Vaginal Prolapse: An Underrated Health Concern Among Nigerian Women

Vaginal prolapse, also referred to as vaginal vault prolapse, is a condition where the top of the vagina falls from its normal position. This condition can severely affect the quality of life for women, causing symptoms like pelvic pain, urinary incontinence, and a feeling of fullness in the pelvic region. Although common, the condition is often overlooked, especially in regions like Nigeria, where societal norms and limited access to healthcare may prevent women from seeking timely help. Understanding the condition, its causes, symptoms, and treatment options is essential for improving women’s reproductive health in Nigeria.

What Is Vaginal Prolapse?

Vaginal prolapse occurs when the muscles and tissues that support the pelvic organs weaken, causing the organs, such as the uterus, bladder, or rectum, to descend into or even outside the vagina. This weakening of the pelvic floor muscles, often caused by childbirth, ageing, or hormonal changes, leads to sagging of organs—a condition medically termed as prolapse. A small prolapse, or incomplete prolapse, may cause minimal discomfort, but a severe or complete prolapse can result in organs protruding from the vaginal opening, leading to significant discomfort and complications.

There are several types of pelvic organ prolapse depending on the organ involved:

Uterine prolapse: When the uterus descends into the vagina.
Cystocele: When the bladder bulges into the vaginal wall.
Rectocele: When the rectum protrudes into the vagina.
Enterocele: When the small intestine presses against the vaginal wall.
Vaginal vault prolapse: When the top of the vagina sags, usually following a hysterectomy.

Prevalence and Cultural Context in Nigeria

In Nigeria, vaginal prolapse is most prevalent among postmenopausal women and those who have had multiple pregnancies, particularly through vaginal delivery. Studies in Nigeria show a prevalence rate of 7.55 to 39.1 per 1,000 gynaecological patients.For instance, a study at the Federal Medical Centre (FMC) Umuahia revealed that genital prolapse constituted 0.8% of gynaecological consultations and 5.2% of major surgeries performed. Despite these figures, many cases go unreported due to cultural taboos and societal stigma surrounding reproductive health issues. For instance, women in rural areas are often expected to bear large families, leading to an increased risk of prolapse due to the physical strain of multiple pregnancies and home births without medical supervision. Cultural norms that discourage discussions around reproductive health further contribute to women delaying medical care until the condition becomes severe.

Causes and Risk Factors

Several factors increase the risk of developing vaginal prolapse, particularly in Nigeria:

Pregnancy and childbirth: Multiple vaginal deliveries, prolonged labour, and the birth of large babies weaken the pelvic floor muscles, increasing the likelihood of prolapse.
Menopause: As oestrogen levels decline, the pelvic muscles lose strength, making postmenopausal women more susceptible.
Physical labour: In rural Nigeria, where many women engage in farming and other physically demanding jobs, the strain from heavy lifting further exacerbates the weakening of pelvic floor muscles.
Genetic predisposition: Some women may naturally have weaker pelvic muscles due to hereditary factors.
Socioeconomic factors: Limited access to healthcare in rural areas and the societal pressure to tolerate reproductive discomfort also contribute to late diagnosis and treatment.

Symptoms of Vaginal Prolapse

Women with vaginal prolapse may experience various symptoms, which worsen as the condition progresses:

A sensation of fullness or heaviness in the pelvic area.
Lower back pain.
Difficulty with urination, such as frequent urination or urinary incontinence.
A visible bulge or tissue protruding from the vaginal opening.
Pain during sexual intercourse.

Treatment and Management Options

Management of vaginal prolapse depends on the severity of the condition. In mild cases, conservative treatments like Kegel exercises, which strengthen the pelvic floor muscles, can help. Vaginal pessaries—devices inserted into the vagina to support the pelvic organs—are also effective for managing symptoms in less severe cases.

For more advanced prolapse, surgical intervention may be necessary. Common surgical procedures include:

Vaginal hysterectomy with pelvic floor repair: A surgical option for severe prolapse, particularly in postmenopausal women.
Sacrocolpopexy: This minimally invasive surgery involves attaching mesh to the vagina to provide support.
Colpocleisis: A procedure that closes the vaginal canal, typically performed in women who do not plan to engage in penetrative sex.

Public Health Interventions and Empowerment

Addressing vaginal prolapse in Nigerian women requires a multi-faceted approach involving public health education, improved access to healthcare, and societal changes. Public health campaigns should aim to raise awareness about pelvic floor health and destigmatize discussions around reproductive issues. Additionally, improving access to prenatal and antenatal care, especially in rural areas, can significantly reduce the incidence of prolapse by ensuring proper medical supervision during childbirth.

Empowering women through education about family planning, the benefits of pelvic floor exercises, and the risks associated with multiple pregnancies is essential. Government initiatives should also prioritize providing access to contraceptives and family planning services to reduce the strain on women’s reproductive systems.

Conclusion

Vaginal prolapse is a significant health concern for women in Nigeria, particularly postmenopausal women and those with multiple pregnancies. Cultural taboos, limited healthcare access, and physical labour contribute to the high prevalence of the condition in rural areas. By raising awareness, improving healthcare services, and empowering women with knowledge about their reproductive health, Nigeria can make substantial progress in addressing vaginal prolapse. Through these efforts, women can receive the compassionate care they deserve, reducing the stigma around reproductive health and ensuring better quality of life.

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