Tuesday, September 17, 2013
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Arizona, USA

y attention was drawn to the myth surrounding the word fibroid in Nigeria when I read an article in the Sun Newspaper on the 17th of September 2013. This was the ordeal a woman went through in her quest for a cure for her fibroid. By the time I got through this article I noticed that tears was beginning to well up in my eyes. This was about the second time I shed tears because of medical problems that caused me so much concern. The first time was when my mother was on her death bed and every effort to get the doctors to commence treatment for a condition known as pulmonary embolism failed. The doctors laughed off my concern but I was so sure of what I was talking about that I told my wife that my mother was going to die that night. I shed tears that evening because I was helpless and several thousands of miles away in the United States. She died that night of pulmonary embolism. If what I read in the Sun Newspaper about this woman's ordeal was not a hyped up story designed to sensationalize with a view to enhancing sales and maximizing profit, then there is a crisis out there. The level of ignorance is mind bugling and it is a shame not a lot is being done to rectify the situation.

I had the opportunity to watch a live Al-Jazerra program known as the Stream discussing the issue of child marriage in Nigeria. I was surprised to hear that this issue made it to the floor of the House. My main concern here is vesico-vaginal fistula which is associated with getting young teenage girls pregnant and probably in situations where appropriate medical care is lacking. I was privileged to treat cases of VVF during my NYSC posting several years ago in Bauchi State. The fact remains that since Left Nigeria to practice abroad in the eighties, I am yet to see a single case of VVF in any hospital. Religion has nothing to do with this issue and should on no account be brought into the argument. Sorry for the digression. I got carried away by the level of ignorance and misplaced priorities that make the rounds in Nigeria. Now back to fibroids.

There are some excellent gynaecologists offering state of the art services in Nigeria but I am sorry to say that there are quite a few of them. The vast majorities are busy "making money" that they relegate to the background, the need to improve their knowledge and skills. The freshly graduated medical practitioners will be in a hurry to get on with it and thereby not go through the necessary period of apprenticeship to be full trained. I have read about doctors being referred to as fibroid specialists in Nigeria. This is notwithstanding the fact that fibroid is one of several gynaecological problems facing women and certainly not the most significant. No other country in the world has the word fibroid bandied about like in Nigeria. For the women, it is like a death sentence. Marriages have been known to be annulled and engagements cancelled as a result of this word. It is synonymous with infertility. A woman diagnosed with fibroid is treated like one with a contagious disease that everybody in his right senses should avoid. How this came about is worrying. The only beneficiaries are the doctors who smile all the way to the bank treating fibroids. Not to be outdone are the charlatans who join the queue to rake in their part of the loot. The Imams and Pastors are not left far behind. It is a mundane free for all type of situation in the land. The women on their part remain ignorant because of lack of health education. It is sad that in the 21st century, Nigerian women remain so ignorant of their basic health needs and are happy to wallow in their ignorance to the point of death in some circumstances.

During one of my visits to Nigeria, my wife encouraged her friend who was scheduled for a fibroid operation to talk to me for advice as this was my area of specialization. She informed me she had been married for a while but was not getting pregnant and was under tremendous pressure from her in-laws to undergo surgery for fibroid removal. I counseled her that the operation may not be necessary and before she goes for it however, I would like her husband to go for semen analysis. He agreed and the result was that he was "azoospermic". This is a medical term for lack of sperm in the semen. The reason for the infertility was glaringly obvious. She still had the operation despite my advice and she remains infertile. My sympathy goes with her because of the African culture that lays the entire blame of infertility on the woman.

Another encounter with fibroid is a friend of mine who abandoned a girl he was engaged to simply on the fact that she was known to have fibroid and may not be able to raise a family for him. All efforts to make him change his mind failed. To cut a long story short, the lady soon got married to someone else and went on to have as many babies as they wanted.

From here onwards I will attempt to demystify fibroid to the extent that whoever reads this will pass on the information to help educate the masses.

Fibroid is a benign (non-cancerous) growth of the fibrous tissue of the uterine (womb) muscle. To avoid making this article difficult for the lay person to understand, I will make it as brief as possible and keep off medical terminology if it can be avoided. It is three times more common among blacks than the white women. The incidence of fibroids in black women in the reproductive age may be as high as 75%. The vast majority remain asymptomatic, have as many babies as they want and fibroid is discovered incidentally during operation to remove the uterus for other reasons, for example excessive bleeding or during caesarean section. The current trend in Nigeria is that with the advent of ultrasound scan, when small fibroid seedlings are discovered, the woman is told she has fibroid, all with a view to making extra money through an unnecessary operation. Generally speaking fibroids should be left well alone except they start causing symptoms. Fibroids are hormone dependent and may grow bigger during pregnancy due to increase in oestrogen production. On the other hand fibroids may become smaller or regress in size during the menopause due to deficient oestrogen in the circulation,

Without the risk of writing as if I am addressing a medical audience, I would like to mention the various types of fibroids, the symptoms associated with each type and the relationship of fibroid with infertility.

The first is the type described as submucous fibroid. This is the type that encroaches on the cavity of the uterus. This type is usually associated with excessive bleeding. These are the women who present to the gynaecologist to complain of flooding during menstruation. It is not my intention to go through the treatment modality for each type since my intention is to make women aware of what fibroid is all about.

The second type is the intra mural fibroid. This type is found with the wall of the uterine musculature. Ultrasound scan may reveal a large uterus due to the fibroid. The majority of these will remain asymptomatic and therefore no treatment will be required.

Another type of fibroid is the subserous fibroid found on the outer covering of the uterus. This type also may not cause any problem whatsoever and no treatment will be required. Finally the other type is the pedunculated fibroid. From the name, you will realize that this type of fibroid is connected to the uterus through a small stalk or pedicle. This type may grow to be so large as to cause pressure symptoms to the extent that surgery may be required to relieve the symptoms. I have deliberately left out the other types of fibroids as they are not relevant in this write-up.

Why is fibroid associated with infertility? The answer lies in the type of fibroid, the site and the effect on the fallopian tube. Fibroids may cause compression of the tubes and thereby block them. When the tubes are blocked, sperm cannot gain access through the tube to fertilize the egg and infertility will occur. Immediate recourse to surgery without first establishing whether the tubes are blocked is not the right approach. You need to perform an X-ray test call hysterosalpingography (HSG) to determine the status of the tubes. One has to bear in mind that even in a situation where one tube is blocked, surgery to remove the fibroid is not necessary as long as the other tube is open. If a doctor tells you that you will need surgery to remove the fibroid and unblock the tube, please hold on tightly to your wallet and say No but Thanks.

Fibroid may cause infertility by inducing some changes within the lining of the uterus. This may be referred to as inflammatory changes which have the tendency to make the uterus hostile to the implantation of the fertilized embryo. Early miscarriage may be the result in this situation. Fibroid may also mechanically distort the anatomy of the cavity with the same result.

From the foregoing, you would have picked up that fibroid is a benign growth of the uterus, the vast majority of which should be left well alone if not causing symptoms. The misconception that an innocent solitary fibroid found on ultrasound scan and not causing any problems whatsoever has to be removed surgically is wrong. I am sorry, but my colleagues are not going to be happy with me because this is a good source of their income. We owe it as duty to inform and educate the masses. There is no herbal concoction or magic wand out there that is effective in the treatment of fibroids. It is a shame that in a country such as Nigeria, with all her mineral and oil wealth, witchcraft practitioners and assorted array of charlatans enjoy a good clientele of women of various social standing bumping into one another in a queue to avail themselves treatment for fibroid. This was the pathetic scenario in the Sun article narrated by the woman seeking treatment for her fibroid. A pathetic situation indeed!