Busting the myth behind 'ekinanansi'
Oct 04, 2012
There is no doubt, sex is a key factor in marriage. But what happens when your wife’s vagina gets ‘closed’ because of a large swelling therein and the penis cannot penetrate?
By Francis Kagolo and Carol Natukunda
There is no doubt, sex is a key factor in marriage. But what happens when your wife’s vagina gets ‘closed’ because of a large swelling therein and the penis cannot penetrate?
Stories are told of how women in Buganda would develop “pineapple-like” boils (ebinanansi) in their private parts, a problem they would blame on witchcraft from co-wives who wanted to personalise a polygamous husband.
And indeed Sylivia Namutebi alias Mama Fina, the leader of witchdoctors in Uganda, believes it is possible to bewitch a woman and she develops ekinanansi. “It is common in polygamous families where co-wives fight for the same husband,” she claims.
However, although the cause of the “pineapple-like” boils is yet to be proved scientifically, medical experts have revealed a new clinical condition, which almost manifests in a similar way. What is clear, though, is that it is the female version of hydrocele, or what some call the vaginal hydrocele.
Dr. Ambrose Onapa, the country programme manager of the Research Triangle Institute, describes the problem as a swelling that starts developing from the valve inside the vagina. As it continues to swell, the swelling accumulates water. And as time goes by, it slowly pushes out.
Dr. Edridah Tukahebwa Muheki, the director for vector control in the health ministry, says the lower parts of the vagina, including the labia minoras, also swell as they get filled with fluid. She says it can cover up the entire vaginal opening, if untreated.
Prevalence
Matwale says it is not easy to find a woman with vaginal swellings because majority of the victims remain silent for fear of being stigmatised. However, he remembers encountering one woman in Alebtong district in 2010.
Despite the women’s fear to speak out, Onapa says the problem is common in areas where elephantiasis and hydroceles are endemic. In fact, health ministry statistcs show that 54 out of 112 districts (as of 2011) are likely to have cases of hydroceles.
In all, 14.6 million Ugandans are said to be at risk of contracting elephantiasis and the resultant hydrocele,while 4.8 million are said to be infected.
The affected areas include the West Nile, northern and the Karamoja region, including the districts of Amuria, Apac, Arua, Moroto, Nakapiripirit, Gulu and Oyam, among others. Other affected areas are around Lake Kyoga and the eastern districts of Tororo, Bugiri, Busia, Kaliro and Iganga, among others.
Treatment
Matwale says the thread-like worms can be killed if the victim seeks medical attention early. Once the worms are killed, the hydrocele will stop swelling. However, when the problem is in advanced stages where the swelling has covered the vagina, Matwale says it cannot be cured.
“If it is in advanced stages, we can only advise patients to keep the affected parts clean. Women can also massage the labia minora with jelly for the fluid to move slowly within the tissues,” he says.
Massaging the labia minora only helps to improve the quality of life. Otherwise, there’s no cure and the woman can spend the rest of her life with the condition,” says Matwale. Only men’s hydroceles can be cured through surgery.
Matwale advises victims to use the safe drugs that the ministry distributes to areas where the problem is endemic for relief. The medicines are usually distributed in March or October.
He also calls for the elimination of mosquitoes around homes using insecticides, clearing bushes and sleeping under insecticide-treated nets.
Experts speak
Dr. Josephat Byamugisha, a gynaecologist, says women only suffer hernias in the vagina, but he is reluctant to discuss more about it, and refers New Vision to the surgeons. A hernia happens when a weakened area of the muscle, such as the abdominal muscles, allows tissue or an organ to bulge through.
Dr. Filbert Nyeko, a surgeon at Soroti Hospital, says he has never handled any case of hydrocele among women.
“I have not come across it. The part of the body (testis) it affects is not in a woman so I don’t think women suffer from it,” he says, breaking into laughter.
Dr. James Nyonyintono, a surgeon at Kiwoko Hospital in Luwero district, says while he has never handled any case, he is aware it exists.
“Women too can suffer from hydrocele, but I have not seen any. It must be a very rare condition,” Nyonyintono says.
Dr. Rosemary Nassanga, a consultant urologist at Mulago Hospital, vehemently doubts it happens: “No no no; hydroceles in women? No.”
Causes and symptoms
Causes
Like the real hydroceles in men, vaginal hydroceles are signs of elephantiasis (lymphatic filariasis), which is transmitted by a species of the female anopheles mosquito.
Although he is reluctant to call it a hydrocele, Gabriel Matwale, the national programme manager for the elimination of hydroceles and elephantiasis in the health ministry, explains that the vaginal swellings occur when fluids gather within the tissue, usually in the labia minora, forcing the skin to lose its elasticity.
Matwale says it is caused by a thread-like worm (wuchereria bancrofti) transmitted in pairs of male and female from an infected person by the anopheles mosquito. “When the worms enter one’s body, they look for a suitable place, usually the lymphatic, which they turn into their home and build nests there,” explained Matwale.
The worms, he says, usually settle in the groin or under the armpits and as they multiply, they block the free flow of body fluids. When the fluids fight their way out of the blockage, they end up in the scrotal sack (in men), causing the hydrocele.
In women, Matwale explains, the fluids can collect in the labia minora, causing tense swelling in various vaginal parts. “The swelling later enlarges and can prevent sexual intercourse because the penis will have nowhere to pass,” Matwale said.
According to Matwale, the breasts can also swell and become hard if the worms build nests below the armpits.
Symptoms
According to Matwale, hydroceles present with malaria-like symptoms, especially filarial fever, headache and body weakness.