A vaginal fistula is an artificial opening that develops in the wall of the vagina. The vagina is the muscular tube between the vulva (external female genitalia) and the cervix. A vaginal fistula opens between the vagina and an organ in the urinary system or digestive system. Damage to the tissue in the vaginal wall causes a hole to form where it doesn’t belong. Genitourinary vaginal fistulas form between the vagina or uterus and organs in the urinary system. The word urogenital system refers to the genitals and urinary system. The most common type is a vesicovaginal fistula, where an opening develops between the vagina and the bladder. Genitourinary vaginal fistulas also include: Ureterovaginal fistulas between the vagina and the ureters, the tubes that carry urine from the kidneys to the bladder. Uretrovaginal fistulas between the vagina and the urethra, the tube that carries urine from the bladder outside the body. What are the other types of vaginal fistulas? Fistulas can also form between the vagina and the organs of the digestive system. These include: Rectovaginal fistulas between the vagina and the rectum; Colovaginal fistulas between the vagina and the colon; Enterovaginal fistulas between the vagina and the small intestine. The World Health Organization estimates that 50,000 to 100,000 women worldwide develop vaginal fistulas each year. The problem is more common among women who live in countries with limited medical resources. These women can spend days in labor. The pressure of the baby’s birth on the vaginal wall can cut off the blood supply to the vaginal tissue, leading to a fistula. The lack of blood supply to the vaginal tissue causes the tissue to die. A hole or fistula forms in the tissue where this has happened. These openings can develop within a few days or over several years. Rarely, a person is born with a congenital vaginal fistula. Causes of vaginal fistulas include: Prolonged labor; Vaginal tear during childbirth or episiotomy; Abdominal or pelvic surgery, including caesarean section and hysterectomy; Cancer in the pelvic area, such as cervical cancer or colorectal carcinoma; Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis; Colon infections such as diverticulitis; Radiation therapy in the pelvic area. What are vaginal fistulas? Genitourinary vaginal fistulas, which form between the vagina and the organs of the urinary system, can cause: Constant leakage of urine or urinary incontinence; Skin irritation in the vagina, vulva (vaginal entrance) or perineum (the area between the vagina and the anus); Painful intercourse (dyspareunia); Recurrent urinary tract infections, kidney infections (pyelonephritis) or vaginal infections (vaginitis). Fistulas that form between the vagina and organs in the digestive system can cause:Stomach ache; Foul-smelling vaginal discharge; Faecal incontinence, leakage of faeces from the vagina; Nausea and vomiting or diarrhea; Recurrent urinary tract infections or kidney infections; Rectal bleeding or vaginal bleeding; Unexplained weight loss. Treatment depends on the type of fistula and includes: Antibiotics for infections or drugs for inflammatory bowel disorders; Temporary self-catheterization (pure intermittent catheterization) to drain the bladder while the vesicovaginal fistula is being treated; Ureteral stents (renal stents) to keep the ureters open while the ureterovaginal fistula is treated. References: 1. American Urogynecologic Society. Fistulas: Genitourinary and Rectovaginal (https://www.augs.org/assets/2/6/Fistulas.pdf). 2. Bladder and Bowel Community (UK). Vaginal and Recto Vaginal Fistulas (https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/vaginal-and-recto-vaginal-fistulas/). 3. Tuma F, McKeown DG, Al-Wahab Z. Rectovaginal Fistula (https://www.ncbi.nlm.nih.gov/books/NBK535350/). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 4. World Health Organization. Obstetric Fistula (https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula)