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class="vector-toc-numb">2.2</span> <span>Malnutrition</span> </div> </a> <ul id="toc-Malnutrition-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Lack_of_education" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Lack_of_education"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Lack of education</span> </div> </a> <ul id="toc-Lack_of_education-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Early_childbirth" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Early_childbirth"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Early childbirth</span> </div> </a> <ul id="toc-Early_childbirth-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Lack_of_healthcare" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Lack_of_healthcare"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Lack of healthcare</span> </div> </a> <ul id="toc-Lack_of_healthcare-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Status_of_women" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Status_of_women"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.6</span> <span>Status of women</span> </div> </a> <ul id="toc-Status_of_women-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Prevention</span> </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Surgery</span> </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Challenges" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Challenges"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Challenges</span> </div> </a> <ul id="toc-Challenges-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Catheterization" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Catheterization"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Catheterization</span> </div> </a> <ul id="toc-Catheterization-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Society and culture</span> </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Society and culture subsection</span> </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Campaign_to_end_fistula" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Campaign_to_end_fistula"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>Campaign to end fistula</span> </div> </a> <ul id="toc-Campaign_to_end_fistula-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Fistula_Fortnight" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fistula_Fortnight"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.2</span> <span>Fistula Fortnight</span> </div> </a> <ul id="toc-Fistula_Fortnight-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Community_organizations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Community_organizations"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.3</span> <span>Community organizations</span> </div> </a> <ul id="toc-Community_organizations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment_centers" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Treatment_centers"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.4</span> <span>Treatment centers</span> </div> </a> <ul id="toc-Treatment_centers-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main 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class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Obstetric fistula</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 13 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-13" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">13 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%86%D8%A7%D8%B3%D9%88%D8%B1_%D8%A7%D9%84%D9%88%D9%84%D8%A7%D8%AF%D8%A9" title="ناسور الولادة – Arabic" lang="ar" hreflang="ar" data-title="ناسور الولادة" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/F%C3%ADstula_obst%C3%A8trica" title="Fístula obstètrica – Catalan" lang="ca" hreflang="ca" data-title="Fístula obstètrica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/F%C3%ADstula_obst%C3%A9trica" title="Fístula obstétrica – Spanish" lang="es" hreflang="es" data-title="Fístula obstétrica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Fistule_obst%C3%A9tricale" title="Fistule obstétricale – French" lang="fr" hreflang="fr" data-title="Fistule obstétricale" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Fistola_ostetrica" title="Fistola ostetrica – Italian" lang="it" hreflang="it" data-title="Fistola ostetrica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A4%D7%99%D7%A1%D7%98%D7%95%D7%9C%D7%94_%D7%94%D7%A8%D7%99%D7%95%D7%A0%D7%99%D7%AA" title="פיסטולה הריונית – Hebrew" lang="he" hreflang="he" data-title="פיסטולה הריונית" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ht mw-list-item"><a href="https://ht.wikipedia.org/wiki/Obstetrik_fo_kannal" title="Obstetrik fo kannal – Haitian Creole" lang="ht" hreflang="ht" data-title="Obstetrik fo kannal" data-language-autonym="Kreyòl ayisyen" data-language-local-name="Haitian Creole" class="interlanguage-link-target"><span>Kreyòl ayisyen</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%94%A3%E7%A7%91%E7%98%BB%E5%AD%94" title="産科瘻孔 – Japanese" lang="ja" hreflang="ja" data-title="産科瘻孔" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%85%E0%AC%AC%E0%AC%B8%E0%AD%8D%E0%AC%9F%E0%AD%87%E0%AC%9F%E0%AD%8D%E0%AC%B0%E0%AC%BF%E0%AC%95%E0%AD%8D%E0%AC%B8_%E0%AC%AB%E0%AC%BF%E0%AC%B8%E0%AC%9A%E0%AD%81%E0%AC%B2%E0%AC%BE" title="ଅବସ୍ଟେଟ୍ରିକ୍ସ ଫିସଚୁଲା – Odia" lang="or" hreflang="or" data-title="ଅବସ୍ଟେଟ୍ରିକ୍ସ ଫିସଚୁଲା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/F%C3%ADstula_obst%C3%A9trica" title="Fístula obstétrica – Portuguese" lang="pt" hreflang="pt" data-title="Fístula obstétrica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Obstetric_fistula" title="Obstetric fistula – Simple English" lang="en-simple" hreflang="en-simple" data-title="Obstetric fistula" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D8%B2%DA%86%DA%AF%DB%8C_%D8%B3%DB%92_%DB%81%D9%88%D9%86%DB%92_%D9%88%D8%A7%D9%84%D8%A7_%D9%86%D8%A7%D8%B3%D9%88%D8%B1" title="زچگی سے ہونے والا ناسور – Urdu" lang="ur" hreflang="ur" data-title="زچگی سے ہونے والا ناسور" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target"><span>اردو</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/L%E1%BB%97_r%C3%B2_s%E1%BA%A3n_khoa" title="Lỗ rò sản khoa – Vietnamese" lang="vi" hreflang="vi" data-title="Lỗ rò sản khoa" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q679020#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit 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dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Hole that develops in the birth canal as a result of childbirth</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Obstetric fistula</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Prolonged_obstructed_labour_sequelae.jpg" class="mw-file-description"><img alt="Diagram of maternal and foetal sequelae of prolonged obstructed labour, increasing the risk of obstetric fistula." src="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Prolonged_obstructed_labour_sequelae.jpg/220px-Prolonged_obstructed_labour_sequelae.jpg" decoding="async" width="220" height="156" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Prolonged_obstructed_labour_sequelae.jpg/330px-Prolonged_obstructed_labour_sequelae.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/ff/Prolonged_obstructed_labour_sequelae.jpg/440px-Prolonged_obstructed_labour_sequelae.jpg 2x" data-file-width="3508" data-file-height="2480" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Diagram of maternal and foetal sequelae of prolonged obstructed labour, highlighting areas that are at high risk of developing obstetric fistula(s).</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Urology" title="Urology">Urology</a>, <a href="/wiki/Gynecology" class="mw-redirect" title="Gynecology">gynecology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Urinary_incontinence" title="Urinary incontinence">Incontinence of urine</a> or feces<sup id="cite_ref-UN2017_1-0" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Mood_disorder" title="Mood disorder">Depression</a>, <a href="/wiki/Infertility" title="Infertility">infertility</a>, social isolation<sup id="cite_ref-UN2017_1-1" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data"><a href="/wiki/Childbirth" title="Childbirth">Childbirth</a><sup id="cite_ref-UN2017_1-2" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><a href="/wiki/Obstructed_labor" class="mw-redirect" title="Obstructed labor">Obstructed labor</a>, poor access to medical care, <a href="/wiki/Malnutrition" title="Malnutrition">malnutrition</a>, <a href="/wiki/Teenage_pregnancy" title="Teenage pregnancy">teenage pregnancy</a><sup id="cite_ref-UN2017_1-3" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-WHO2014Fact_2-0" class="reference"><a href="#cite_note-WHO2014Fact-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms, supported <a href="/wiki/Methylene_blue" title="Methylene blue">methylene blue</a><sup id="cite_ref-Cr2007_3-0" class="reference"><a href="#cite_note-Cr2007-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data">Appropriate use of <a href="/wiki/Cesarean_section" class="mw-redirect" title="Cesarean section">cesarean section</a><sup id="cite_ref-UN2017_1-4" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Surgery, <a href="/wiki/Urinary_catheter" class="mw-redirect" title="Urinary catheter">urinary catheter</a>, <a href="/wiki/Counseling" class="mw-redirect" title="Counseling">counseling</a><sup id="cite_ref-UN2017_1-5" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Cr2007_3-1" class="reference"><a href="#cite_note-Cr2007-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">2 million (<a href="/wiki/Developing_world" class="mw-redirect" title="Developing world">developing world</a>), rare (<a href="/wiki/Developed_world" class="mw-redirect" title="Developed world">developed world</a>)<sup id="cite_ref-UN2017_1-6" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Obstetric fistula</b> is a medical condition in which a <a href="/wiki/Fistula" title="Fistula">hole</a> develops in the <a href="/wiki/Birth_canal" class="mw-redirect" title="Birth canal">birth canal</a> as a result of <a href="/wiki/Childbirth" title="Childbirth">childbirth</a>.<sup id="cite_ref-UN2017_1-7" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-WHO2014Fact_2-1" class="reference"><a href="#cite_note-WHO2014Fact-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> This can be between the <a href="/wiki/Vagina" title="Vagina">vagina</a> and <a href="/wiki/Rectovaginal_fistula" title="Rectovaginal fistula">rectum</a>, <a href="/wiki/Ureter" title="Ureter">ureter</a>, or <a href="/wiki/Vesicovaginal_fistula" title="Vesicovaginal fistula">bladder</a>.<sup id="cite_ref-UN2017_1-8" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It can result in <a href="/wiki/Urinary_incontinence" title="Urinary incontinence">incontinence of urine</a> or <a href="/wiki/Fecal_incontinence" title="Fecal incontinence">feces</a>.<sup id="cite_ref-UN2017_1-9" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Complications may include <a href="/wiki/Mood_disorder" title="Mood disorder">depression</a>, <a href="/wiki/Infertility" title="Infertility">infertility</a>, and social isolation.<sup id="cite_ref-UN2017_1-10" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Risk factors include <a href="/wiki/Obstructed_labor" class="mw-redirect" title="Obstructed labor">obstructed labor</a>, poor access to medical care, <a href="/wiki/Malnutrition" title="Malnutrition">malnutrition</a>, and <a href="/wiki/Teenage_pregnancy" title="Teenage pregnancy">teenage pregnancy</a>.<sup id="cite_ref-UN2017_1-11" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-WHO2014Fact_2-2" class="reference"><a href="#cite_note-WHO2014Fact-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The underlying mechanism is <a href="/wiki/Ischemia" title="Ischemia">poor blood flow</a> to the affected area for a prolonged period of time.<sup id="cite_ref-UN2017_1-12" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Diagnosis is generally based on symptoms and may be supported by use of <a href="/wiki/Methylene_blue" title="Methylene blue">methylene blue</a>.<sup id="cite_ref-Cr2007_3-2" class="reference"><a href="#cite_note-Cr2007-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Obstetrics" title="Obstetrics">Obstetric</a> fistulae are almost entirely preventable with appropriate use of <a href="/wiki/Cesarean_section" class="mw-redirect" title="Cesarean section">cesarean section</a>.<sup id="cite_ref-UN2017_1-13" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Treatment is typically by surgery.<sup id="cite_ref-UN2017_1-14" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> If treated early, the use of a <a href="/wiki/Urinary_catheter" class="mw-redirect" title="Urinary catheter">urinary catheter</a> may help with healing.<sup id="cite_ref-Cr2007_3-3" class="reference"><a href="#cite_note-Cr2007-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Counseling" class="mw-redirect" title="Counseling">Counseling</a> may also be useful.<sup id="cite_ref-UN2017_1-15" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> An estimated 2 million people in <a href="/wiki/Sub-Saharan_Africa" title="Sub-Saharan Africa">sub-Saharan Africa</a>, Asia, the <a href="/wiki/Arab_region" class="mw-redirect" title="Arab region">Arab region</a>, and <a href="/wiki/Latin_America" title="Latin America">Latin America</a> have the condition, with about 75,000 new cases developing a year.<sup id="cite_ref-UN2017_1-16" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> It occurs very rarely in the <a href="/wiki/Developed_world" class="mw-redirect" title="Developed world">developed world</a> and is considered a <a href="/wiki/Diseases_of_poverty" title="Diseases of poverty">disease of poverty</a>.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Symptoms of obstetric fistula include: </p> <ul><li><a href="/wiki/Flatulence" title="Flatulence">Flatulence</a>, <a href="/wiki/Urinary_incontinence" title="Urinary incontinence">urinary incontinence</a>, or <a href="/wiki/Fecal_incontinence" title="Fecal incontinence">fecal incontinence</a>, which may be continual or only happen at night<sup id="cite_ref-Cr2007_3-4" class="reference"><a href="#cite_note-Cr2007-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-webmd_6-0" class="reference"><a href="#cite_note-webmd-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-our_7-0" class="reference"><a href="#cite_note-our-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></li> <li>Foul-smelling vaginal discharge<sup id="cite_ref-webmd_6-1" class="reference"><a href="#cite_note-webmd-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-our_7-1" class="reference"><a href="#cite_note-our-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-mayo_8-0" class="reference"><a href="#cite_note-mayo-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></li> <li>Repeated vaginal or urinary tract infections<sup id="cite_ref-our_7-2" class="reference"><a href="#cite_note-our-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-mayo_8-1" class="reference"><a href="#cite_note-mayo-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-recto_9-0" class="reference"><a href="#cite_note-recto-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li> <li>Irritation or pain in the vagina or surrounding areas<sup id="cite_ref-mayo_8-2" class="reference"><a href="#cite_note-mayo-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-recto2_10-0" class="reference"><a href="#cite_note-recto2-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-fist_11-0" class="reference"><a href="#cite_note-fist-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></li> <li>Pain during sexual activity<sup id="cite_ref-mayo_8-3" class="reference"><a href="#cite_note-mayo-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-recto2_10-1" class="reference"><a href="#cite_note-recto2-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-fist_11-1" class="reference"><a href="#cite_note-fist-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup></li></ul> <p>Other effects of obstetric fistulae include stillborn babies due to prolonged labor, which happens 85% to 100% of the time,<sup id="cite_ref-shame_12-0" class="reference"><a href="#cite_note-shame-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ahmed_13-0" class="reference"><a href="#cite_note-ahmed-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-zheng_15-0" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> severe <a href="/wiki/Ulcer_(dermatology)" title="Ulcer (dermatology)">ulcerations</a> of the vaginal tract, "<a href="/wiki/Foot_drop" title="Foot drop">foot drop</a>", which is the paralysis of the lower limbs caused by nerve damage, making it impossible to walk,<sup id="cite_ref-our_7-3" class="reference"><a href="#cite_note-our-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Donnay_254–261_16-0" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-arrow_17-0" class="reference"><a href="#cite_note-arrow-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> infection of the fistula forming an <a href="/wiki/Abscess" title="Abscess">abscess</a>,<sup id="cite_ref-mayo_8-4" class="reference"><a href="#cite_note-mayo-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> and up to two-thirds of sufferers become <a href="/wiki/Amenorrhoea" class="mw-redirect" title="Amenorrhoea">amenorrhoeic</a>.<sup id="cite_ref-browning_18-0" class="reference"><a href="#cite_note-browning-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>Obstetric fistulae have far-reaching physical, social, economic, and psychological consequences for the women affected. According to UNFPA, "Due to the prolonged obstructed labour, the baby almost inevitably dies, and the parent is left with chronic incontinence. Unable to control the flow of urine or faeces, or both, they may be abandoned by their spouse and family and ostracized by their community. Without treatment, their prospects for work and family life are virtually nonexistent."<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Physical">Physical</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=2" title="Edit section: Physical"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The most direct consequence of an obstetric fistula is the constant leakage of urine, feces, and blood as a result of a hole that forms between the vagina and bladder or rectum.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> This leaking has both physical and societal penalties. The acid in the urine, feces, and blood causes severe burn wounds on the legs from the continuous dripping.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Nerve damage that can result from the leaking can cause women to struggle with walking and eventually lose mobility. In an attempt to avoid the dripping, women limit their intake of water and liquid, which can ultimately lead to dangerous cases of <a href="/wiki/Dehydration" title="Dehydration">dehydration</a>. Ulceration and infections can persist, as well as <a href="/wiki/Kidney_disease" title="Kidney disease">kidney disease</a> and <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>, which can each lead to death. Further, only a quarter of women who develop a fistula in their first birth are able to have a living baby, and therefore have minuscule chances of conceiving a healthy baby later on. Some, due to obstetric fistulae and other complications from childbirth, do not survive.<sup id="cite_ref-zheng_15-1" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Social">Social</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=3" title="Edit section: Social"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Physical consequences of obstetric fistulae lead to severe sociocultural stigmatization for various reasons. For example, in <a href="/wiki/Burkina_Faso" title="Burkina Faso">Burkina Faso</a>, most citizens do not believe an obstetric fistula to be a medical condition, but as a divine punishment or a curse for disloyal or disrespectful behavior.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Other sub-Saharan cultures view offspring as an indicator of a family's wealth. A woman who is unable to successfully produce children as assets for her family is believed to make her and her family socially and economically inferior. A patient's incontinence and pain also render her unable to perform household chores and childrearing as a wife and as a mother, thus devaluing her.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Other misconceptions about obstetric fistulae are that they are caused by <a href="/wiki/Sexually_transmitted_disease" class="mw-redirect" title="Sexually transmitted disease">venereal diseases</a> or are divine punishment for sexual misconduct.<sup id="cite_ref-roush_24-0" class="reference"><a href="#cite_note-roush-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p><p>As a result, many girls are divorced or abandoned by their husbands and partners, disowned by family, ridiculed by friends, and even isolated by health workers.<sup id="cite_ref-Donnay_254–261_16-1" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Divorce rates for women who have an obstetric fistula range from 50%<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Epidemiological_determinants_of_ves_27-0" class="reference"><a href="#cite_note-Epidemiological_determinants_of_ves-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> to as high as 89%.<sup id="cite_ref-roush_24-1" class="reference"><a href="#cite_note-roush-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Now marginalized members of society, girls are forced to live on the edges of their villages and towns, often in isolation in a hut where they will likely die from <a href="/wiki/Starvation" title="Starvation">starvation</a> or an infection in the birth canal. The unavoidable odor is viewed as offensive, thus their removal from society is seen as essential. Accounts of women who develop obstetric fistulae proclaim that their lives have been reduced to the leaking of urine, feces, and blood because they are no longer capable or allowed to participate in traditional activities, including the duties of wife and mother. Because such consequences highly stigmatize and marginalize the woman, the intense loneliness and shame can lead to clinical depression and suicidal thoughts. Some women have formed small groups and resorted to walking to seek medical help, where their characteristic odor makes them a target for sub-Saharan predatory wildlife, further endangering their lives. This trip can take on average 12 hours to complete.<sup id="cite_ref-mckinney_29-0" class="reference"><a href="#cite_note-mckinney-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Moreover, women are sometimes forced to turn to <a href="/wiki/Prostitution" title="Prostitution">commercial sex work</a> as a means of survival because the extreme <a href="/wiki/Poverty" title="Poverty">poverty</a> and social isolation that result from obstetric fistulae eliminate all other income opportunities. With only 7.5% of women with fistulae able to access treatment, the vast majority of women end up with the consequences of obstructed and prolonged labor simply because options and access to help is so limited.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Psychological">Psychological</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=4" title="Edit section: Psychological"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some common psychological consequences that women with a fistula face are the despair from losing their child, the humiliation from their smell, and inability to perform their family roles.<sup id="cite_ref-ahmed_13-1" class="reference"><a href="#cite_note-ahmed-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Additionally, a fear of developing another fistula in future pregnancies exists.<sup id="cite_ref-restore_31-0" class="reference"><a href="#cite_note-restore-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Obstetrics" title="Obstetrics">Obstetric</a> fistula is not only debilitating physically, but emotionally. A woman is presented with an array of psychological trauma that she must oftentimes deal with herself unless provided with ample resources. Oftentimes ostracized by her community, a woman with obstetric fistula tends to face these issues on her own. In a study of The lived experience of Malawian women with obstetric fistula, the immense psychological trauma is addressed: "For these women, internalizing this constant struggle leads to psychological morbidity."<sup id="cite_ref-Yeakey_2009_499–513_32-0" class="reference"><a href="#cite_note-Yeakey_2009_499–513-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> It was striking how many women discussed constant sadness and giving up hope in their interviews." </p><p>Although the psychological impacts center around the woman experiencing the fistula, others around them, and especially loved ones, feel the impact as well. The same study references this: "This attitude was often shared by their family members, both husbands and female relatives."<sup id="cite_ref-Yeakey_2009_499–513_32-1" class="reference"><a href="#cite_note-Yeakey_2009_499–513-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p><p>Women with obstetric fistula face severe mental health issues.<sup id="cite_ref-Polan_2015_33-0" class="reference"><a href="#cite_note-Polan_2015-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Among women with obstetric fistula from Bangladesh and Ethiopia 97% screened positive for potential mental health dysfunctions and about 30% had major depression.<sup id="cite_ref-Polan_2015_33-1" class="reference"><a href="#cite_note-Polan_2015-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Risk_factors">Risk factors</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=5" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In less-developed countries, obstetric fistulae usually develop as a result of <a href="/wiki/Obstructed_labour" title="Obstructed labour">prolonged labor</a> when a cesarean section cannot be obtained.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Over the course of the three to five days of labor, the unborn child presses against the mother's <a href="/wiki/Vagina" title="Vagina">vagina</a> very tightly, cutting off blood flow to the surrounding tissues between the vagina and the rectum and between the vagina and the bladder, causing the tissues to <a href="/wiki/Necrosis" title="Necrosis">disintegrate</a> and rot away.<sup id="cite_ref-our_7-4" class="reference"><a href="#cite_note-our-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Donnay_254–261_16-2" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-browning_18-1" class="reference"><a href="#cite_note-browning-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>Obstetric fistulae can also be caused by poorly performed <a href="/wiki/Abortion" title="Abortion">abortions</a>,<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> and pelvic <a href="/wiki/Fracture_(bone)" class="mw-redirect" title="Fracture (bone)">fracture</a>, cancer, or radiation therapy targeted at the pelvic area, <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">inflammatory bowel disease</a> (such as <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a> and <a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">ulcerative colitis</a>). Other potential causes for the development of obstetric fistulae are sexual abuse and <a href="/wiki/Rape" title="Rape">rape</a>, especially in conflict/postconflict areas,<sup id="cite_ref-keeton_36-0" class="reference"><a href="#cite_note-keeton-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> and other trauma, such as surgical trauma.<sup id="cite_ref-Donnay_254–261_16-3" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-acquire_37-0" class="reference"><a href="#cite_note-acquire-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p><p>In the developed world, such as the US, the primary cause of obstetric fistulae, particularly <a href="/wiki/Rectovaginal_fistula" title="Rectovaginal fistula">rectovaginal fistulae</a>, is the use of <a href="/wiki/Episiotomy" title="Episiotomy">episiotomy</a> and forceps.<sup id="cite_ref-ReferenceA_38-0" class="reference"><a href="#cite_note-ReferenceA-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Primary risk factors include early or closely spaced pregnancies and lack of access to emergency obstetric care. For example, a 1983 study in <a href="/wiki/Nigeria" title="Nigeria">Nigeria</a> found that 54.8% of the women affected were under 20 years of age, and 64.4% gave birth at home or in poorly equipped local clinics.<sup id="cite_ref-Epidemiological_determinants_of_ves_27-1" class="reference"><a href="#cite_note-Epidemiological_determinants_of_ves-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> When available at all, cesarean sections and other medical interventions are usually not performed until after tissue damage has already been done.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2020)">citation needed</span></a></i>]</sup> </p><p>Social, political, and economic causes that indirectly lead to the development of obstetric fistulae concern issues of <a href="/wiki/Poverty" title="Poverty">poverty</a>, <a href="/wiki/Malnutrition" title="Malnutrition">malnutrition</a>, lack of education, early marriage and childbirth, the role and status of women in developing countries, harmful traditional practices, <a href="/wiki/Sexual_violence" title="Sexual violence">sexual violence</a>, and lack of good quality or accessible maternal and health care.<sup id="cite_ref-our_7-5" class="reference"><a href="#cite_note-our-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-zheng_15-2" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Donnay_254–261_16-4" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Obstetric_fistula:_a_preventable_tr_39-0" class="reference"><a href="#cite_note-Obstetric_fistula:_a_preventable_tr-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Poverty">Poverty</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=6" title="Edit section: Poverty"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Poverty" title="Poverty">Poverty</a> is the main indirect cause of obstetric fistulae around the world. As obstructed labor and obstetric fistulae account for 8% of maternal deaths worldwide<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> and "a 60-fold difference in gross national product per person shows up as a 120-fold difference in maternal mortality ratio," impoverished countries produce higher maternal mortality rates and thus higher obstetric fistula rates.<sup id="cite_ref-Gale_Virtual_Reference_Library_41-0" class="reference"><a href="#cite_note-Gale_Virtual_Reference_Library-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Furthermore, impoverished countries not only have low incomes, but also lack adequate infrastructure, trained and educated professionals, resources, and a centralized government that exist in developed nations to effectively eradicate obstetric fistulae.<sup id="cite_ref-wilson_42-0" class="reference"><a href="#cite_note-wilson-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p>According to UNFPA, "Generally accepted estimates suggest that 2.0-3.5 million women live with obstetric fistulae in the developing world, and between 50,000 and 100,000 new cases develop each year. All but eliminated from the developed world, obstetric fistula continues to affect the poorest of the poor: women and girls living in some of the most resource-starved remote regions in the world."<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Malnutrition">Malnutrition</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=7" title="Edit section: Malnutrition"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One reason that <a href="/wiki/Poverty" title="Poverty">poverty</a> produces such high rates of fistula cases is the malnutrition that exists in such areas.<sup id="cite_ref-zheng_15-3" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Lack of money and access to proper nutrition,<sup id="cite_ref-cook_44-0" class="reference"><a href="#cite_note-cook-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> as well as vulnerability to diseases that exist in impoverished areas because of limited basic health care and disease prevention methods, cause inhabitants of these regions to experience <a href="/wiki/Stunted_growth" title="Stunted growth">stunted growth</a>. Sub-Saharan Africa is one such environment where the shortest women have on average lighter babies and more difficulties during birth when compared with full-grown women. This stunted growth causes expectant mothers to have skeletons unequipped for proper birth, such as an underdeveloped pelvis.<sup id="cite_ref-zheng_15-4" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> This weak and underdeveloped bone structure increases the chances that the baby will get stuck in the pelvis during birth, cutting off circulation and leading to tissue necrosis. Because of the correlation between malnutrition, stunted growth, and birthing difficulties, maternal height can at times be used as a measure for expected labor difficulties.<sup id="cite_ref-Gale_Virtual_Reference_Library_41-1" class="reference"><a href="#cite_note-Gale_Virtual_Reference_Library-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Lack_of_education">Lack of education</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=8" title="Edit section: Lack of education"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>High levels of poverty also lead to low levels of education among impoverished women concerning <a href="/wiki/Maternal_health" title="Maternal health">maternal health</a>. This lack of information in combination with obstacles preventing <a href="/wiki/Rural_women" title="Rural women">rural women</a> to easily travel to and from hospitals lead many to arrive at the birthing process without <a href="/wiki/Prenatal_care" title="Prenatal care">prenatal care</a>. This can cause a development of unplanned complications that may arise during home births, in which traditional techniques are used. These techniques often fail in the event of unplanned emergencies, leading women to go to the hospital for care too late, desperately ill, and therefore vulnerable to the risks of anesthesia and surgery that must be used on them. In a study of women who had prenatal care and those who had unbooked emergency births, "the death rate in the booked-healthy group was as good as that in many developed countries, [but] the death rate in the unbooked emergencies was the same as the death rate in England in the 16th and 17th centuries." In this study, 62 unbooked emergency women were diagnosed with obstetric fistulae out of 7,707 studied, in comparison to three diagnosed booked mothers out of 15,020 studied.<sup id="cite_ref-Gale_Virtual_Reference_Library_41-2" class="reference"><a href="#cite_note-Gale_Virtual_Reference_Library-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> In addition, studies find that education is associated with lower desired family size, greater use of contraceptives, and increased use of professional medical services. Educated families are also more likely to be able to afford health care, especially maternal healthcare.<sup id="cite_ref-half_45-0" class="reference"><a href="#cite_note-half-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Early_childbirth">Early childbirth</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=9" title="Edit section: Early childbirth"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In sub-Saharan Africa, many girls enter into arranged marriages <a href="/wiki/Child_marriage" title="Child marriage">soon after</a> <a href="/wiki/Menarche" title="Menarche">menarche</a> (usually between the ages of 9 and 15). Social factors and economic factors contribute to this practice of early marriages. Socially, some grooms want to ensure their brides are <a href="/wiki/Virginity" title="Virginity">virgins</a> when they get married, so an earlier marriage is desirable.<sup id="cite_ref-cook_44-1" class="reference"><a href="#cite_note-cook-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Economically, the <a href="/wiki/Bride_price" title="Bride price">bride price</a> received and having one less person to feed in the family helps alleviate the financial burdens of the bride's family.<sup id="cite_ref-africa_46-0" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Early marriages lead to early childbirth, which increases the risk of obstructed labor, since young mothers who are poor and malnourished may have underdeveloped pelvises. In fact, obstructed labor is responsible for 76 to 97% of obstetric fistulae.<sup id="cite_ref-shame_12-1" class="reference"><a href="#cite_note-shame-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Lack_of_healthcare">Lack of healthcare</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=10" title="Edit section: Lack of healthcare"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Even women who do make it to the hospital may not get proper treatment. Countries that suffer from poverty, civil and political unrest or conflict, and other dangerous public health issues such as <a href="/wiki/Malaria" title="Malaria">malaria</a>, <a href="/wiki/HIV/AIDS" title="HIV/AIDS">HIV/AIDS</a>, and <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a> often suffer from a severe burden and breakdown within the healthcare system. This breakdown puts many people at risk, specifically women. Many hospitals within these conditions have shortages of staff, supplies, and other forms of medical technology that would be necessary to perform reconstructive obstetric fistula repair.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (January 2019)">citation needed</span></a></i>]</sup> There is a shortage of doctors in rural Africa, and studies find that the doctors and nurses who do exist in rural Africa often do not show up for work.<sup id="cite_ref-half_45-1" class="reference"><a href="#cite_note-half-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>Poverty hinders women from being able to access normal and emergency obstetric care because of long distances and expensive procedures. For some women, the closest maternal care facility can be more than 50 km away. In Kenya, a study by the Ministry of Health found that the "rugged landscape, long distances to health facilities, and societal preferences for delivery with a traditional birth attendant contributed to delays in accessing necessary obstetric care."<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Emergency cesarean sections, which can help avoid fistulae caused by prolonged vaginal deliveries, are very expensive.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2020)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Status_of_women">Status of women</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=11" title="Edit section: Status of women"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In developing countries, women who are affected by obstetric fistulae do not necessarily have full agency over their bodies or their households. Rather, their husbands and other family members have control in determining the healthcare that the women receive.<sup id="cite_ref-zheng_15-5" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> For example, a woman's family may refuse medical examinations for the patient by male doctors, but female doctors may be unavailable, thus barring women from prenatal care.<sup id="cite_ref-cook_44-2" class="reference"><a href="#cite_note-cook-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Furthermore, many societies believe that women are supposed to suffer in childbirth, thus are less inclined to support maternal health efforts.<sup id="cite_ref-half_45-2" class="reference"><a href="#cite_note-half-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=12" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Prevention is the key to ending fistulae. UNFPA states that, "Ensuring skilled birth attendance at all births and providing emergency obstetric care for all women who develop complications during delivery would make fistula as rare in developing countries as it is in the industrialized world."<sup id="cite_ref-UN2017_1-17" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In addition, access to health services and education – including family planning, gender equality, higher living standards, child marriage, and human rights – must be addressed to reduce the marginalization of women and girls. Reducing marginalization in these areas could reduce maternal disability and death by at least 20%.<sup id="cite_ref-UN2017_1-18" class="reference"><a href="#cite_note-UN2017-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Prevention comes in the form of access to <a href="/wiki/Obstetrics" title="Obstetrics">obstetrical care</a>, support from trained health care professionals throughout pregnancy, providing access to <a href="/wiki/Family_planning" title="Family planning">family planning</a>, promoting the practice of spacing between births, supporting women in education, and postponing early marriage. Fistula prevention also involves many strategies to educate local communities about the cultural, social, and physiological factors of that condition and contribute to the risk for fistulae. One of these strategies involves organizing community-level awareness campaigns to educate women about prevention methods such as proper hygiene and care during pregnancy and labor.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Prevention of prolonged obstructed labor and fistulae should preferably begin as early as possible in each woman's life. For example, improved nutrition and outreach programs to raise awareness about the nutritional needs of children to prevent malnutrition, as well as improve the physical maturity of young mothers, are important fistula prevention strategies. It is also important to ensure access to timely and safe delivery during childbirth: measures include availability and provision of emergency obstetric care, as well as quick and safe cesarean sections for women in obstructed labor. Some organizations train local nurses and midwives to perform emergency cesarean sections to avoid vaginal delivery for young mothers who have underdeveloped pelvises.<sup id="cite_ref-mckinney_29-1" class="reference"><a href="#cite_note-mckinney-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Midwives located in the local communities where obstetric fistulae are prevalent can contribute to promoting health practices that help prevent future development of obstetric fistulae. NGOs also work with local governments, like the government of <a href="/wiki/Niger" title="Niger">Niger</a>, to offer free cesarean sections, further preventing the onset of obstetric fistulae.<sup id="cite_ref-zheng_15-6" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Promoting education for girls is also a key factor to preventing fistulae in the long term. Former fistula patients often act as "community fistula advocates" or "ambassadors of hope", a UNFPA-sponsored initiative, to educate the community.<sup id="cite_ref-MHTF_49-0" class="reference"><a href="#cite_note-MHTF-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> These survivors help current patients, educate pregnant mothers, and dispel cultural myths that obstetric fistulae are caused by adultery or evil spirits.<sup id="cite_ref-acquire_37-1" class="reference"><a href="#cite_note-acquire-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Successful ambassador programs are in place in Kenya, Bangladesh, Nigeria, Ghana, Côte d'Ivoire, and Liberia.<sup id="cite_ref-zheng_15-7" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Several organizations have developed effective fistula prevention strategies. One, the Tanzanian Midwives Association, works to prevent fistulae by improving clinical healthcare for women, encouraging the delay of early marriages and childbearing years, and helping the local communities to advocate for women's rights.<sup id="cite_ref-Obstetric_fistula:_a_preventable_tr_39-1" class="reference"><a href="#cite_note-Obstetric_fistula:_a_preventable_tr-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=13" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Addis-ababa-fistula-hospital.jpg" class="mw-file-description"><img alt="Patients at the Addis Ababa Fistula Hospital" src="//upload.wikimedia.org/wikipedia/commons/thumb/e/eb/Addis-ababa-fistula-hospital.jpg/220px-Addis-ababa-fistula-hospital.jpg" decoding="async" width="220" height="144" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/eb/Addis-ababa-fistula-hospital.jpg/330px-Addis-ababa-fistula-hospital.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/eb/Addis-ababa-fistula-hospital.jpg/440px-Addis-ababa-fistula-hospital.jpg 2x" data-file-width="2428" data-file-height="1588" /></a><figcaption>Patients at the Addis Ababa Fistula Hospital in Ethiopia are all treated free of charge.</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=14" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The nature of the injury varies depending on the size and location of the fistula, so a surgeon with experience is needed to improvise on the spot.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Before the person undergoes surgery, treatment and evaluation are needed for conditions including <a href="/wiki/Anemia" title="Anemia">anemia</a>, <a href="/wiki/Malnutrition" title="Malnutrition">malnutrition</a>, and <a href="/wiki/Malaria" title="Malaria">malaria</a>. Quality treatment in low-resource settings are possible (as in the cases of Nigeria and Ethiopia).<sup id="cite_ref-Donnay_254–261_16-5" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>Treatment is available through reconstructive surgery.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> Primary fistula repair has a 91% success rate.<sup id="cite_ref-africa_46-1" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> The corrective surgery costs about US$100–400,<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> and the cost for the entire procedure, which includes the actual surgery, postoperative care, and rehabilitation support, is estimated to cost $300–450. Initial surgeries done by inadequately trained doctors and midwives increase the number of follow-up surgeries that must be performed to restore full continence.<sup id="cite_ref-africa_46-2" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Successful surgery enables women to live normal lives and have more children, but it is recommended to have a cesarean section to prevent the fistula from recurring. Postoperative care is vital to prevent infection. Some women are not candidates for this surgery due to other health problems. In those cases, <a href="/wiki/Colostomy" title="Colostomy">fecal diversion</a> can help the patient, but not necessarily cure them.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p><p>Besides physical treatment, mental health services are also needed to rehabilitate fistula patients, who experience psychological trauma from being ostracized by the community and from fear of developing fistulae again. A study on the first formal counseling program for fistula survivors in Eritrea shows positive results, whereby counseling significantly improved the women's self-esteem, knowledge about fistulae and fistula prevention, and behavioral intentions for "health maintenance and social reintegration" following surgery.<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Challenges">Challenges</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=15" title="Edit section: Challenges"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Challenges with regards to treatment include the very high number of women needing reconstructive surgery, access to facilities and trained surgeons, and the cost of treatment. For many women, US$300 is a price they cannot afford. Access and availability of treatment also vary widely across different sub-Saharan countries. Certain regions also do not have enough maternal care clinics that are equipped, willing to treat fistula patients, and adequately staffed. At the Evangelical Hospital of Bemberéke in <a href="/wiki/Benin" title="Benin">Benin</a>, only one expatriate volunteer obstetrics and gynecology doctor is available a few months per year, with one certified nurse and seven informal hospital workers.<sup id="cite_ref-needs_57-0" class="reference"><a href="#cite_note-needs-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> In all of <a href="/wiki/Niger" title="Niger">Niger</a>, two medical centers treat fistula patients.<sup id="cite_ref-africa_46-3" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> In Nigeria, more dedicated health professionals operate on up to 1,600 women with a fistula per year.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> The world is currently severely under capacity for treating the problem; it would take up to 400 years to treat the backlog of patients.<sup id="cite_ref-browning_18-2" class="reference"><a href="#cite_note-browning-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> To prevent any new cases of obstetric fistulae, about 75,000 new emergency obstetric care facilities would have to be built in Africa alone,<sup id="cite_ref-waal_59-0" class="reference"><a href="#cite_note-waal-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> plus an increase in financial support and an even higher number of certified doctors, midwives, and nurses needed. </p><p>Another challenge standing between women and fistula treatment is information. Most women have no idea that treatment is available. Because this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence. In addition, after receiving initial treatment, <a href="/wiki/Health_education" title="Health education">health education</a> is important to prevent fistulae in subsequent pregnancies.<sup id="cite_ref-Donnay_254–261_16-6" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>Another challenge is the lack of trained professionals to provide surgery for fistula patients. As a result, nonphysicians are sometimes trained to provide obstetric services. For example, the Addis Ababa Fistula Hospital has medical staff without formal degrees, and one of its top surgeons was illiterate, but she had been trained over years and now regularly successfully performs fistula surgery.<sup id="cite_ref-half_45-3" class="reference"><a href="#cite_note-half-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Catheterization">Catheterization</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=16" title="Edit section: Catheterization"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Fistula cases can also be treated through <a href="/wiki/Urinary_catheterization" title="Urinary catheterization">urethral catheterization</a> if identified early enough. The <a href="/wiki/Foley_catheter" title="Foley catheter">Foley catheter</a> is recommended because it has a balloon to hold it in place. The indwelling Foley catheter drains urine from the bladder. This decompresses the bladder wall so that the wounded edges come together and stay together, giving it a greater chance of closing naturally, at least in the smaller fistulae.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2020)">citation needed</span></a></i>]</sup> </p><p>About 37% of obstetric fistulae that are treated within 75 days after birth with a Foley catheter resolve. Even without preselecting the least complicated obstetric fistula cases, a Foley catheter by midwives after the onset of urinary incontinence could treat over 25% of all new fistulae.<sup id="cite_ref-waal_59-1" class="reference"><a href="#cite_note-waal-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=17" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Obstetric fistulae are common in the developing world, especially in sub-Saharan <a href="/wiki/Africa" title="Africa">Africa</a> (Kenya,<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> Mali, Niger,<sup id="cite_ref-africa_46-4" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Nigeria, Rwanda, Sierra Leone, South Africa, Benin, Chad, Malawi, Mali, Mozambique, Niger, Nigeria, Uganda, and Zambia) and much of <a href="/wiki/South_Asia" title="South Asia">South Asia</a> (<a href="/wiki/Afghanistan" title="Afghanistan">Afghanistan</a>, <a href="/wiki/Bangladesh" title="Bangladesh">Bangladesh</a>, <a href="/wiki/India" title="India">India</a>, <a href="/wiki/Pakistan" title="Pakistan">Pakistan</a>, and <a href="/wiki/Nepal" title="Nepal">Nepal</a>). According to the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (WHO), an estimated 50,000 to 100,000 women develop obstetric fistulae each year and over two million women currently live with an obstetric fistula.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> In particular, most of the two million-plus women in developing nations who develop obstetric fistulae are under the age of 30.<sup id="cite_ref-africa_46-5" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Between 50 and 80% of women under the age of 20 in poor countries develop obstetric fistulae (the youngest patients are 12–13 years old).<sup id="cite_ref-cook_44-3" class="reference"><a href="#cite_note-cook-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Other estimates indicate about 73,000 new cases occur per year.<sup id="cite_ref-abou_62-0" class="reference"><a href="#cite_note-abou-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p><p>Obstetric fistulae were very common throughout the world, but since the late 19th century, the rise of gynecology developed safe practices for <a href="/wiki/Childbirth" title="Childbirth">childbirth</a>, including giving birth at local hospitals rather than at home, which dramatically reduced rates of obstructed labor and obstetric fistulae in Europe and North America.<sup id="cite_ref-africa_46-6" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p><p>Adequate population-based epidemiological data on obstetric fistulae are lacking due to the historic neglect of this condition since it was mostly eradicated in developed nations. Available data are estimations that should be viewed with caution.<sup id="cite_ref-Donnay_254–261_16-7" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> About 30% of women over age 45 in developed nations are affected by <a href="/wiki/Urinary_incontinence" title="Urinary incontinence">urinary incontinence</a>.<sup id="cite_ref-africa_46-7" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> The rate of obstetrical fistulae is much lower in places that discourage early marriage, encourage and provide general education for women, and grant women access to family planning and skilled medical teams to assist during childbirth.<sup id="cite_ref-needs_57-1" class="reference"><a href="#cite_note-needs-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=18" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Evidence of obstetric fistula dates back to 2050 BCE, when Queen Henhenit had a fistula. </p><p>The first acknowledgments of obstetric fistula date back to various Egyptian documents known as the papyri. These documents, including rare medical engravings, were found of the entrance of a tomb located in the necropolis of Saqquarah, Egypt. The tomb belonged to an unknown physician who lived during the 6th dynasty. The translation of this document became possible with the discovery of the Rosetta stone in 1799.<sup id="cite_ref-Zacharin_64-0" class="reference"><a href="#cite_note-Zacharin-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p><p>In 1872, the <a href="/wiki/Ebers_Papyrus" title="Ebers Papyrus">Ebers papyrus</a> was discovered in a mummy from the Theban acropolis. This papyrus, 65 feet long, 14 inches wide, consisting of 108 columns each about 20 lines, now resides in the library at the University of Leipzig. The gynecological reference in this papyrus addresses uterine prolapse, but at the end of page three, there seems to be a mention of the <a href="/wiki/Vesicovaginal_fistula" title="Vesicovaginal fistula">vesicovaginal fistula</a>, warning the physician against trying to cure it, saying, "prescription for a woman whose urine is in an irksome place: if the urine keeps coming and she distinguishes it, she will be like this forever."<sup id="cite_ref-Zacharin_64-1" class="reference"><a href="#cite_note-Zacharin-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> This seems to be the oldest reference to vesicovaginal fistula, one which articulates the storied history of the problem. </p><p><a href="/wiki/J._Marion_Sims" title="J. Marion Sims">James Marion Sims</a>, in 1852 in Alabama, developed an operation for fistula. He worked at the New York Women's Hospital.<sup id="cite_ref-Zacharin_64-2" class="reference"><a href="#cite_note-Zacharin-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=19" title="Edit section: Society and culture"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>During most of the 20th century, obstetric fistulae were largely missing from the international global health agenda. This is reflected by the fact that the condition was not included as a topic at the landmark United Nations 1994 <a href="/wiki/International_Conference_on_Population_and_Development" title="International Conference on Population and Development">International Conference on Population and Development</a> (ICPD).<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> The 194-page report from the ICPD does not include any reference to obstetric fistulae. In 2000, eight <a href="/wiki/Millennium_Development_Goals" title="Millennium Development Goals">Millennium Development Goals</a> were adopted after the United Nations Millennium Summit to be achieved by 2015. The fifth goal of improving maternal health is directly related to obstetric fistula. Since 2003, obstetric fistula has been gaining awareness amongst the general public and has received critical attention from <a href="/wiki/UNFPA" class="mw-redirect" title="UNFPA">UNFPA</a>, who has organized a global "Campaign to End Fistula".<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> <i>New York Times</i> columnist <a href="/wiki/Nicholas_Kristof" title="Nicholas Kristof">Nicholas Kristof</a>, a Pulitzer Prize–winning writer, wrote several columns in 2003, 2005, and 2006<sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> focusing on fistula and particularly treatment provided by <a href="/wiki/Catherine_Hamlin" title="Catherine Hamlin">Catherine Hamlin</a> at the Fistula Hospital in Ethiopia. In 2007, <a href="/wiki/Fistula_foundation" class="mw-redirect" title="Fistula foundation">Fistula Foundation</a>, Engel Entertainment, and a number of other organizations including PBS NOVA released the documentary film, <i><a href="/wiki/A_Walk_to_Beautiful" title="A Walk to Beautiful">A Walk to Beautiful</a></i>, which traced the journey of five women from Ethiopia who sought treatment for their obstetric fistulae at the Addis Ababa Fistula Hospital in Ethiopia. The film still airs frequently on PBS in the U.S. and is credited with increasing awareness of obstetric fistulae greatly. Increased public awareness and corresponding political pressure have helped fund the UNFPA's Campaign to End Fistula, and helped motivate the United States Agency for International Development to dramatically increase funding for the prevention and treatment of obstetric fistulae.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2020)">citation needed</span></a></i>]</sup> </p><p>Countries that signed the <a href="/wiki/United_Nations_Millennium_Declaration" title="United Nations Millennium Declaration">United Nations Millennium Declaration</a> have begun adopting policies and creating task forces to address issues of <a href="/wiki/Maternal_morbidity" class="mw-redirect" title="Maternal morbidity">maternal morbidity</a> and <a href="/wiki/Infant_mortality" title="Infant mortality">infant mortality</a>, including Tanzania, Democratic Republic of Congo, Sudan, Pakistan, Bangladesh, Burkina Faso, Chad, Mali, Uganda, Eritrea, Niger, and Kenya. Laws to increase the minimum age for marriage have also been enacted in Bangladesh, Nigeria, and Kenya. To monitor these countries and hold them accountable, the UN has developed six "process indicators", a benchmark tool with minimum acceptable levels that measures whether or not women receive the services they need.<sup id="cite_ref-zheng_15-8" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>The UNFPA set out several strategies to address fistulae, including "postponing marriage and pregnancy for young girls, increasing access to education and family planning services for women and men, provide access to adequate medical care for all pregnant women and emergency obstetric care for all who develop complications, and repairing physical damage through medical intervention and emotional damage through counselling."<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> One of the UNFPA's initiatives to reduce the cost of transportation in accessing medical care provided ambulances and motorcycles for women in Benin, Chad, Guinea, Guinea-Bissau, Kenya, Rwanda, Senegal, Tanzania, Uganda, and Zambia.<sup id="cite_ref-zheng_15-9" class="reference"><a href="#cite_note-zheng-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Campaign_to_end_fistula">Campaign to end fistula</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=20" title="Edit section: Campaign to end fistula"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Addis Ababa Fistula Hospital in Ethiopia successfully treats women with obstetric fistulae, even in less than desirable environments. As a result, the UNFPA gathered partners in London in 2001, and officially launched an international initiative to address obstetric fistulae later in 2003. Partners in this initiative include Columbia University's Averting Maternal Death and Disability Program, the International Federation of Gynecology and Obstetrics, and the World Health Organization. The official international partnership formed by the Campaign to End Fistula is named the Obstetric Fistula Working Group (OFWG) and its purpose is to coordinate and collaborate global efforts to eliminate obstetric fistulae.<sup id="cite_ref-Donnay_254–261_16-8" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>The initiative's first action was to quantitatively assess the issue in countries where the prevalence is suspected to be high, including nine countries in sub-Saharan Africa. The studies found that fistula patients are mostly illiterate, young, and poor women. Moreover, local legislators and government officials' lack of awareness exacerbate the problem.<sup id="cite_ref-needs_57-2" class="reference"><a href="#cite_note-needs-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> The OFWG improves awareness for prenatal and neonatal care and develops strategies for clinically managing obstetric fistula cases.<sup id="cite_ref-Donnay_254–261_16-9" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>To date, the Campaign to End Fistula has involved more than 30 countries in sub-Saharan Africa, South Asia, and the Middle East, and completed rapid needs assessments in many of those countries to continually assess the needs in each country. The strategies that the campaign helps each nation to develop are three-fold: prevention of new cases, treatment for patients, and support for reintegration into society after the operation. Prevention efforts include access to maternal health services and mobilizing communities and legislators to increase awareness of maternal health problems. Training health providers and ensuring affordable treatment services, as well as providing social services such as <a href="/wiki/Health_education" title="Health education">health education</a> and mental health services, help treat and reintegrate women into their communities. Other tasks undertaken by the campaign include fundraising and introducing new donors and gathering new partners of all perspectives, such as faith-based organizations, <a href="/wiki/Non-governmental_organization" title="Non-governmental organization">NGOs</a>, and private-sector companies.<sup id="cite_ref-Donnay_254–261_16-10" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Fistula_Fortnight">Fistula Fortnight</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=21" title="Edit section: Fistula Fortnight"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Fistula Fortnight was a two-week initiative that took place from February 21 to March 6, 2005, where fistula experts treated fistula patients for free at four surgical camps in the northern Nigerian states of Kano, Katsina, Kebbi, and Sokoto. The initiative was collaborated by many partners such as the federal and state governments of Nigeria, 13 Nigerian fistula surgeons, the Nigerian Red Cross, and UNFPA. During the nine-month preparation period, facilities were renovated, equipment were provided, and staff were extensively trained to treat fistula.<sup id="cite_ref-Donnay_254–261_16-11" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The goals of this initiative were to alleviate the backlog of patients waiting for surgery, provide treatment services at host sites, and to raise awareness for maternal health. </p><p>The Fistula Fortnight treated 569 women at no cost, with an 87.8% rate of successful closures. Follow-up treatments and services were provided, such as bed rest, analgesics, oral fluids, visual monitoring of urination by nurses, a catheter, catheter removal, and an examination and discharge from the hospital at a minimum of four weeks, with instruction to avoid sexual intercourse. The Fistula Fortnight also had preoperative and postoperative counseling provided by nurses and social workers and held health education workshops for fistula patients and their families.<sup id="cite_ref-fort_70-0" class="reference"><a href="#cite_note-fort-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Community_organizations">Community organizations</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=22" title="Edit section: Community organizations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People recovering from a fistula in the postoperative period need support to fully reintegrate into society.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> In particular, physical labor is limited in the first year of recovery, so women need alternative ways to earn an income.<sup id="cite_ref-restore_31-1" class="reference"><a href="#cite_note-restore-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Since poverty is an indirect cause of obstetric fistulae, some community organizations aim to provide postoperative services to enhance the women's socioeconomic situation. Delta Survie, located in Mopti, <a href="/wiki/Mali" title="Mali">Mali</a>, is a community center that provides skills training and helps women to produce hand-made jewelry to generate income and meet other women while they recover.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Another organization, IAMANEH Suisse, identifies Malian fistula patients, facilitates operations for those without the financial means, and helps them access follow-up services to prevent recurrence of fistulae in their subsequent pregnancies.<sup id="cite_ref-73" class="reference"><a href="#cite_note-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> </p><p>Other organizations also help to arrange mission trips for medical personnel to visit countries with women affected by fistulae, perform surgeries, and train local doctors to give medical assistance for fistula patients. The International Organization for Women and Development (IOWD) is one such nonprofit organization. The IOWD hosts four to five mission trips per year to provide relief to obstetric fistula patients in West Africa. IOWD mission trip members have evaluated thousands of patients at no cost and performed surgeries for over a thousand women.<sup id="cite_ref-africa_46-8" class="reference"><a href="#cite_note-africa-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Treatment_centers">Treatment centers</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=23" title="Edit section: Treatment centers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A complete fistula treatment center includes investigative services like laboratory work, radiology, and a blood bank, to ensure that the medical history of patients is clearly understood before treatment options are evaluated.<sup id="cite_ref-Polan_2015_33-2" class="reference"><a href="#cite_note-Polan_2015-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> The surgical services would include operating theaters, postoperative wards, and anesthetic services. Physiotherapy and social-reintegration services are also necessary to arm women affected by obstetric fistula with the tools necessary to re-enter a society from which they have been ostracised. The size of the facility should be tailored to the need in the area, and the most successful centers work in collaboration with other treatment centers and organizations, forming a larger network of resources.<sup id="cite_ref-Donnay_254–261_16-12" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> The cost of salaries, single-use medical equipment, up to date technology and equipment, and maintenance of infrastructure, collectively provide large economic burdens to treatment centers.<sup id="cite_ref-Polan_2015_33-3" class="reference"><a href="#cite_note-Polan_2015-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> A barrier also arises when governments and local authorities require that approval be obtained prior to the construction of centers. There is an uneven distribution of specialized health care providers due to the below optimal training and supervision of health works and the low wages of fistula surgeons.<sup id="cite_ref-Polan_2015_33-4" class="reference"><a href="#cite_note-Polan_2015-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Most fistula surgeons come from developed countries and are brought to developing countries, the nations more often affected by fistula, by a variety of organizations. An example of a well functioning treatment center is in Bangladesh where a facility has been created in association with the Dhaka Medical College Hospital with support from the United Nations Population Fund.<sup id="cite_ref-Donnay_254–261_16-13" class="reference"><a href="#cite_note-Donnay_254–261-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Here, 46 doctors and 30 nurses have been trained and have successfully doubled the number of fistula cases addressed and operated on. Another example is a fistula unit in N'djamena, Chad, which has a mobile clinic that travels to rural, hard-to-reach areas, to provide services, and works in association with Liberty Hospital.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> The World Health Organization has created a manual articulating necessary principles for surgical and pre- and post- operative care regarding obstetric fistula, providing a beneficial outline for affected nations.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> Treatment centers are crucial for the survival of obstetric fistula patients and well-equipped centers help the emotional, physical, and psychological aspects of their lives. </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=24" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Double_dye_test" title="Double dye test">Double dye test</a></li> <li><i><a href="/wiki/Shout_Gladi_Gladi" title="Shout Gladi Gladi">Shout Gladi Gladi</a></i></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Obstetric_fistula&action=edit&section=25" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-UN2017-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-UN2017_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-UN2017_1-1"><sup><i><b>b</b></i></sup></a> <a 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a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.unfpa.org/obstetric-fistula">"Obstetric fistula"</a>. <i>UNFPA - United Nations Population Fund</i>. 8 May 2017<span class="reference-accessdate">. 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Contribution to the development of a mechanism for autonomous social for women with fistula in the region of Mopti. Proceedings of the meeting making motherhood safer by addressing obstetric fistula. Johannesburg, South Africa, 23—26 October; 2005.</span> </li> <li id="cite_note-73"><span class="mw-cite-backlink"><b><a href="#cite_ref-73">^</a></b></span> <span class="reference-text">Kadiatou K. Prevention of obstetric fistula and support to women identified in Se´gou, Mali. proceedings of the meeting making motherhood safer by addressing obstetric fistula. 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Kristof, <i><a href="/wiki/New_York_Times" class="mw-redirect" title="New York Times">New York Times</a></i>, 14 July 2013</li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 1em;line-height:1.5em;text-align:center}.mw-parser-output .navbox-group{white-space:nowrap;text-align:right}.mw-parser-output .navbox,.mw-parser-output .navbox-subgroup{background-color:#fdfdfd}.mw-parser-output .navbox-list{line-height:1.5em;border-color:#fdfdfd}.mw-parser-output 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class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q679020" class="extiw" title="d:Q679020">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#2088138730">GC04.1</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/N82">N82</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=619">619</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D014624">D014624</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="x18px_Women&#039;s_health" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2" style="background: #F2D4CE;"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Women%27s_health" title="Template:Women's health"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Women%27s_health" title="Template talk:Women's health"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Women%27s_health" title="Special:EditPage/Template:Women's health"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="x18px_Women&#039;s_health" style="font-size:114%;margin:0 4em"><span class="mw-default-size" typeof="mw:File"><a href="/wiki/File:Women%27s_health_icon.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/Women%27s_health_icon.svg/12px-Women%27s_health_icon.svg.png" decoding="async" width="12" height="18" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/Women%27s_health_icon.svg/18px-Women%27s_health_icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/49/Women%27s_health_icon.svg/24px-Women%27s_health_icon.svg.png 2x" data-file-width="274" data-file-height="412" /></a></span> <a href="/wiki/Women%27s_health" title="Women's health">Women's health</a></div></th></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0; line-height:1.2em"><a href="/wiki/Sexual_and_reproductive_health" title="Sexual and reproductive health">Reproductive <br />health</a></div></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Female_reproductive_system" title="Female reproductive system">Reproductive <br />tract</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Vulva" title="Vulva">External female genitalia (vulva)</a> <ul><li><a href="/wiki/Clitoris" title="Clitoris">Clitoris</a> <ul><li><a href="/wiki/Clitoral_hood" title="Clitoral hood">Clitoral hood</a></li></ul></li> <li><a href="/wiki/Labia_minora" title="Labia minora">Labia minora</a></li> <li><a href="/wiki/Labia_majora" title="Labia majora">Labia majora</a></li></ul></li> <li><a href="/wiki/Vagina" title="Vagina">Vagina</a></li> <li><a href="/wiki/Cervix" title="Cervix">Cervix</a></li> <li><a href="/wiki/Uterus" title="Uterus">Uterus</a></li> <li><a href="/wiki/Fallopian_tube" title="Fallopian tube">Fallopian tube</a></li> <li><a href="/wiki/Ovary" title="Ovary">Ovary</a></li> <li><a href="/wiki/Reproductive_system_disease" title="Reproductive system disease">Reproductive system disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Maternal_health" title="Maternal health">Maternal <br />health</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Pregnancy" title="Pregnancy">Pregnancy</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Unintended_pregnancy" title="Unintended pregnancy">Unintended pregnancy</a></li> <li><a href="/wiki/Gravidity_and_parity" title="Gravidity and parity">Gravidity and parity</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Antenatal_care" class="mw-redirect" title="Antenatal care">Antenatal care</a></li> <li><a href="/wiki/Adolescent_pregnancy" class="mw-redirect" title="Adolescent pregnancy">Adolescent pregnancy</a></li> <li><a href="/wiki/Complications_of_pregnancy" title="Complications of pregnancy">Complications of pregnancy</a> <ul><li><a href="/wiki/Hyperemesis_gravidarum" title="Hyperemesis gravidarum">Hyperemesis gravidarum</a></li> <li><a href="/wiki/Ectopic_pregnancy" title="Ectopic pregnancy">Ectopic pregnancy</a></li> <li><a href="/wiki/Miscarriage" title="Miscarriage">Miscarriage</a></li> <li><a href="/wiki/Obstetrical_bleeding" title="Obstetrical bleeding">Obstetrical bleeding</a></li> <li><a href="/wiki/Gestational_diabetes" title="Gestational diabetes">Gestational diabetes</a></li> <li><a href="/wiki/Hypertensive_disease_of_pregnancy" title="Hypertensive disease of pregnancy">Hypertension</a> <ul><li><a href="/wiki/Preeclampsia" class="mw-redirect" title="Preeclampsia">Preeclampsia</a></li> <li><a href="/wiki/Eclampsia" title="Eclampsia">Eclampsia</a></li></ul></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Childbirth" title="Childbirth">Childbirth</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Midwifery" title="Midwifery">Midwifery</a></li> <li><a href="/wiki/Preterm_birth" title="Preterm birth">Preterm birth</a></li> <li><a href="/wiki/Multiple_births" class="mw-redirect" title="Multiple births">Multiple births</a></li> <li><a href="/wiki/Oxytocin" title="Oxytocin">Oxytocin</a></li> <li><a href="/wiki/Obstructed_labor" class="mw-redirect" title="Obstructed labor">Obstructed labor</a></li> <li><a href="/wiki/Cesarian_section" class="mw-redirect" title="Cesarian section">Cesarian section</a></li> <li><a href="/wiki/Retained_placenta" title="Retained placenta">Retained placenta</a></li> <li><a href="/wiki/Obstetrical_fistulae" class="mw-redirect" title="Obstetrical fistulae">Obstetrical fistulae</a> <ul><li><a href="/wiki/Vesicovaginal_fistula" title="Vesicovaginal fistula">Vesicovaginal fistula</a></li> <li><a href="/wiki/Rectovaginal_fistula" title="Rectovaginal fistula">Rectovaginal fistula</a></li></ul></li> <li><a href="/wiki/Episiotomy" title="Episiotomy">Episiotomy</a> <ul><li><a href="/wiki/Husband_stitch" title="Husband stitch">Husband stitch</a></li></ul></li> <li><a href="/wiki/Postpartum_care" title="Postpartum care">Postpartum care</a></li> <li><a href="/wiki/Postpartum_confinement" title="Postpartum confinement">Postpartum confinement</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Maternal_deaths" class="mw-redirect" title="Maternal deaths">Maternal deaths</a></li> <li><a href="/wiki/Perinatal_mortality" title="Perinatal mortality">Perinatal mortality</a></li> <li><a href="/wiki/Stillbirths" class="mw-redirect" title="Stillbirths">Stillbirths</a></li> <li><a href="/wiki/Abortion" title="Abortion">Abortion</a></li> <li><a href="/wiki/Mother-to-child_transmission" class="mw-redirect" title="Mother-to-child transmission">Mother-to-child transmission</a></li> <li><a href="/wiki/Human_sterilization" class="mw-redirect" title="Human sterilization">Sterilization</a> <ul><li><a href="/wiki/Compulsory_sterilization" title="Compulsory sterilization">Compulsory sterilization</a></li></ul></li> <li><a href="/wiki/Breastfeeding_and_mental_health" title="Breastfeeding and mental health">Breastfeeding and mental health</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Reproductive_life_plan" class="mw-redirect" title="Reproductive life plan">Reproductive <br />life plan</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Infertility" title="Infertility">Infertility</a> <ul><li><a href="/wiki/Childlessness" title="Childlessness">Childlessness</a></li> <li><a href="/wiki/Assisted_reproductive_technology" title="Assisted reproductive technology">Assisted reproductive technology</a></li> <li><a href="/wiki/In_vitro_fertilization" class="mw-redirect" title="In vitro fertilization">In vitro fertilization</a></li></ul></li> <li><a href="/wiki/Parenting" title="Parenting">Parenting</a> <ul><li><a href="/wiki/Adoption" title="Adoption">Adoption</a></li> <li><a href="/wiki/Fostering" class="mw-redirect" title="Fostering">Fostering</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Contraception" class="mw-redirect" title="Contraception">Contraception</a> and<br /><a href="/wiki/Family_planning" title="Family planning">family planning</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intrauterine_device" title="Intrauterine device">Intrauterine devices</a></li> <li><a href="/wiki/Oral_contraceptive_pill" title="Oral contraceptive pill">Oral contraceptives</a></li> <li><a href="/wiki/Condom" title="Condom">Condoms</a></li> <li><a href="/wiki/Male_contraceptive" title="Male contraceptive">Male contraceptive</a></li> <li><a href="/wiki/Contraceptive_prevalence" class="mw-redirect" title="Contraceptive prevalence">Contraceptive prevalence</a></li> <li><a href="/wiki/Contraceptive_security" title="Contraceptive security">Contraceptive security</a></li> <li><a href="/wiki/Planned_parenthood" class="mw-redirect" title="Planned parenthood">Planned parenthood</a></li> <li><a href="/wiki/Fertility_awareness" title="Fertility awareness">Fertility awareness</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Menstruation" title="Menstruation">Menstruation</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Culture_and_menstruation" title="Culture and menstruation">Culture and menstruation</a></li> <li><a href="/wiki/Feminine_hygiene" title="Feminine hygiene">Feminine hygiene</a></li> <li><a href="/wiki/Menarche" title="Menarche">Menarche</a></li> <li><a href="/wiki/Menstrual_cycle" title="Menstrual cycle">Menstrual cycle</a></li> <li><a href="/wiki/Menstrual_aids" class="mw-redirect" title="Menstrual aids">Menstrual aids</a> <ul><li><a href="/wiki/Cloth_menstrual_pad" title="Cloth menstrual pad">Cloth menstrual pad</a></li> <li><a href="/wiki/Menstrual_cup" title="Menstrual cup">Menstrual cup</a></li> <li><a href="/wiki/Tampon" title="Tampon">Tampon</a></li> <li><a href="/wiki/Sanitary_napkin" class="mw-redirect" title="Sanitary napkin">Sanitary pad</a></li></ul></li> <li><a href="/wiki/Dysmenorrhea" title="Dysmenorrhea">Dysmenorrhea</a></li> <li><a href="/wiki/Menorrhagia" class="mw-redirect" title="Menorrhagia">Menorrhagia</a></li> <li><a href="/wiki/Amenorrhoea" class="mw-redirect" title="Amenorrhoea">Amenorrhoea</a></li> <li><a href="/wiki/Menopause" title="Menopause">Menopause</a> <ul><li><a href="/wiki/Hormone_replacement_therapy" title="Hormone replacement therapy">Hormone replacement therapy</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%">Sexual <br />health</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Sexually_transmittedinfections" scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Sexually_transmitted_infections" class="mw-redirect" title="Sexually transmitted infections">Sexually transmitted<br />infections</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Safe_sex" title="Safe sex">Safe sex</a></li> <li><a href="/wiki/HIV" title="HIV">HIV</a></li> <li><a href="/wiki/Human_papilloma_virus" class="mw-redirect" title="Human papilloma virus">Human papilloma virus</a> <ul><li><a href="/wiki/HPV_vaccine" title="HPV vaccine">HPV vaccine</a></li></ul></li> <li><a href="/wiki/Pelvic_inflammatory_disease" title="Pelvic inflammatory disease">Pelvic inflammatory disease</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Female_genital_mutilation" title="Female genital mutilation">Female genital mutilation</a> <ul><li><a href="/wiki/Clitoridectomy" title="Clitoridectomy">Clitoridectomy</a></li> <li><a href="/wiki/Infibulation" title="Infibulation">Infibulation</a></li></ul></li> <li><a href="/wiki/Breast_binding" title="Breast binding">Breast binding</a></li> <li><a href="/wiki/Breast_health" class="mw-redirect" title="Breast health">Breast health</a></li> <li><a href="/wiki/Breast_ironing" title="Breast ironing">Breast ironing</a></li> <li><a href="/wiki/Child_marriage" title="Child marriage">Child marriage</a></li> <li><a href="/wiki/Dyspareunia" title="Dyspareunia">Dyspareunia</a></li> <li><a href="/wiki/Forced_marriage" title="Forced marriage">Forced marriage</a></li> <li><a href="/wiki/Gynaecological_disorders" class="mw-redirect" title="Gynaecological disorders">Gynaecological disorders</a> <ul><li><a href="/wiki/Vaginitis" title="Vaginitis">Vaginitis</a></li></ul></li> <li><a href="/wiki/Leblouh" title="Leblouh">Leblouh</a></li> <li><a href="/wiki/Polygamy" title="Polygamy">Polygamy</a></li> <li><a href="/wiki/Sexual_intercourse" title="Sexual intercourse">Sexual intercourse</a></li> <li><a href="/wiki/Orgasm" title="Orgasm">Orgasm</a></li> <li><a href="/wiki/Puberty" title="Puberty">Puberty</a></li> <li><a href="/wiki/Sex_differences" class="mw-redirect" title="Sex differences">Sex differences</a></li> <li><a href="/wiki/Sex_education" title="Sex education">Sex education</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%">Non-reproductive<br /> health</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Violence_against_women" scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Violence_against_women" title="Violence against women">Violence <br />against women</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abuse_during_childbirth" title="Abuse during childbirth">Abuse during childbirth</a></li> <li><a href="/wiki/Domestic_violence" title="Domestic violence">Domestic violence</a> <ul><li><a href="/wiki/Domestic_violence_and_pregnancy" title="Domestic violence and pregnancy">Pregnancy</a></li></ul></li> <li><a href="/wiki/Intimate_partner_violence" title="Intimate partner violence">Intimate partner violence</a></li> <li><a href="/wiki/Misogyny" title="Misogyny">Misogyny</a></li> <li><a href="/wiki/Sexual_harassment" title="Sexual harassment">Sexual harassment</a></li> <li><a href="/wiki/Sexual_assault" title="Sexual assault">Sexual assault</a> <ul><li><a href="/wiki/Rape" title="Rape">Rape</a></li></ul></li> <li><a href="/wiki/Femicide" title="Femicide">Femicide</a></li> <li><a href="/wiki/Gender_discrimination" class="mw-redirect" title="Gender discrimination">Gender discrimination</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Non-communicable_diseases" class="mw-redirect" title="Non-communicable diseases">Non-communicable <br />diseases</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Cancer" scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/Cancer" title="Cancer">Cancer</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Lung_cancer" title="Lung cancer">Lung cancer</a></li> <li><a href="/wiki/Breast_cancer" title="Breast cancer">Breast cancer</a></li> <li><a href="/wiki/Uterine_cancer" title="Uterine cancer">Uterine cancer</a> <ul><li><a href="/wiki/Endometrial_cancer" title="Endometrial cancer">Endometrial cancer</a></li> <li><a href="/wiki/Cervical_cancer" title="Cervical cancer">Cervical cancer</a> <ul><li><a href="/wiki/Papanicolaou_test" class="mw-redirect" title="Papanicolaou test">Papanicolaou test</a></li></ul></li></ul></li> <li><a href="/wiki/Ovarian_cancer" title="Ovarian cancer">Ovarian cancer</a></li></ul> </div></td></tr></tbody></table><div> <ul><li><a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">Cardiovascular disease</a></li> <li><a href="/wiki/Dementia" title="Dementia">Dementia</a> <ul><li><a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's disease</a></li></ul></li> <li><a href="/wiki/Bone_health" title="Bone health">Bone health</a> <ul><li><a href="/wiki/Osteoporosis" title="Osteoporosis">Osteoporosis</a> <ul><li><a href="/wiki/Hip_fracture" title="Hip fracture">Hip fracture</a></li></ul></li></ul></li> <li><a href="/wiki/Anaemia" class="mw-redirect" title="Anaemia">Anaemia</a></li></ul></div></td></tr></tbody></table><div> <ul><li><a href="/wiki/Mental_health" title="Mental health">Mental health</a> <ul><li><a href="/wiki/Anxiety" title="Anxiety">Anxiety</a></li> <li><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depression</a> <ul><li><a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">Major depressive disorder</a></li></ul></li></ul></li> <li><a href="/wiki/Urinary_tract" class="mw-redirect" title="Urinary tract">Urinary tract</a> <ul><li><a href="/wiki/Urethra" title="Urethra">Urethra</a></li> <li><a href="/wiki/Urinary_tract_infection" title="Urinary tract infection">Urinary tract infection</a></li> <li><a href="/wiki/Urinary_incontinence" title="Urinary incontinence">Urinary incontinence</a></li></ul></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%">Sociocultural <br />factors</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Poverty" title="Poverty">Poverty</a></li> <li><a href="/wiki/Disadvantaged" title="Disadvantaged">Disadvantaged</a></li> <li><a href="/wiki/Gender_equality" title="Gender equality">Gender equality</a></li> <li><a href="/wiki/Healthcare_inequality" class="mw-redirect" title="Healthcare inequality">Healthcare inequality</a></li> <li><a href="/wiki/Gender_disparities_in_health" title="Gender disparities in health">Gender disparities in health</a></li> <li><a href="/wiki/Social_determinants_of_health" title="Social determinants of health">Social determinants of health</a></li> <li><a href="/wiki/Reproductive_justice" title="Reproductive justice">Reproductive justice</a></li> <li><a href="/wiki/Women%27s_empowerment" title="Women's empowerment">Women's empowerment</a></li> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%">Politics, research<br />and advocacy</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/United_Nations" title="United Nations">United Nations</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/The_Convention_on_the_Elimination_of_All_Forms_of_Discrimination_against_Women" class="mw-redirect" title="The Convention on the Elimination of All Forms of Discrimination against Women">The Convention on the Elimination of All Forms of Discrimination against Women</a></li> <li><a href="/wiki/Declaration_on_the_elimination_of_violence_against_women" class="mw-redirect" title="Declaration on the elimination of violence against women">Declaration on the elimination of violence against women</a></li> <li><a href="/wiki/International_Day_of_the_Girl_Child" title="International Day of the Girl Child">International Day of the Girl Child</a></li> <li><a href="/wiki/Commission_on_the_Status_of_Women" class="mw-redirect" title="Commission on the Status of Women">Commission on the Status of Women</a></li> <li><a href="/wiki/UN_Women" title="UN Women">UN Women</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%"><a href="/wiki/United_States" title="United States">United States</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Office_of_Research_on_Women%27s_Health" class="mw-redirect" title="Office of Research on Women's Health">Office of Research on Women's Health</a></li> <li><a href="/wiki/Women%27s_Health_Initiative" title="Women's Health Initiative">Women's Health Initiative</a></li></ul> </div></td></tr></tbody></table><div> <ul><li><a href="/wiki/International_Center_for_Research_on_Women" title="International Center for Research on Women">International Center for Research on Women</a></li> <li><a href="/wiki/Nurses%27_Health_Study" title="Nurses' Health Study">Nurses' Health Study</a></li> <li><a href="/wiki/Black_Women%27s_Health_Study" title="Black Women's Health Study">Black Women's Health Study</a></li> <li><a href="/wiki/Cartwright_Inquiry" title="Cartwright Inquiry">Cartwright Inquiry</a></li> <li><a href="/wiki/Society_for_Women%27s_Health_Research" title="Society for Women's Health Research">Society for Women's Health Research</a></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="background: #F2D4CE;;width:1%">Women's health<br />by country</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Women%27s_health_in_China" title="Women's health in China">China</a></li> <li><a href="/wiki/Women%27s_health_in_Ethiopia" title="Women's health in Ethiopia">Ethiopia</a></li> <li><a href="/wiki/Women%27s_health_in_India" title="Women's health in India">India</a> <ul><li><a href="/wiki/Family_planning_in_India" title="Family planning in India">Family planning</a></li></ul></li> <li><a href="/wiki/Women%27s_reproductive_health_in_Russia" title="Women's reproductive health in Russia">Russia</a></li> <li><a href="/wiki/Birth_control_in_the_United_States" title="Birth control in the United States">Birth control in the United States</a></li> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2" style="background: #F2D4CE;"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span><b><a href="/wiki/Category:Women%27s_health" title="Category:Women's health">Category</a></b></li> <li><span class="noviewer" typeof="mw:File"><span title="Commons page"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/12px-Commons-logo.svg.png" decoding="async" width="12" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/18px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/24px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /></span></span><b><a href="https://commons.wikimedia.org/wiki/Category:Women%27s_health" class="extiw" title="commons:Category:Women's health">Commons</a></b></li> <li><span class="noviewer" typeof="mw:File"><span title="WikiProject"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/16px-People_icon.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/24px-People_icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/32px-People_icon.svg.png 2x" data-file-width="100" data-file-height="100" /></span></span><b><a href="/wiki/Wikipedia:WikiProject_Women%27s_Health" title="Wikipedia:WikiProject Women's Health">WikiProject</a></b></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Female_diseases_of_the_pelvis_and_genitals" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Female_diseases_of_the_pelvis_and_genitals" title="Template:Female diseases of the pelvis and genitals"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Female_diseases_of_the_pelvis_and_genitals" title="Template talk:Female diseases of the pelvis and genitals"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Female_diseases_of_the_pelvis_and_genitals" title="Special:EditPage/Template:Female diseases of the pelvis and genitals"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Female_diseases_of_the_pelvis_and_genitals" style="font-size:114%;margin:0 4em"><a href="/wiki/Female_genital_disease" title="Female genital disease">Female diseases</a> of the <a href="/wiki/Human_pelvis" class="mw-redirect" title="Human pelvis">pelvis</a> and <a href="/wiki/Sex_organ" title="Sex organ">genitals</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Internal</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Adnexa" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adnexa_of_uterus" class="mw-redirect" title="Adnexa of uterus">Adnexa</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ovarian_disease" title="Ovarian disease">Ovary</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Endometriosis_of_ovary" class="mw-redirect" title="Endometriosis of ovary">Endometriosis of ovary</a></li> <li><a href="/wiki/Female_infertility" title="Female infertility">Female infertility</a> <ul><li><a href="/wiki/Ovulatory_disorder" class="mw-redirect" title="Ovulatory disorder">Ovulatory disorder</a> <ul><li><a href="/wiki/Anovulation" title="Anovulation">Anovulation</a></li> <li><a href="/wiki/Oligoovulation" class="mw-redirect" title="Oligoovulation">Oligoovulation</a></li></ul></li> <li><a href="/wiki/Poor_ovarian_reserve" title="Poor ovarian reserve">Poor ovarian reserve</a></li></ul></li> <li><a href="/wiki/Mittelschmerz" title="Mittelschmerz">Mittelschmerz</a></li> <li><a href="/wiki/Oophoritis" title="Oophoritis">Oophoritis</a></li> <li><a href="/wiki/Ovarian_apoplexy" title="Ovarian apoplexy">Ovarian apoplexy</a></li> <li><a href="/wiki/Ovarian_cyst" title="Ovarian cyst">Ovarian cyst</a> <ul><li><a href="/wiki/Corpus_luteum_cyst" title="Corpus luteum cyst">Corpus luteum cyst</a></li> <li><a href="/wiki/Follicular_cyst_of_ovary" title="Follicular cyst of ovary">Follicular cyst of ovary</a></li> <li><a href="/wiki/Theca_lutein_cyst" title="Theca lutein cyst">Theca lutein cyst</a></li></ul></li> <li><a href="/wiki/Ovarian_hyperstimulation_syndrome" title="Ovarian hyperstimulation syndrome">Ovarian hyperstimulation syndrome</a></li> <li><a href="/wiki/Ovarian_cancer" title="Ovarian cancer">Ovarian cancer</a></li> <li><a href="/wiki/Ovarian_torsion" title="Ovarian torsion">Ovarian torsion</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Fallopian_tube" title="Fallopian tube">Fallopian tube</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Female_infertility" title="Female infertility">Female infertility</a> <ul><li><a href="/wiki/Fallopian_tube_obstruction" title="Fallopian tube obstruction">Fallopian tube obstruction</a></li></ul></li> <li><a href="/wiki/Fallopian_tube_cancer" title="Fallopian tube cancer">Fallopian tube cancer</a></li> <li><a href="/wiki/Hematosalpinx" title="Hematosalpinx">Hematosalpinx</a></li> <li><a href="/wiki/Hydrosalpinx" title="Hydrosalpinx">Hydrosalpinx</a></li> <li><a href="/wiki/Salpingitis" title="Salpingitis">Salpingitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Uterus" title="Uterus">Uterus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endometrium" title="Endometrium">Endometrium</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Asherman%27s_syndrome" title="Asherman's syndrome">Asherman's syndrome</a></li> <li><a href="/wiki/Dysfunctional_uterine_bleeding" class="mw-redirect" title="Dysfunctional uterine bleeding">Dysfunctional uterine bleeding</a></li> <li><a href="/wiki/Endometrial_hyperplasia" title="Endometrial hyperplasia">Endometrial hyperplasia</a></li> <li><a href="/wiki/Endometrial_polyp" title="Endometrial polyp">Endometrial polyp</a></li> <li><a href="/wiki/Endometriosis" title="Endometriosis">Endometriosis</a></li> <li><a href="/wiki/Endometritis" title="Endometritis">Endometritis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i><a href="/wiki/Menstrual_disorder" title="Menstrual disorder">Menstruation</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Menstrual_disorder#Disorders_of_flow" title="Menstrual disorder">Flow</a> <ul><li><a href="/wiki/Amenorrhea" title="Amenorrhea">Amenorrhea</a></li> <li><a href="/wiki/Hypomenorrhea" title="Hypomenorrhea">Hypomenorrhea</a></li> <li><a href="/wiki/Oligoamenorrhea" title="Oligoamenorrhea">Oligoamenorrhea</a></li> <li><a href="/wiki/Oligomenorrhea" title="Oligomenorrhea">Oligomenorrhea</a></li> <li><a href="/wiki/Polymenorrhea" title="Polymenorrhea">Polymenorrhea (epimenorrhea)</a></li></ul></li> <li><a href="/wiki/Menstrual_disorder#Dysmenorrhea" title="Menstrual disorder">Pain</a> <ul><li><a href="/wiki/Dysmenorrhea" title="Dysmenorrhea">Dysmenorrhea</a></li> <li><a href="/wiki/Premenstrual_syndrome" title="Premenstrual syndrome">Premenstrual syndrome</a></li></ul></li> <li><a href="/wiki/Menstrual_disorder#Disorders_of_cycle_length" title="Menstrual disorder">Timing</a> <ul><li><a href="/wiki/Menorrhagia" class="mw-redirect" title="Menorrhagia">Menorrhagia (hypermenorrhea)</a></li> <li><a href="/wiki/Metrorrhagia" class="mw-redirect" title="Metrorrhagia">Metrorrhagia</a></li></ul></li> <li>Mixed <ul><li><a href="/wiki/Menometrorrhagia" title="Menometrorrhagia">Menometrorrhagia</a></li> <li><a href="/wiki/Polymenorrhagia" title="Polymenorrhagia">Polymenorrhagia</a></li></ul></li> <li>Other <ul><li><a href="/wiki/Metropathia_haemorrhagica" title="Metropathia haemorrhagica">Metropathia haemorrhagica</a></li></ul></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Female_infertility" title="Female infertility">Female infertility</a> <ul><li><a href="/wiki/Recurrent_miscarriage" title="Recurrent miscarriage">Recurrent miscarriage</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Myometrium" title="Myometrium">Myometrium</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adenomyosis" title="Adenomyosis">Adenomyosis</a></li> <li><a href="/wiki/Uterine_fibroid" title="Uterine fibroid">Uterine fibroid</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Parametrium" title="Parametrium">Parametrium</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Parametritis" title="Parametritis">Parametritis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cervix" title="Cervix">Cervix</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cervical_cancer" title="Cervical cancer">Cervical cancer</a></li> <li><a href="/wiki/Cervical_intraepithelial_neoplasia" title="Cervical intraepithelial neoplasia">Cervical dysplasia</a></li> <li><a href="/wiki/Cervical_incompetence" class="mw-redirect" title="Cervical incompetence">Cervical incompetence</a></li> <li><a href="/wiki/Cervical_polyp" title="Cervical polyp">Cervical polyp</a></li> <li><a href="/wiki/Cervicitis" title="Cervicitis">Cervicitis</a></li> <li><a href="/wiki/Female_infertility" title="Female infertility">Female infertility</a> <ul><li><a href="/wiki/Stenosis_of_uterine_cervix" title="Stenosis of uterine cervix">Cervical stenosis</a></li></ul></li> <li><a href="/wiki/Nabothian_cyst" title="Nabothian cyst">Nabothian cyst</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hematometra" title="Hematometra">Hematometra</a> / <a href="/wiki/Pyometra" title="Pyometra">Pyometra</a></li> <li><a href="/wiki/Retroverted_uterus" title="Retroverted uterus">Retroverted uterus</a></li> <li><a href="/wiki/Vesicouterine_fistula" title="Vesicouterine fistula">Vesicouterine fistula</a></li> <li><a href="/wiki/Uterine_prolapse" title="Uterine prolapse">Uterine prolapse</a></li> <li><a href="/wiki/Uterine_cancer" title="Uterine cancer">Uterine cancer</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vaginal_disease" title="Vaginal disease">Vagina</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hematocolpos" title="Hematocolpos">Hematocolpos</a> / <a href="/wiki/Hydrocolpos" title="Hydrocolpos">Hydrocolpos</a></li> <li><a href="/wiki/Leukorrhea" title="Leukorrhea">Leukorrhea</a> / <a href="/wiki/Vaginal_discharge" title="Vaginal discharge">Vaginal discharge</a></li> <li><a href="/wiki/Vaginitis" title="Vaginitis">Vaginitis</a> <ul><li><a href="/wiki/Atrophic_vaginitis" title="Atrophic vaginitis">Atrophic vaginitis</a></li> <li><a href="/wiki/Bacterial_vaginosis" title="Bacterial vaginosis">Bacterial vaginosis</a></li> <li><a href="/wiki/Candidal_vulvovaginitis" class="mw-redirect" title="Candidal vulvovaginitis">Candidal vulvovaginitis</a></li></ul></li> <li><a href="/wiki/Hydrocolpos" title="Hydrocolpos">Hydrocolpos</a></li> <li><a href="/wiki/Vaginal_atresia" title="Vaginal atresia">Vaginal atresia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i><a href="/wiki/Sexual_dysfunction" title="Sexual dysfunction">Sexual dysfunction</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dyspareunia" title="Dyspareunia">Dyspareunia</a></li> <li><a href="/wiki/Hypoactive_sexual_desire_disorder" title="Hypoactive sexual desire disorder">Hypoactive sexual desire disorder</a></li> <li><a href="/wiki/Sexual_arousal_disorder" title="Sexual arousal disorder">Sexual arousal disorder</a></li> <li><a href="/wiki/Vaginal_cancer" title="Vaginal cancer">Vaginal cancer</a></li> <li><a href="/wiki/Vaginismus" title="Vaginismus">Vaginismus</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Urogenital_fistula" title="Urogenital fistula">Urogenital fistulas</a> <ul><li><a href="/wiki/Ureterovaginal_fistula" title="Ureterovaginal fistula">Ureterovaginal</a></li> <li><a href="/wiki/Vesicovaginal_fistula" title="Vesicovaginal fistula">Vesicovaginal</a></li> <li><a class="mw-selflink selflink">Obstetric fistula</a></li></ul></li> <li><a href="/wiki/Rectovaginal_fistula" title="Rectovaginal fistula">Rectovaginal fistula</a></li> <li><a href="/wiki/Female_genital_prolapse" class="mw-redirect" title="Female genital prolapse">Prolapse</a> <ul><li><a href="/wiki/Cystocele" title="Cystocele">Cystocele</a></li> <li><a href="/wiki/Cul-de-sac_hernia" title="Cul-de-sac hernia">Cul-de-sac hernia</a></li> <li><a href="/wiki/Enterocele" title="Enterocele">Enterocele</a></li> <li><a href="/wiki/Rectocele" title="Rectocele">Rectocele</a></li> <li><a href="/wiki/Sigmoidocele" title="Sigmoidocele">Sigmoidocele</a></li> <li><a href="/wiki/Urethrocele" title="Urethrocele">Urethrocele</a></li></ul></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Vaginal_bleeding" title="Vaginal bleeding">Vaginal bleeding</a> <ul><li><a href="/wiki/Postcoital_bleeding" title="Postcoital bleeding">Postcoital bleeding</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pelvic_congestion_syndrome" title="Pelvic congestion syndrome">Pelvic congestion syndrome</a></li> <li><a href="/wiki/Pelvic_inflammatory_disease" title="Pelvic inflammatory disease">Pelvic inflammatory disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">External</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Vulvar_disease" title="Vulvar disease">Vulva</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Vulvar_cancer" title="Vulvar cancer">Vulvar cancer</a></li> <li><a href="/wiki/Bartholin%27s_cyst" title="Bartholin's cyst">Bartholin's cyst</a></li> <li><a href="/wiki/Kraurosis_vulvae" title="Kraurosis vulvae">Kraurosis vulvae</a></li> <li><a href="/wiki/Vestibular_papillomatosis" title="Vestibular papillomatosis">Vestibular papillomatosis</a></li> <li><a href="/wiki/Vulvitis" title="Vulvitis">Vulvitis</a></li> <li><a href="/wiki/Vulvodynia" title="Vulvodynia">Vulvodynia</a></li> <li><a href="/wiki/Persistent_genital_arousal_disorder" title="Persistent genital arousal disorder">Persistent genital arousal disorder</a></li></ul> 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