VULVAL CANCER: BREAKING THE SILENCE

Doris* was sitting on her hospital bed lost in thought. It was a cold, rainy, Tuesday morning that seemed to dampen the mood in the ward. Even the usually jovial professor with his dry British humour was a tad subdued.

Doris was on her second post-operative day. She had undergone surgery to remove a vulval tumour. This was the first phase of her treatment. She still had radiotherapy up ahead but the immediate battle was the prolonged confinement as she recovered from the surgical wound. She was still coming to terms with having to wear a urinary catheter for 21 days.

With the medical students away on recess, the ward round was not crowded. My colleague took us through a summary of Doris’ medical condition and her recovery from surgery. The professor took us through the discussions around vulval cancer diagnosis and treatment options but the whole time, my mind was stuck on the Doris’ psychological response to what she was going through.

Right up until 35, Doris had lived a full life. She was a science teacher who loved her job and away from work, she was a free spirit who loved the outdoors. She had just added another feather to her cap by scaling Mount Kenya at 34 and she felt so proud.

Then her woes began. She started noticing a persistent itch in her vulva (external genitalia). At first it was mild, coming on and off and she ignored it. As it persisted, she walked in to a pharmacy and was given a cream across the counter. She used it for a while with some relief while another two months flew by.

One day, after participating in a charity half-marathon, her itch overwhelmed her and she sought medical help. She was seen at the emergency department and the doctor prescribed some antifungal capsules and a steroid cream. She faithfully used her medication but she did not get much relief.

Her discomfort was beginning to affect her life. She lost interest in sex, which strained the relationship with her boyfriend. She spent all her time online trying to find solutions for her itch. She tried all manner of remedies. She discarded all her fancy sheer underwear in favour of cottons, she tried different types of sanitary towels, she ditched her denims and resorted to wearing dresses, to no avail. She adjusted her diet, went vegan, changed her toilet soap and replaced her bathing flannel but it was all in vain.

Repeated treatments for candidiasis did not help Doris. She visited various outpatient clinics that her medical insurance permitted but never quite got an answer to her problem. She even attempted the old wives therapies of applying natural yoghurt to her vulva  at bedtime, using aloe vera therapies that she purchased online and even traditional herbs from herbal clinics in town. Her efforts were all in vain and the itch soldiered on unperturbed.

Doris suffered in complete isolation. Having grown up without sisters and had never quite formed strong bonds with her female friends. Due to her love for the outdoors, most of her close friends were men. She realized she did not have anyone to talk to about her issues, which are viewed as private. She silently suffered her nightmare.

She noted that her vulval skin was dry, flaky and was becoming indurated. She failed to appreciate the developing mass underneath as she attributed these changes to the prolonged itch-scratch cycle that had become her life.

One day, Doris‘ church hosted a free cervical cancer screening camp. Doris decided to consult the screening nurse. By this time, Doris had developed an ulcer in her genitals. The nurse referred her straight to the teaching hospital where she had a biopsy done and a diagnosis of vulval cancer was made.

Doris was devastated. She had no idea how to explain this to her loved ones. Yes she had cancer but she had no way of even putting a name to it. She could not even explain it to her mother. She could only show her the lesion. The fact that the vulva is a private body part that isn’t publicly discussed remains a hindrance to many when it comes to talking about this uncommon cancer.

She was grateful she had a female headmistress who was very understanding and allowed her off work to go and seek medical care. The next week she was admitted to the ward and underwent surgery. No amount of counselling prepared her for the mutilation occasioned by the surgery. To fully excise the tumour, a large chunk of flesh had to be taken out of her vulva, extending all the way to the inguinal area.

The healing was slow and exhausting. She spent her days sitting on her bed, legs together to prevent tension on the sutures and avoid the risk of the wound breaking down. She was on antibiotics for weeks to prevent infection and had to keep the dreaded urinary catheter for a month.

Her wounds healed but the scars remained as a testimony for what she had undergone. She survived the radiotherapy and despite the odds, Doris survived the cancer. Five years on, she has gotten her life back but she hasn’t quite found the words to describe her experience.

Doris is a true representation of the average Kenyan woman. Vulval itching is   not a normal event. A majority of cases will be due to candidiasis (yeast infection) but this is a cardinal sign of vulval cancer. Stop rationalizing it. No, it is not your underwear, it is not your tight jeans, it is not your sanitary towel. See your gynaecologist and get proper diagnosis. It will save your life!