Hesperian Health Guides
Juanita lives in a small village in the mountains of western Honduras where she and her husband grow corn on a small plot of land. Their land does not produce enough to feed their 3 children, so several times each year Juanita’s husband, Raul, goes off to the coast with other men from the village to work on the banana plantations.
About 3 weeks after the last time her husband returned home from the coast, Juanita began to notice more discharge than usual from her vagina. Then she started having pain when passing urine. Juanita knew that something was wrong, but she had no idea what it was.
Juanita decided to ask her friend Suyapa for help. Suyapa suggested drinking teas made from corn silk, because this had helped her when she had had pain passing urine. So Juanita tried the teas—but the pain and discharge did not go away. Suyapa then recommended the remedy her friend María del Carmen had used for pains after childbirth. The local midwife had given María a cotton cloth filled with plant medicines to wrap around her belly. When Juanita tried the remedy and it didn’t work, she thought putting the medicines inside her vagina might be better. But nothing helped, and her signs kept on bothering her.
Finally Juanita decided to go see the health worker, Don Pedro. She felt shy about having a man examine her, but by this time she was scared that something serious was wrong.
What is the Problem?
- When did you first notice the problem?
- What signs made you suspect that something was wrong?
- How often do you have these signs? What are they like?
- Have you ever had these signs before, or has anyone in your family or community had them before?
- Does anything make the signs better or worse?
Some Illnesses Are Hard to Tell Apart
After listening carefully to Juanita describe her pain and discharge, Don Pedro explained that signs often tell us the general kind of health problem someone has. But sometimes several different illnesses can cause the same signs. For example, a change in the amount, color, or smell of a woman’s vaginal discharge could be caused by:
- a sexually transmitted infection (STI).
- an infection of the vagina that is not an STI.
- pelvic inflammatory disease (PID), which is an infection of the womb
and tubes, often caused by an STI.
- cancer of the cervix.
To get a better idea about which of these problems was causing Juanita’s signs, Don Pedro needed to know whether Juanita and her husband used condoms, and whether either of them had had other sex partners. Juanita admitted that she suspects her husband has sex with other women, since he is gone for months at a time to work. But they had never discussed it, so she did not know for sure. The last time her husband came home, however, he had complained of some pain when passing urine. He blamed it on the foods he ate at the coast.
With this added information, Don Pedro said he suspected Juanita had an STI, probably gonorrhea or chlamydia. Because it is difficult to tell these infections apart, it is better to treat both of them.