstetric care is recommended.