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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 59-60

Self-inflicted genital incision: a rare case report


1 Department of Obstetrics and Gynaecology, College of Health Sciences, Kaduna State University, Zaria, Nigeria
2 Department of Obstetrics and Gynaecology, Faculty of Medicine Ahmadu Bello University Zaria, Nigeria

Date of Web Publication1-Nov-2018

Correspondence Address:
Matthew C Taingson
Department of Obstetrics and Gynaecology, College of Medicine, Kaduna State University
Nigeria
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DOI: 10.4103/ssajm.ssajm_27_17

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  Abstract 

Yankan gishiri, a genital cut, on the vagina for various illnesses is a harmful cultural practice. It is usually performed by traditional barbers. We report a case of Mrs. AA, a 20-year-old para 3 who presented with a history of a long-standing vaginal swelling which became painful after the patient made an incision on it. She was treated with antibiotics and analgesics, and subsequently had an anterior colporrhaphy.

Keywords: Anterior colporrhaphy, cystocele, genital cutting, yankan gishiri


How to cite this article:
Taingson MC, Adze JA, Bature SB, Durosinlorun AM, Caleb M, Amina A, Solomon A, Lydia A. Self-inflicted genital incision: a rare case report. Sub-Saharan Afr J Med 2018;5:59-60

How to cite this URL:
Taingson MC, Adze JA, Bature SB, Durosinlorun AM, Caleb M, Amina A, Solomon A, Lydia A. Self-inflicted genital incision: a rare case report. Sub-Saharan Afr J Med [serial online] 2018 [cited 2018 Nov 19];5:59-60. Available from: http://www.ssajm.org/text.asp?2018/5/2/59/243938


  Introduction Top


Local genital cut called “yakan gishiri,” which literally means salt cut, is a cultural practice that is predominant amongst Hausa/Fulani tribe living in Northern Nigeria.[1] It is usually a longitudinal cut made on the anterior or posterior vaginal wall using sharp cutting tools. It is done for many reasons including difficult birth, vaginal stenosis, infertility, and uterovaginal prolapse.[1] It is mainly performed by traditional barbers (Wanzami), traditional birth attendants (TBAs) (Ungozoma), and rarely by the patient.[1]

Female genital incision is a type 4 form of female genital mutilation.[2] Other types of nonmedical interventions on female genitals include piercing, pricking, tattooing, labioplasty, and cauterization.[3]


  Case report Top


Mrs. AA was a 20-year-old P3+0 2 alive, who presented to the gynecological clinic of Barau Dikko Teaching Hospital Kaduna on the June 14, 2016. She had her menstrual period on May 10, 2016. She complained of vaginal bulge of 14 months duration. She had no problem with bladder emptying or bowel movement, and did not have dyspareunia. She had vaginal pain for 5 days. The pain started after she incised the bulge with a razor blade, as advised by a local traditional barber (Wanzami) whom she had consulted. Following the incision, there was mild vaginal bleeding, but no leakage of urine. However, the bulge persisted. She was a homemaker with no formal education. She had no menstrual problems. She had three previous unsupervised home deliveries; her last child birth was 14 months prior to presentation, whereas her first delivery resulted in an early neonatal death.

On examination she was anxious, not pale, anicteric, and had no pedal edema. Her chest was clinically free of congestion. Her pulse rate was 80 bpm and blood pressure was 120/80 mmHg. Abdominal examination revealed no abnormality. Pelvic examination revealed a grade 3 cystocele, with a curvilinear scarification over the anterior vaginal wall about 3 to 4-cm long and 1.5-cm short of the external urethral meatus, and 4 cm from the cervix [Figure 1]. The patient was admitted and placed on caps ampiclox 500 mg 6 hourly, tabs metronidazole 400 mg 8 hourly, and sitz bath. She had anterior colporrhaphy on the 5th day on admission when the inflammation had subsided [Figure 2]. A sagittal incision was made from a point 2 cm from the cervicovaginal junction in the midline anteriorly to connect with existing scar on the anterior vaginal wall. The mucosa was separated from the underlying fibromuscular tissue and dissected up to the lateral sulcus, with the pubocervical fascia exposed. The fascial plication was conducted with vicryl 2-0 suture. The vaginal skin over the incised area was excised, and the remaining was then closed with interrupted 2-0 vicryl mattress sutures. She was catheterized for 4 days. The catheter was removed on the 4th day and was discharged on the 5th postoperative day. Subsequently, she visited the gynecological clinic with no complaints.
Figure 1 Incision on the cystocele at presentation

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Figure 2 Incision on the cystocele day 5 on admission

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  Discussion Top


Pelvic organ prolapse is a common condition with prevalence rate of 25% to 65% amongst women aged 18 to 65 years of age.[4] The risk factor of prolapse increases with increasing parity, specifically the number of vaginal deliveries.[5] Mrs. AA had three vaginal home deliveries. Female genital incision is mainly performed by a local traditional barber, a TBA, or in some cases by the patient herself,[1] as in this case of Mrs. AA. The process of making the cut involves the use of sharp objects to incise, scratch, or excise some tissue from a site in the vagina which is usually a few centimeters away from the external urethral opening.[1],[6] Use of razor, and proximity to the urethral meatus where seen in this patient. Uterovaginal prolapse has been reported to be the reason for female genital cutting in 10.9% of the 577 patients who had associated urinary fistula.[7] Fortunately for Mrs. AA, incision on the vaginal skin over the cystocele did not involve the bladder [Figure 3].This case highlights the fact that female genital cutting is still an issue in our society and can be self-inflicted. Health education of the community is important in reducing this harmful practice.
Figure 3 Repaired cystocele

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Yola AI. Yankan gishiri (salt cut). Int J Obstet Trauma 2011;1:2046-65.  Back to cited text no. 1
    
2.
Cook RJ, Dickens BM, Fathalla MF. Female genital cutting (mutilation/circumcision): Ethical and legal dimensions. Int J Gynaecol Obstet 2002;79:281-7.  Back to cited text no. 2
    
3.
Saracoglu M, Zengin T, Ozturk H, Genc M. Female genital mutilation/cutting type 4. J Androl Gynaecol 2014;2:5.  Back to cited text no. 3
    
4.
Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D et al. Pelvic Organ Support Study (POSST): The distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005;192:795-806.  Back to cited text no. 4
    
5.
Mant J, Painter R, Vessey M. Epidemiology of genital prolaspe: Observations from the Oxford family planning study. Br J Obstet Gynaecol 1997;104:579.  Back to cited text no. 5
    
6.
Tahzib F. Epidemiological determinant of vesicovaginal fistulas. Br J Obstset Gynaecol 1983;90:387-91.  Back to cited text no. 6
    
7.
Waaldijk K. Surgical classification of obstetric fistulas. Int J Gynaecol Obstet 1995;49:161-3.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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