Fistula is a hole. An obstetric fistula of the kind that occurs in many developing countries is a hole between a woman’s vagina and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder (called a vesicovaginal fistula or VVF) and sometimes between her vagina and rectum (rectovaginal fistula, RVF). This hole results in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their foul smell.

Because many women with fistula sustained their injury as young women — many still in their early twenties or even late teens — they are likely to live with their condition for decades if it is left untreated

Any woman who can gain access to timely and competent emergency obstetric care when labor is obstructed, by obtaining a Cesarean section, will not develop a fistula

While harmful traditional practices such as female genital cutting (FGC) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients have been victims of FGC, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGC does not “cause” a fistula. FGC can, however, make treatment of an obstetric fistula more complicated, because the scar tissue resulting from FGC can make fistula repair surgery more difficult.

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