Medical Zambia

Nsunko – warning

Warning this post contains graphic sexual material which may be offensive to some

When I am consulting in the health centre, I normally work with a female clinical officer. We see the patients together. She takes the history in Cinyanja and summarises the problem; I ask further questions for clarification.  She doesn’t normally examine patients, so I do that and point out any physical signs. We usually see one or two ladies with gynaecological problems in each session. They could be suffering from a variety of disorders – anything from dysfunctional uterine bleeding to carcinoma of the cervix; genital herpes to secondary syphilis. The clinical officer regards me as an expert, so my examination of the patient becomes a teaching session (with the patient’s consent, of course).

Close up of an elephant, no relevance to this post

We had just seen one lady with post-menopausal discomfort, dryness and pain on intercourse. I made a diagnosis of oestrogen-deficiency resulting in atrophic vaginitis but the clinical officer asked if this could have been caused by Nsunko. I had never heard of Nsunko. She told me that it was a herb which was used in various forms to improve sexual pleasure by tightening the vagina. “For the man, right?” I asked her. She laughed and said, “For both. But it is mainly to make the vagina warm for the man.”

I was aware of certain astringent herbs which some women put inside their vagina, but these act by shrinking the vagina and can cause painful scarring. The clinical officer said that Nsunko could be used like this, but it can also be inserted into the anus for several hours at the same time as the woman has vaginal sex. It seemed farfetched, but she insisted that the chemical could diffuse from the anal canal to exert an effect on the vagina. This technique was commonly used by female sex workers.

Always being curious, I asked, “How do they do that?” She told me that women boiled herbs in water and soaked strips of cloth in the resulting liquid. They would then push the cloth into their anal canal.

In parts of Africa, men prefer “dry sex” for increased friction and pleasure. However, traumatic intercourse is associated with increased transmission of sexual infections, including HIV, because of abrasions on the sexual organs.

In Zambia if a wife has sex with another man, the husband is entitled to an immediate divorce. However when a husband is unfaithful, it does not mean that the marriage is over – “ubuchende bwamwaume tabutoba inganda”.

She told me that she had worked in other regions of Zambia where there had been a sexual health outreach programme targeting sex workers. “We could go to the Obama Bar at midnight and offer sexual health screenings,” she said. I wasn’t sure about extending my working day that long. And I had been warned about the perfidious practices of  “harlots” in the village bars by Mrs Mwanza, one of the nurses with whom I worked in 2014. You can read about this here.

I told her that if she brought it up at the next health centre staff meeting, I would support her, but she backed down. She didn’t want to be associated with such a sensitive initiative.

Elephant squirting mud onto its back

PS I was saddened to hear that the infamous “Penis Inn”, a hotel-cum-brothel where the local Rotary Club used to meet, has now closed down. The Rotary Club now meets at the new Tinta’s Restaurant. Chicken and chips, US $4 with complimentary popcorn.