title: Sexual violence-related fistulas in the Democratic Republic of Congo.
abstract: OBJECTIVE
  To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo.
  
  
  METHODS
  A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007.
  
  
  RESULTS
  Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor.
  
  
  CONCLUSIONS
  Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.
authors.affiliation: Department of Obstetrics and Gynecology, Panzi Hospital, Bukavu, Democratic Republic of Congo. mathiaso@online.no
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.forename: Solbjørg
authors.initials: S
authors.lastname: Sjøveian
authors.forename: Roger
authors.initials: R
authors.lastname: Luhiriri
authors.forename: Dennis
authors.initials: D
authors.lastname: Mukwege
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008499:Medical Records; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014621:Vagina / Q000293:injuries; D014624:Vaginal Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*