The Medical Component

 

 Dr. Asem Anwar Moussa MDProfessor of OB/GYNAl-Azhar School of Medicine  

The medical component

focused on:1 -Clinical assessment of the current

health status of women participated in the present study.

2-reviewing their gynecologic history as well as past obstetric history. to evaluate the impact of marriage at an early age on the reproductive health.

3-Laboratory investigations.

METHODLOGY:

A purposive sample of 31 women were chosen. Actually, 44 participants out of the 300 women wished to be examined vaginally. However, only 31 were able to attend the examination and the resting 13 couldn’t, because of social constraints and logistic problems.

 HISTORY TAKING:

The researcher took it in a non judgmental, sensitive and a thorough manner. The complaints of the clients were classified into 7 categories.

: PHYSICAL EXAMINATION

The general appearance, vital signs and body mass index were recorded.. Breast examination, cardiac, chest and abdominal examination were done. Ultrasound examination was performed to rule out any pelvic swellings. Mental and sexual health were also considered to exclude mental health problems such as depression and sexual problems.

PELVIC EXAMINATION:It was carried out at a private clinic

where privacy was strictly ensured. Counseling, preparation of the patient, adequate lubrication and sensitivity to pain and discomfort were considered during the examination. The external genitalia were inspected for any

abnormalities ..

 LABORATORY ASSESSMENT:

Some laboratory tests were requested for some patients as hormonal profile, complete blood picture ,cervical smear and coloposcopy to rule out any cervical premalignant lesions.

Laparoscopy 

RESULTS

Table E1: Age at Marriage

% No 48.4 51.6 100.0

15 16 31

Less than 18 More than 18 Total

<18 years, 15, 48% >18 years

, 16, 52%

E2 Table : Main Complaints in Relation to Age at Marriage

Main Complaints in Relation to Age at Marriage

�ِAbove 18 Less than 18 Complaint% No % No18.0 3 40.0 6 Menstrual disturbances 50.0 8 26.7 4 Inability to conceive 6.3 1 26.7 4 Urinary problems25.0 4 13.3 2 Non gynecological problems

6.3 1 6.7 1 More than one complaint

6.3 1 6.7 1 Sexual problems ( dyspareunia) 6.3 1 6.7 1 Antenatal Care

16 15 Total

table E3:: Body Mass Index in Relation to Age at Marriage

Above 18 Less than 18 % N % N 0.0 0 11.1 2 Under weight 38.4 5 27.8 5 Normal 7.7 1 16.7 3 Over weight 30 4 22.2 4 Obese 23.1 3 22.2 4 Severe obese

100.0 13 100.0 18 Total Two cases of the younger age group were under weight.

Table E4: Past Obstetric History in Relation to Age at Marriage

Table E3: Past Obstetric History in Relation to Age at Marriage

Above 18 Less than 18

% N % N 8.3 1 31.6 6 Miscarriages 50.0 6 15.8 3 CS delivery 41.7 5 36.8 7 Normal labor

0.0 0 10.5 2 Infertile 0.0 0 5.3 1 Pregnancy complications 100.0 12 100.0 19 Total

Younger age group was more likely to have miscarriages as well as pregnancy complications.

Table E5: Breast Examination in Relation to Age at

marriage Table E5: Breast Examination in Relation to Age at Marriage

Above 18 Less than 18 % N % N 100.0 13 83.3 15 No Abnormities

Detected[NAD] 0.0 0 16.7 3 Galactorrhea 100.0 13 100.0 18 Total

Breast examination showed that 16.7 % of the younger age group had galactorrhea.

Above 18 Less than 18

% N % N 6.25 1 6.7 1 NAD

75.0 12 66.7 10 Vulvo-vaginitis 0.0 0 13.3 2 Unhealthy cervix

6.25 1 0.0 0 Prolapse 12.5 2 13.3 2 Not done 100.0 16 100.0 15 Total

Two cases of the younger age group had an unhealthy cervix. While, most of the older age group had a sort of vulvo-vaginal infection.

Table E6: Vaginal Examination in Relation to Age at Marriage

Table E7: Type of Vaginal Discharge

% NO 41.9 13 Monilial 25.8 8 Bacterial vaginosis 6.5 2 Trichomonilial 6.5 2 Mixed 9.7 3 Nil 9.7 3 Not done 100.0 31 Total

The commonest vaginal infection was monilial infection constituting 41.9% of the cases followed by bacterial vaginosis, 25.8%.

Monilial, 13, 42%

Mixed, 2, 6%

Nill, 3, 10%

Not done, 3, 10%

Bacterial vaginosis , 8,

26%

Trichomonilial, 2, 6%

Type of Vaginal Discharge

Table E8: Provisional Diagnosis in Relation to Age at Marriage

Above 18 Less than 18

% N % N 25.6 10 13.0 7 Vaginal infection 0.0 0 1.9 1 Amenorrhea 2.6 1 13.0 7 Infertility 0.0 0 3.7 2 Suspicious cervix 5.1 2 0.0 0 Prolapse 2.6 1 3.7 2 Antenatal care 43.6 17 31.5 17 Non gynecological pathology 7.7 3 0.0 0 None 12.8 5 33.3 18 NA

Percentages do not add to 100% due to multiple responses. Non gynecological pathology was more common than the gynecological pathology, followed by vaginitis.

Table E9: Treatment of cases in Relation to Age at Marriage

Above 18 Less than 18 % N % N 92.3 12 94.4 17 Medical 7.7 1 5.6 1 Surgical

100.0 13 100.0 18 Total Most cases were treated medically.

94.4

5.6

92.3

7.7

<18 years >18 years

Table E10: Referred Cases in Relation to Age at

Marriage

Above 18 Less than 18 % N % N 30.8 4 55.6 10 For further investigations 46.2 6 38.9 7 Not referred 23.1 3 5.6 1 NA

13 18 Total Percentages do not add to 100% due to multiple responses. More than 55% of cases with current age less than 34 years were referred to higher centers for further evaluation and treatment.

55.6

38.9

5.6

30.8

46.2

23.1

For further investigations Not referred NA

<18 years >18 years

Table E11: Other Findings in Relation to Age at Marriage

Above 18 Less than 18

% N % N 30.8 4 55.6 10 For further investigations 46.2 6 38.9 7 Not referred 23.1 3 5.6 1 NA

13 18 Total Percentages do not add to 100% due to multiple responses. More than 55% of cases with current age less than 34 years were referred to higher centers for further evaluation and treatment.

55.6

38.9

5.6

30.8

46.2

23.1

For further investigations Not referred NA

<18 years >18 years

Female pelvis

Conclusion

This a small sample sized qualitative study, further more studies on the implications and consequences of early marriage on reproductive health as well as sexual and mental health should be addressed.

The 4 “Ts” Recalled

“THROMBIN” Check labs if suspicious.