• Mathias Onsrud, Solbjørg Sjøveian, Roger Luhiriri, and Dennis Mukwege.
• Department of Obstetrics and Gynecology, Panzi Hospital, Bukavu, Democratic Republic of Congo. mathiaso@online.no
• Int J Gynaecol Obstet. 2008 Dec 1; 103 (3): 265-9.

ObjectiveTo determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo.MethodsA retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007.ResultsOf the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor.ConclusionTraumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.

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