CHAPTER XXXVI.
GENITAL FISTULÆ.
Fistulous openings may exist between the different portions of the genital tract and the neighboring structures. Such fistulæ are the result of childbirth, operative or other form of traumatism, congenital defect, cancer, syphilis, or suppuration. The accompanying diagram ([Fig. 180]) shows the chief varieties of fistula that occur.
Fig. 180.--Diagram illustrating the chief varieties of genital fistula: v. u., vesico-uterine fistula; v. v., vesico-vaginal fistula; u. v., urethro-vaginal fistula; r. v., recto-vaginal fistula.
Vesico-vaginal Fistula.—The most frequent form of fistulous opening occurs in the septum between the bladder and the vagina. The condition is usually caused by sloughing, the result of prolonged pressure from the fetal head at labor.
In some cases such an opening is made for therapeutic reasons by the physician, for the cure of cystitis.
Intelligent midwifery and the prompt and proper use of the obstetrical forceps have greatly diminished the frequency of vesico-vaginal fistula. It was formerly a very common disease. At the present day it is but rarely seen, at least in those parts of the country where women have competent attendance at labor.
The vesico-vaginal opening may be situated at any portion of the septum. It varies very much in size and shape. It may be a small hole barely admitting a fine probe-point, a median slit, or a large irregular opening involving the whole base of the bladder.