Hi All, I hope this email finds you well. I'm in remission (THANK GOD!) from crohn's, but I am scheduled to have surgery at the end of June to repair the recto-vaginal fistulas that I have had for over 2 years. My surgeon is going to perform a gricilis muscle repositioning flap... has anyone ever done this? It will be my 4th major surgery in 5 years, and I am NOT looking forward to it.
I have a j-pouch... my original diagnosis was ulcerative colitis, and 3 years after my colectomy, I was diagnosed with crohns. UGH. This disease is never ending!
I was also wondering if anyone knows whether or not that the pH necessary to get pregnant can be affected by fistulas. I'm hoping if so, that the surgery will correct any issues that we might have.
Erin,
Best of luck with your surgery and I wish you all the best with your future pregnancies and family members.
A rectovaginal fistula can absolutely affect the ability to get pregnant. However, women have become pregnant with them so it should not be relied upon as birth control.
Not only could it change the pH in the vagina but can also cause recurrent vaginal infections and introduces bacteria that should not normally be present in the vagina. The vagina is supposed to have a normal balance of bacteria but not the type (and quantity) that are present in the GI tract.
The introduction of bacteria, skewed pH, and infections will cause an increase in activated immune cells present in the vagina. These overactivated immune cells can attack sperm cells before they are able to combine with the egg.
Implantation of the newly fertilized egg into the uterine wall and subsequent growth of the embryo requires an *extremely* delicate balance of Immune cell functioning - between the "Protect the body" and "Allow the embryo to grow". The embryo is technically a "foreign" invader so the immune system is tuned to destroy it by default. The embryo is tagged as foreign because approximately half is from the male contributor and will not be recognized as "self" by your immune system. During the earliest stages of pregnancy your immune system "allows" this foreign embryo to take hold and grow. It is an extremely complex process. If the immune system is trying to clear material that enters from the fistula, it is less likely to "allow" a foreign body (the embryo). The immune system may attack it directly, or simply increase the thickness and composition of the mucous.
I don't know if you have ever noticed but around ovulation, the cervical mucous gets thinner and more slippery. In fact, it's composition changes quite a bit. The "Ovulation type mucous" allows the sperm to travel through it more easily so they can reach the egg. However, it can allow other material to enter more easily as well and increases chances of infection so the presence of this type of mucous is minimized to a very short window.
During non-fertile periods the cervical mucous completely changes composition. It becomes thicker and more sticky and becomes less penetrable to sperm and other foreign material.
One of the major (and effective) defense systems of the body includes increased (sticky) mucous production when a foreign invader is suspected. You can see this when you have a cold or allergies = mucous. The female reproductive tract has a similar defense mechanism, especially in the case of rectovaginal fistula.
Once that has healed, the immune system should calm down. I would expect it to take a couple of cycles though for things to get back to normal.
Sorry it is such a long post.
I wish you all the best.
