OVARIAN CANCER - THE DISEASE WITH VAGUE SYMPTOMS

Enter patient *Miriam . She is in her 50s, carries some gloom and worry on her face . She has  usual menopause symptoms and is managing them well ; but you see , her friend got diagnosed with stage IVB Ovarian Cancer . She didn’t have any symptoms beyond menopause symptoms ; some bloating here and there , occasional insomnia, some back pains and arthritis , on and off  loss of appetite and occasional mood swings . She is worried because she wonders if her friend could have been diagnosed earlier had she seen a Gynaecologist more often . She worries if she would be to be in the same boat in the future if she doesn’t keep checking . She asks me if there  is any screening test for ovarian cancer like we do for the cervix . At this time I also a remember a story told by one of my patients of a lady who died in this month of June and diagnosis of advanced ovarian cancer was only made at autopsy ; her wasting and symptoms were so vague she withered away before a diagnosis could be made . 

Miriam had many other questions including if we could remove ovaries and entire reproductive system after end of childbearing age to prevent future cancers . She asks me if there are  particular symptoms to be keen on. She worries if her friend’s daughters and sisters are now at risk of ovarian cancer . Keep reading , you will get answers in the write up . 

It’s important to remember that there are 3 different broad categories of ovarian cancers including ovarian cancers we see much early in children up to early 20s. For this write-up I’m focusing on Epithelial type of Ovarian Cancers ; the ones that mostly inflict ladies in age 40 and above (may rarely occur earlier), are notorious for severe malignant effects and high morbidity and mortality . 

There is no clear cut screening modality for ovarian cancer unless for very high risk clients with genetic predispositions or strong family histories of ovarian , breast and endometrial cancers ( and colon cancer - I won’t go here lest I bore you with advanced Gyane-oncology)  . Routine tumor markers and ultrasounds/other imaging have not been seen to reduce the burden of advanced disease at diagnosis in the general population. The tumor marker for ovarian cancer called Ca-125 can be somewhat non-specific in some situations and thus not a good screening modality for the general population but only a useful tool in suspected ovarian cancer. 

Some risk factors for ovarian cancer are as tabled below 

Nulliparity ( having had never given birth)

Early menarche ( early age at first menses)

Late menopause

White race

Increasing age

Family history

Personal history of breast cancer

Ethnic background (European Jewish, Icelandic, Hungarian)

Postmenopausal hormone therapy

Pelvic inflammatory disease

Having more children, late beginning of menses, early menopause ,  is postulated to be protective against ovarian cancer . The daily combined contraceptive pill (despite its other risks) is known to be protective against ovarian cancer due to prohibition of ovulation . Uninterrupted ovulation (eg in nulliparous women) is thought to cause repetitive ovarian surface ‘damages and repairs ’ during expulsion of the monthly ‘egg’  may cause mutations and thus risk of cancer .

If you are client that has passed through my hands for permanent family planning i.e tubal ligation , you know that I’m a die-hard for total removal of the Fallopian Tube and not simply a knick and cut . I routinely do Total Salpingectomies (I remove the whole tube) because this is also known to be protective against ovarian cancer. Studies have shown that a significant number of ovarian cancers originate from lesions the finger-like ends of fallopian tubes i.e the fimbriae . 

Family history of breast or ovarian cancer has been associated with Ovarian Cancer

•Approx 10% of patients have an inherited genetic predisposition with mutations in a gene called BRCA1 and BRCA2

 

•A family history of ovarian cancer in a 1st degree relative, that is, a mother, daughter, or sister, triples a woman's lifetime risk 

 

•The risks further escalate with two or more an affected 1st degree relatives, or with other individuals with premenopausal breast cancer.

We have testing for the BRCA 1 and 2 gene mutations in Kenya , extremely costly but a good guide on which patients can undergo prophylactic removal of both ovaries after completion of child bearing or by age 40 years. Labs like Kalebi Lab , Lancet etc are currently doing the tests in Nairobi. 

So back to Miriam’s question , can we remove the ovaries for everyone fearing ovarian cancer ? Absolutely not unless a genetic mutation is confirmed . Remember the ovaries have an estrogen producing function even in menopause albeit in reduced quantities. Estrogen is important for many other benefits in the body and protection against cardiovascular diseases and for general well being in almost all body systems including bone, skin and brain health  ( story for another write up). So women undergoing surgeries say removal of uterus due to fibroids , the ovaries are mostly never touched and are left in-situ. 

Symptoms : Ovarian cancer is typically portrayed as a “silent” killer that lacks appreciable early signs or symptoms. This is a misconception. Symptoms are there but vague. The difficulty is distinguishing these symptoms from those that normally occur in women especially in menopause . In general, persistent symptoms that are more severe or frequent than expected and have a recent onset warrant further diagnostic investigation. Fatigue, indigestion, inability to eat normally, constipation, and back pain may be noted . Abnormal vaginal bleeding or postmenopausal bleeding  occurs rarely but if it occurs it must be investigated. May present with nausea, vomiting, and signs of intestinal obstruction. Any unexplained weight loss or a feeling of an abdominal swelling or a mass  of suspicious increase in abdominal girth must be investigated. 

Once you see your Gynaecologist , appropriate tests and imaging will be done and further management initiated if disease is confirmed or suspected .

For Miriam , we offered her a well detailed menopause guide talk,general examination including BP,  a thorough breast , abdominal and vaginal gynaecological examination , we did cervical cancer screening via HPV testing as it was due and did an abdominal-pelvic ultrasound with focus of endometrial thickness, ovaries , and search for any abnormal findings . 

A yearly Gyane-visit may be reasonable for all women and especially in menopause . Genetic testing of the gene mutations despite the high cost ( ~130,000 - 150,000 Kenya Shillings) is not unreasonable in current times to  high-risk clients ( we third world countries are very quickly catching up with standard procedures done elsewhere). Maybe insurance companies can partly or fully cover this if we are ever going to reduce the incidence and burden of the monster that is ovarian cancer . These same gene mutations are also important for patients at risk for breast cancer who may need prophylactic mastectomies(removal of breasts) >> hey the breast in Kenya is considered an organ for the general surgeons and not the gyanes’; I call upon my surgeon colleagues to consider doing a blog/vlog/talk on breast cancer as well . 

May you have healthy and productive ovaries all days of your life . Amen . 

I tried to simplify the blog as much as possible to avoid being too academic and to minimise medical jargon . Feel free to ask any questions or to pop in for a consultation. 

13th May 2025. Packed Day

 Today was such a packed day . I have been with a sickness which in my big-headed medical personality , I decided to manage conservatively quietly because it wasn’t causing much issues . Shit hit the fan last week . I had such bad pain on a Tuesday night but me being me , I kept it low to avoid alarming my household , gobbled down some painkillers and drove over 30Kms to work and ran a full clinic and even did a procedure.  I sneaked into our radiology department in between and asked for some thorough sonography; it picked my usual ka-disease but couldn’t explain the severe stabbing pain I was having .  I continued on painkillers but the Friday night attack was the worst ; I have never felt so much pain . I couldn’t sleep, breath , lie down or stand; rolling on the floor didn’t help either. Painkillers weren’t working and I vomited them all . I had to be rushed to the E.R at 4am ; God bless a clinician called K* . He put me on proper pain meds and listened to me when I insisted on particular tests and a CT-Scan (ujuaji ya patients who are doctors; another clinician would have kicked me out but turns out that my predictions were point on). The problem was picked ; my little ka-disease was somehow complicating and putting me in danger . I quickly saw a senior and he referred me pronto to the Nairobi Hospital . I argued with him if I could please first attend a compulsory work meeting scheduled for 15/5/2025 and if I could do some booked surgeries ; he reminded me that my well-being should come first before anything and a small problem could worsen due to postponing unnecessarily. He further told me that work/patients/the world moves on whether we are there or not so to prioritize myself at all times. 

The particular Nairobi Hospital clinic was fully booked for the week but after listening to what I had and for being a colleague , the professor  squeezed me in for Tuesday 13th May - in 3 days time  . I had a very important online interview on the same day and I had to choose my well being or the interview or both and I chose both . I had to prepare a full research concept paper for it and man , I prepared it fully from scratch on my sick-bed over the weekend and combed through 10 research papers in detail. I didn’t even have an idea on what I wanted to write about but Alhamdulilah I managed.  I chose to work on the Monday of 12th despite some little pain and even preponed my surgical cases for later in the week to that day 12th. I was in some pain but neither my patients or colleagues noticed ( nurse Cate noticed because she had to give me a few painkiller shots) . Staying at home would only worsen my feeling of pain and create anxiety  so I chose to take pain killers and do what I love ; my professional duties as an ObsGyn . Working wasn’t going to affect my anyway ongoing disease process. The day went quick and my mental well being was on check ; there is a euphoria that comes with knowing that you have helped others(and made some buck) even in our own pain. 

Tuesday 13/5/2025 - I had the doctor’s appointment all the way in Nairobi at 12.00noon, I had the interview at 4.20pm and yet I was in Meru. Driving was out of the picture because I was still in pain and prone to some bad attacks ; my husband had to be left behind because of my kid’s school and my insistence ; I didn’t want them to be left alone for days with the nanny and not see atleast one of us  - they are so small and I also didn’t want my son to miss school for a prolonged period ; so travelling as a family was out of the picture.   I opted to jump onto the 5am shuttle and have my mum , siz and bro wait for me off Thika Road  and take me to hospital : talk of splitting tasks m. I hadn’t been in a Meru-Nairobi matatu for over a decade but this was my most convenient means for the day. I made it on time and was sitted in Nairobi Hospital at noon sharp . I requested the secretary to slot me in such a way that I wouldn’t miss my interview but medical secretaries are funny people ; they will either be super nice because you are a doctor or decide to humble you because you are in their domain - I remained humble throughout and called her ‘madam’ all through but can’t tell how she chose to treat me at this moment and even made one patient who came late skip me on the queue despite my reminders. I couldn’t complain because remember this was such a precious booking  . My slotted time to see the prof doc delayed and so I waited , my interview coincided to the dot with my ongoing doctor review when I walked in and I was torn so I requested to continue seeing the doctor because he would leave for a procedure.  I requested the panelists for a delay in the interview by 15 minutes but they were strict and so I narrowly missed my ‘possible-life-changing’ interview just like that. Its funny that after this I had a whole idle 3 hours being processed for hospital admissions;l was angry. Why did they slot the interviews at such odd late office hours ? Too many questions.

I got admitted to hospital for an immediate procedure- had I missed the doctor slot I would have had to battle with pain , worsening complications and no solution for another few nights . I chose me in those critical 15 minutes . The Prof doc attending  to me saw me shed a tear for missing the interview but haidhuru. I apologized profusely to the panel on text and email but will they understand that I’m just a very strong focused  girl who even dared to read for the interview in the doctors waiting room and be very optimistic to attend and pass ? I was all set with the clinic wifi on my laptop and had warned the patients next to me that I was about to take an exam there and then if called upon - they joked that I was too calm for someone with an ‘exam’ . Am I joker to have chosen to be seen and not miss a rare Doctor’s slot ? They gladly decided to reschedule me. I could however feel the disappointment in their replies  ; they should know how determined I was against all odds. I hope my career trajectory doesn’t take a lifelong twist because of these precious 15 minutes.

I’m typing this from my hospital bed , unable to sleep , thinking of my babies and very hopeful that my midnight imaging and procedure tomorrow morning goes well. I’m just a very strong willed girl with such big dreams and a very big heart (sometimes I wonder if I ever receive back the so much I give to the world and those around me) .I remember the many times I move up patients when they need to be elsewhere urgently ; why didn’t the same happen to me today? I realize that this is among the rare times when I’m all alone without being called ‘mama’ a million times by my precious little ones and so my mind is in a wandering mode. 

Sometimes being too strong can make our loved ones to overlook if we ever have times of need. I just hang up the phone on a relative who called to ask for directions for something minor; I reminded him that I’m sick , in hospital, alone and in pain . Please allow us to be vulnerable for once ; this very strong will and concern for others but myself has made those around me to never know when I’m breaking inside , afraid and just in need of some attention, space and pampering. I told my mum that had she not come  and if I had had to admit myself  alone with my big safari bag and interview laptop/gadgets ningejihurumia sana; I would break down. ( It reminds when as little girl who had never gone to a different town let alone a different country, had to travel overseas solo at age 19 and find her way around alone in new continent/country 😎; long story for another day - I have always been super strong 💪). 

I won’t advertise this post , it shall be seen later by my binge readers when I bounce back and post my many fantastic clinical stories . 

I’m now blubbering, time to rest for the few hours before my midnight imaging . 

Update - my subsequent days in hospital were very dramatic. One major procedure and one major surgery later  . I got very very sick but gladly pulled through . I ended up staying in for more than 10 days . I’m well now and so thankful for recovery . 

EMERGENCY CONTRACEPTION - NOT JUST P2; THERE ARE BETTER METHODS

 

Rael * 23 year old final year university student walks into my clinic . She is anticipating her final exams and soon thereafter start plans for a wedding with her fiancé Daniel*. They have been very careful with their safe days and using protection but last evening , they had an unprotected moment and she is ovulating today. She comes in because she wants advice on the best emergency contraception that is very efficient  and without complications. She is not ready for a baby now and would like to focus on finishing school , getting high grades  , getting a job and starting the tedious dowry/wedding preparations with Daniel. Her cycle has been very regular to the dot and she is sure that she has a very big chance of conceiving from the previous night’s encounter .

I’m surprised that we have younger ladies who are very armed with information and I congratulate her for seeking care timely and wanting to take control of her life . She says that my blog ( whose link was shared to her by a classmate)on not fearing contraception before marriage opened her eyes.  

Emergency contraception according to WHO refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. These are recommended for use within 5 days of intercourse but are more effective the sooner they are used after the act of intercourse.

Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and they do not induce an abortion. In case ovulation has already occurred, methods like the copper-bearing IUD prevents fertilization by causing a chemical change in the uterus and fallopian tubes that is toxic to sperms before they can reach the egg for fertilization. The copper-bearing IUD therefore acts as a spermicide, killing or impairing sperm so they cannot reach the egg. Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins  which is also toxic to sperm.The very high effectiveness of copper-containing IUDs as emergency contraceptives implies they may also act by preventing implantation.

Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo; therefore doesn’t induce abortion and so it’s legally allowed.

Emergency contraception can be used in a number of situations following sexual intercourse. These include:

• When no contraceptive has been used or was forgotten e.g in patients on the daily pill  .
• Sexual assault when the woman is to be protected against conception 
• When there is concern of possible contraceptive failure such as a condom burst or slippage
• Miscalculation of the  safe window or when not sure how to calculate
• Patients with sudden expulsion of an intrauterine contraceptive device (IUD) during or immediately after intercourse 

So back to Rael , we get talking and the two main methods  available locally are discussed which are as follows

• The high dose progesterone pills (150mg of levonorgestrel) popularly known as the P2  which should be taken within 72 hours of sexual intercourse  (these pills can also be taken in 2 doses of 75mg each, 12 hours apart). This should not be abused and it’s recommended to be used infrequently and mainly during the fertile window.
• The copper IUCD which should be inserted within 120 hours (5 days)of unprotected intercourse 

The pill will have same side effects like the oral contraception pills and if vomiting occurs immediately on taking the pills then it should be repeated immediately. The P2 has a failure rate of around 2% and the resultant pregnancy might be an ectopic pregnancy but this is rare. The P2 pill is also associated with irregularities of subsequent menses . 

The copper IUD (Copper-T) is 99.2% effective as an emergency contraception if put within 120 hours . The downside is that it has to be put  by a professional and may be unreachable by most especially younger students who may shy away from fertility clinics . The less than 1% that conceive would also most likely have an ectopic pregnancy but this is very rare . The advantage is that the woman can keep it as a continued effective contraception method and can last for upto 10 years . Removal is easy in the clinic and can be done by any medical cadre as long as the strings are visible .

The IUCD is also non-hormonal so no hormonal side effects like weight changes , menstrual irregularities are encountered . The return to fertility on removal is instant. 

Rael opted for the IUCD . Luckily I had a a sterile insertion set and piece ready in the office and I was able to insert it for her immediately after confirming that her pregnancy test was negative (we have been conned by patients before so we always want to confirm). She was glad that she took medical consultation and saw a professional . Her next menses came on time and she is busy preparing for her exams . 

I hope this is well understood. Take charge of your life ; do not let an oops moment change the trajectory of your life . 

POSSIBLE EXPLOITATION OF THE YOUTH FOR SPERM/EGG DONATION IN KENYA

 There has been an organ (mainly kidney) donation scandal being addressed in the nation that has gotten many talking . This reminds me of another ‘organ’ or ‘product of an organ’ that we don’t discuss enough ; the subject of sperm or ovum(egg) donation .  I have had the chance and opportunity to work/learn in a few fertility IVF clinics both locally and abroad . The regulation abroad is very stringent to the extent of people buying gametes abroad (from developing countries in Africa and Asia) to avoid the very tight regulations of such transactions in countries like Canada and U.S.A. There are no proper regulations in the Kenyan Legislature and so as long as a donor is over 18 years and signs a legal document , there are no real legal frameworks to safeguard them . Our law (or is it a Millie Odhiambo Bill that is yet to become law) however discourages financial gain from the same but it’s a very grey area because tokens of appreciation to ease the process  are not categorically banned . 

In Kenya, the Assisted Reproductive Technology (ART) Bill, 2022 outlines the legal framework for gamete donation and other assisted reproductive technologies. The Bill prohibits the use of sperm/ovum from donors under 18 years of age, except with parental consent for a minor's future procreation e.g in those minors undergoing cancer treatment that may permanently affect their fertility. It also prohibits the sale and transfer of gametes, zygotes, and embryos. Additionally, the Bill regulates the licensing and operation of facilities offering ART services, including sperm banks. 

Here's a more detailed look at the key aspects of the law: 

1. Donor Eligibility and Consent:

• A donor must be a fit, healthy, typically between 18 and 45 years of age, willing to undergo rigorous testing. 
  
• The donor must agree to relinquish all legal rights to any children resulting from the donation. 
  
• Sperm/egg from donors under 18 is prohibited for use in assisted reproduction, unless for the minor's future procreation with parental consent. 
  

2. Prohibition of Commercialization:

• The sale or transfer of gametes, zygotes, and embryos is prohibited, meaning they cannot be bought and sold.
• The Bill aims to prevent commercial exploitation of assisted reproductive technology. 

My focus today will be on the young over-18 female university students. For male donors , it’s a simple masturbation with no prior drugs , invasive theatre procedures or possible life threatening complications from unregulated donations .

I had a recent discussion with my mother ; Madam-Z and we agreed that unto age 24, one needs to be under guidance and may not be trusted with major life changing decisions - I do not support marriage ; especially of men below this age - this my own personal view . The same applies to organ or gamete donation by our very young college girls . Most end up getting serious mental health issues later ; they may worry about their anonymous multiple offsprings out there in the world, some may get some complications from the egg-retrieval processes that may bring serious uncertainties and anxiety , others may end up perpetually guilty for secretly doing what their parents would never consent to . 

I remember recently reading in a doctor group about a young university girl who had to undergo a major abdominal surgery following a pelvic abscess(pus accumulation) obtained following an egg-retrieval process gone wrong . She had only been pain 30,000 Kenya Shillings and the I.V.F centre did not want to be involved in her care because this was beyond the contract she had signed . Such a surgery that she underwent would cost not less than 100,000 shillings in the rural setting ; the costs may be triple that in Nairobi and this many not be fully catered for by SHA. What about the possible resultant future Subfertility that may arise from this iatrogenically caused infection ? Is 30,000 shillings worth this headache ?

One notable personality , talked about how she almost died from OVARIAN HYPERSTIMULATION SYNDROME (OHSS). You see , a woman ovulates one mature ovum per month unlike a man who ejaculates more than 20million sperms per ejaculate . More eggs are usually required to assist in the IVF process and so a series of hormonal drugs and injections are usually given to stimulate production of many eggs in the cycle sometimes to more than 20 . Depending on the dosages , some girls may over-react and get into a hormonal crises called OHSS which if not well managed can be life threatening; this results from over-stimulation with many follicles produced and resultant very high oestrogen hormone levels  . The body swells up with fluid everywhere including the lungs and these patients may develop life threatening blood clots . Most most of these cases have to be managed in HDU or even ICU with supportive management of all organs affected . In countries with well regulated practices , OHSS occurs in about 1-3 % of women undergoing IVF egg retrieval ; the situation may be worse in our country . Rarely the over-stimulated ovary with many follicles may twist (torsion)due to the abnormal heaviness from many follicles leading to a a major surgery or sadly  loss of an ovary from this torsion. Management of OHSS may end up costing hundreds of thousands all from earning less than 100,000 from egg donation ; the price depends on ‘quality of egg and profile of donor with beautiful students doing STEM courses or courses known to attract exceptionally bright students earning more; it is what it is !!

My take is that these students must be protected .A 19 year old may not be as mature as a 38 year old hustler . Is thorough patient education done ? I doubt it . Holders of national I.D cards automatically become eligible for these unregulated transactions.

Has anyone also thought about future consanguinity ? Of siblings marrying in the future ? There are medical students (male) who survive fully in university by sperm donations and some may donate more than 50 times ; helping over 50 families get multiple babies (do the math, we may be talking about total 200 children over a 5 year college period) . There is no regulation whatsoever  in Kenya on how many times one can donate gametes  . One day we will have siblings marrying each other or procreating together . The future isn’t far because this has been a practise for close to two decades in Kenya  - I have personal friends who donated a a few times in sperm banks in Nairobi when they were younger.

I have no problem with gamete donation ; I have a number of very grateful women in my clinic who have benefited greatly from ‘anonymous purchase’ of eggs from ovum banks and are on their 2nd/3rd pregnancies . I also have a few couples with male infertility problem whose marriages and image in society has been saved by sperm donation from strangers . I fully embrace it but let us protect our very young girls from exploitation unless if helping their relatives . I’m worried both about physical complications and also unseen mental health issues that may arise . 

I want to beseech parents to move with the times and stay alert on these emerging issues in society that may never have been in existence during our times . A new expensive phone by your daughter may not necessary be from a sugar daddy but may be from unregulated egg donation . Talk to your girls , befriend them , be open and make sure they are well provided for and that they learn to live within their means; I believe hardly no girl donates eggs to an anonymous stranger for the goodness of humanity but mostly for financial gain. For those girls who are very sure about these donations , let us make sure that the contracts protect them fully and that any possible mental issue is dealt with accordingly . Dear girls can we open up to our mothers/sisters/gynaecologists before embarking on donation if we are not very sure ? I have no problem with older women(especially those with children) who take it up . Let us keep talking . Thank you!

A WAVE OF VERY YOUNG BABY-MAMAS /BABY-DADDIES IN SOCIETY

 

Jasmine* walks in , tears and confusion is evident from the look in her eyes . I take a quick history, she is in her early 20s , had a caesarean delivery 8 months ago and now is surprised that she has not seen her menses for 1 month and wants me to investigate for a hormonal imbalance . I ask her if she is sexually active currently and she bluntly denies; last sexual contact was before her baby was born . She is not on any family planning method . I  take more history , I ask her to allow me do a pregnancy test first and she refuses . She is in my office for investigation and treatment for hormonal imbalance and I should stop going round for baseless tests. I still proceed and do a serum pregnancy test as I ordered for other blood tests; she didn’t understand that the wording of the test still meant a pregnancy test but not the usual routine urine test . Surprise , surprise , the test was positive . So after all the missed menses were due to a an early pregnancy . Ultrasound doesn’t show much other than a bit of a thickened uterine lining . I break the news and diagnosis but she is annoyed that I didn’t respect her refusal for a pregnancy test . She breaks her own theory that the positive test could be from effects of the delivery 8 months ago ; there is no scientific plausibility to this unless we are dealing with a BHCG producing tumor which would have been picked on imaging anyway. She insists on this fact and wants medicine to ‘clean her up’ and get rid of this positive hormonal test and return her menses. I go into full Reproductive Health expert mode and enquire about any possible rape and she is confident that nothing of that nature happened. I call my secretary and ask her to hold the queue to enable me take time with my patient . I make a final diagnosis of an early pregnancy approx. 4 weeks gestational age . I refuse to issue any medications other than pregnancy supplements . She is not happy with me but finally blunts out ‘Doc wewe unajua vile baby-daddy ni stress half sasa niongeze baby-daddy mwingine kwanza mwenye hataki hiyo story?’.  To me this was in itself a confession of a recent unprotected intercourse . We start talking . I ask her why she is not on family planning and she tells me that she fears that family planning is not good for an unmarried woman and that she fears that it may affect her future fertility . I dismiss these as myths and explain to her on efficiency of family planning and go deeper on what may compromise fertility and family planning is definitely not one of the causes . She still denies the pregnancy and I warn her about dangers of abortion if she decides to take that illegal route. Fast forward , I gave her a return date after 4 weeks in which as expected we had a bouncing 8 week fetus on ultrasound . 

Then I remembered Rhodah, a tiny university student  . She came in with her boyfriend . Again had very irregular and missed menses mainly contributed by the very frequent use of emergency pills. They had been together for 2 years and in all this duration , has never been on a family planning method other than the abuse of the e-pills.  They told me that they normally pray before intercourse that they hopefully do not conceive ; Kwani Maombi is a F.P method ? Maajabu !!.  This time I also insisted on a pregnancy test which gladly came back  negative . I counselled them on the dangers of unprotected intercourse  , dangers of abuse of the e-pill and asked Rhoda if she was ready to be a baby-mama because this was  definitely loading . She still expressed fear over regular longterm family planning despite the counselling ; I really wanted her to leave the office with a method in-situ but sadly she refused . The emergency pill not only causes disturbed hormonal balance but can also fail and cause a pregnancy : studies have shown that a failed e-pill significantly increases the risk of ectopic pregnancies which unfortunately can lead to the loss of a fallopian tube or be life threatening if not caught early . 

Unfortunately women take the brunt of the burden and a lifelong irreversible consequences of unplanned pregnancies. Men don’t have much to lose especially in a country where child support is hardly enforced . They go on with their studies , jobs and even marry easily in the future. Can one sue a jobless student for child support ? 

Whenever I have teenage clients, I promptly kick their parents out . 70% open up on unprotected interrcourse and express discomfort in taking up reversible long term family planning  methods. ( this is very legal in Kenya without parental consent as long the teenager is sexually exposed). Of course at this age , abstinence is emphasized over and above any family planning method. 

Abstinence is best as always for all young women  ; no one ever died due to lack of intercourse . It protects against unplanned pregnancies , HIV/AIDS, STIs(which can cause permanent tubal blockage and infertility), HPV and in essence future cervical cancer  and mental stress/indignity . I’m very sure that no mother would proudly announce that their 20 year old is unmarried and sexually active . I recently cringed watching a national TV interview of a very young man openly discussing his sexual relations with the very young girlfriend who was in studio at the time; I wondered how her parents felt , how her future husband would take this ( I may need to style up and catch up with later generations 😀; niwache ushamba ).

The other alternative in a young couple ‘unable’ to abstain would be to to take up constant barrier method i.e condom use or reversible longterm family planning methods like the non-hormonal intrauterine device (coil) , implants , injections or the daily pill. These young-ins want methods that cannot be seen by their parents or their church elders so we get into this and settle on a favorable one for an individual . They must remember that contraceptives don’t protect against infections and HIV. 

Family planning methods do not cause future infertility; it is risky sexual behaviors that cause this. The IUCD doesn’t cause pelvic inflammatory disease or tubal blockage: it’s exposure to infections like Chlamydia and Gonorrhea that cause this leading to tubal factor infertility . It’s important to note that the return to fertility is immediate with family planning methods like the IUCD and the combine oral daily pill unlike the notion in the public domain that return to fertility may be affected. The depoprovera injection may have a longer return to fertility but this can be managed . See your gyanecologist for detailed F.P talk or watch my prior you-tube videos for more details . 

So we have a long way to go to remind our youths about abstinence and to demystify myths about F.P amongst young unmarried women : until we do that we will continue to encounter the scourge of unwanted pregnancies and complicated parenting called Baby-Mama/Baby-Daddy issue because our young ones are engaging in sexual relations at very young ages before they can be mature enough to marry/settle.  Pregnancy is just one of the side effects as I had discussed earlier . 

This remains a very controversial topic but an important one nonetheless. Let’s keep the talk going . ABSTAIN or RUBBER-UP or TAKE UP F.P. Young girls , how much sacrifice are we willing to make to please men who will only be in our lives very temporarily or for a season ? 

P:S* - Jasmine* and Rhoda* are hypothetical cases bases on so many true scenarios I encounter , this is not a true story of particular individuals