A vaginal fistula is an opening that connects the vagina to another organ, such as the bladder, rectum, or bowel. They usually develop after tissue damage or trauma from childbirth, surgery, infections, cancer, or a chronic condition.

According to the World Health Organization (WHO), 50,000–100,000 individuals are affected by vaginal fistulas each year. It reports that estimates suggest more than 2 million young women live with untreated vaginal fistulas in Asia and sub-Saharan Africa.

Potential complications of this condition include urinary and fecal leakage, tissue damage, infections, and abdominal discomfort. In addition to health problems, some individuals may also experience social exclusion and depression due to the condition.

Treatment options will depend on the cause, size, and location of the fistula. In some cases, the condition may heal on its own. However, surgery is often very successful, and most individuals typically achieve a complete recovery.

In this article, we will discuss vaginal fistulas, including the different types, symptoms, causes, and more.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Image of a pregnant person.Share on Pinterest
Justin Paget/Getty Images

A vaginal fistula is an opening or hole that forms between the vaginal wall and another organ to which it is not normally connected. In females, fistulas involving the genitals and surrounding organs are common. They may occur due to difficult childbirths, pelvic surgery, infections, inflammation, or cancer treatment in the pelvis or genital area.

Depending on which organ the fistula connects to, a person may experience urinary or fecal incontinence. Having continuous leakage into the vaginal area may result in soreness and infections.

A 2020 study notes that a significant number of young females in Nigeria with no childbirth experience may have low levels of awareness of this condition. Although this may not be generalizable to the global population, it suggests there may be a need to increase public health awareness on vaginal fistulas and incorporate this into reproductive health education.

There are several types of vaginal fistulas, including:

Vesicovaginal fistula

A vesicovaginal fistula is a connection between the bladder and the vagina. It most commonly occurs after a gynecological injury or obstructed labor. In North America, damage to the bladder during a hysterectomy is the most common cause of vesicovaginal fistula. Other gynecological surgeries and radiation treatment for gynecologic cancer are also common causes.

A vesicovaginal fistula may lead to continuous leakage of urine from the bladder into the vagina and urinary incontinence. Surgery is often a successful treatment option.

Rectovaginal fistula

A rectovaginal fistula describes a connection between the vagina and the rectum. This opening may result in the passage of stool and gas through the tract. Trauma during vaginal birth is the most common cause of this kind of fistula. This type can also occur due to other medical conditions, such as Crohn’s disease.

Colovaginal fistula

A colovaginal fistula is an opening between the colon and the vagina. These fistulas are the third most common lower reproductive tract fistulas doctors repair through surgery.

Enterovaginal fistula

An enterovaginal fistula is an opening between the small intestine and the vagina.

Urethrovaginal fistula

A urethrovaginal fistula is a connection that develops between the vagina and the urethra, the tube that carries urine out of the body. It often occurs secondary to a foreign body in the vagina or gynecologic surgeries.

Ureterovaginal fistula

A ureterovaginal fistula is a connection between the vagina and the ureter, a tube that carries urine from the kidneys to the bladder. In people with this kind of fistula, urine bypasses the bladder and flows directly into the vagina.

Vaginal fistulas by themselves do not cause pain or discomfort. However, they may result in unpleasant symptoms, which can include:

Vaginal fistulas develop after tissue damage. Common causes include:

To diagnose a vaginal fistula, a doctor will first review a person’s medical and surgical history. They may identify possible causes, such as recent pelvic surgery, childbirth, radiation therapy in the pelvic area, or a condition such as Crohn’s disease.

They will also assess a person’s symptoms and perform a thorough physical and pelvic exam. This will include a speculum exam and potentially a rectal exam if the doctor suspects a person has a rectovaginal fistula. They may order additional imaging tests to rule out other conditions and confirm the presence of a vaginal fistula. For example, diagnosis of a vesicovaginal fistula may involve:

  • a cystoscopy exam to visualize the inside of the bladder
  • a CT scan or voiding cystourethrogram to further check the area
  • a dye test, where the doctor inserts dye into the bladder to help identify leakage
  • a retrograde pyelogram, which helps visualize the kidneys, ureters, and bladder
  • an MRI, CT, or a fistulogram, to produce images of the pelvic area and fistula

A person’s treatment will depend on the type and location of their fistula. Some small vaginal fistulas may heal on their own, while larger ones will require surgery. A doctor may suggest different surgical approaches depending on the fistula’s severity, complexity, and recurrence. Often, a surgeon will perform this through a minimally invasive laparoscopic procedure or open surgery.

For a vesicovaginal fistula, a doctor may perform the surgery via an incision in either the vagina or the abdomen. The surgical process can vary from person to person, depending on the history, method of injury, and extent of the repair. However, the procedure will typically involve most or all of the following steps:

  1. The person will receive a general anesthetic.
  2. Surgeons will use a cystoscope to look inside the urethra and bladder.
  3. They may also pass a plastic tube into the ureters to prevent damage during the procedure.
  4. The surgeons will make an incision inside the vagina or in the lower abdomen.
  5. They will separate the bladder from the vagina and repair the fistula using dissolvable stitches.
  6. Part of the fistula repair will involve removal of the fistulous tract.
  7. The surgeons may reinforce the area using fatty tissue from the labia or abdomen.
  8. They will place a catheter into the bladder through the urethra to allow the bladder to heal.
  9. A person may also receive a second catheter through the abdominal wall, known as a suprapubic catheter.
  10. At the end of the procedure, the surgeons will remove the plastic tubes from the ureters.
  11. The catheter or catheters will stay in place for 2–3 weeks during recovery, but a person can go home with them in place.
  12. A person will return to have a doctor check the bladder and remove the catheters.

Like all major surgeries, surgical repair of vaginal fistulas comes with risks. These may include:

In some rare cases, it can even be fatal.

Some surgeries fail to repair the fistula, while others do not heal properly or return. Other complications include:

  • sexual dysfunction
  • sexual dissatisfaction
  • new-onset incontinence
  • progression of already present incontinence
  • cesarean sections being advisable for subsequent pregnancies
  • pelvic and abdominal adhesions
  • pain during sex

Vaginal fistulas describe openings between the vagina and other organs, such as the rectum, bowel, and bladder, which are not normally present. These openings may occur due to pelvic surgery, childbirth, or radiation treatment for cancer.

Fistulas may cause uncomfortable symptoms such as continuous fecal and urine leaks, infections, and abdominal pain. While some small fistulas may heal on their own, many require surgery to separate the organs. The steps involved in these operations will depend on the fistula’s severity, location, and complexity.