Sexual violence-related fistulas in the Democratic Republic of Congo.
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.
Onsrud
Mathias
M
Department of Obstetrics and Gynecology, Panzi Hospital, Bukavu, Democratic Republic of Congo. mathiaso@online.no
Sjøveian
Solbjørg
S
Luhiriri
Roger
R
Mukwege
Dennis
D
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*