Free Book Excerpt from "The V Book: A Doctor's Guide to Complete Vulvovaginal Health"

A fistula

A fistula is an opening between two places that isn't supposed to be there—like a chink in a wall. In gynecology, the best known of these chinks are tiny holes between the vagina and the rectum (called rectovaginal fistulas) or between the vagina and the bladder (vesicovaginal fistulas). A rectovaginal fistula often happens after an injury related to a complicated labor. As a result, gas and stool in tiny amounts can come out of the vagina. As you might imagine, this fistula is quickly recognized and repaired.

Vesicovaginal fistulas result chiefly from obstetrical injury, complications of hysterectomy, radiation treatment for cervical cancer, or after surgery for incontinence. With a vesicovaginal fistula, urine may leak out of the vagina, but it may be small in amount and, mixed with other vaginal secretions, may seem like discharge. So this kind of fistula can be harder to recognize…

While a rare cause of vaginal discharge, it's something for your clinician to explore if you have significant discharge that does not fit into the usual categories. Have you had any pelvic surgery or bladder work? Did you have a complicated delivery with forceps, or a bad infection after a cesarean delivery? Have you had gyn cancer surgery and radiation treatment? Once recognized, the fistula can be surgically closed off…