Obstetric fistula
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Obstetric fistula is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina (see rectovaginal fistula) or between the bladder and vagina (see vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available.
The fistula usually develops when a prolonged labor presses the unborn child so tightly in the birth canal that blood flow is cut off to the surrounding tissues, which die and eventually rot away. More rarely, the injury can be caused by female circumcision, poorly performed abortions, or pelvic fractures.
The resulting disorders typically include incontinence, infertility, severe infections and ulcerations of the vaginal tract, and often paralysis caused by nerve damage. Sufferers from this disorder are usually also subject to severe social stigma due to odor, perceptions of uncleanliness, a mistaken assumption of venereal disease, and the inability to have children.
Primary risk factors are early and/or closely-spaced pregnancies, and poor medical care; a 1993 study in Nigeria found that 55 percent of the victims were under 19 years of age, and 94 percent gave birth at home or in poorly equipped local clinics. When available at all, cesarean sections and other medical interventions are usually not performed until after tissue damage has already been done.
According to the UN, in 2002 over 100,000 women were at risk of obstetric fistula each year, and over 2 million women have already been injured and stigmatized.