Traumatic gynecologic fistula as a result of sexual violence.

While global awareness about obstetric fistula--a vaginal tear resulting from prolonged obstructed labor-- has increased less is known about traumatic gynecologic fistula a condition that can occur as the result of sexual violence often in conflict settings. Brutal rape (including the use of gun barrels beer bottles or sticks) can result in a tear or fistula between a womans vagina and bladder or rectum or both. Due to the fistula these women are unable to control the flow of their urine and/or feces and find it impossible to keep clean. As survivors of violent sexual assault women with traumatic fistula may have sustained additional physical injuries and are at an increased risk for unwanted pregnancy and sexually transmitted infections (STIs) including HIV. Often divorced by their husbands shunned by their communities and unable to work or care for their families survivors must also cope with the psychological trauma caused by rape. Frequently a surgical procedure is all that is needed to repair the physical injury. More long-term and comprehensive counseling rehabilitation and advocacy services are also critical to ensuring that a womans psychological wounds are healed and that her perpetrator is brought to justice. (authors)