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Genital Fistulae A Continuing Tragedy

Fistulous communication between the genital tract and adjacent organs is a social calamity. It is among the most distressing, demoralizing and degrading conditions from which women suffer. The etiology of genital fistulae is varied but the overwhelming proportion are complications of neglected obstructed labour. This is of paramount importance in the developing countries. There is not only obstruction of labour but also obstruction at every level of management of obstructed labour, viz, obstruction of diagnosis, obstruction of decision making regarding what to do with the patient, obstruction of fund raising for medical care, obstruction of transport to get patients to a proper hospital and obstruction at secondary or tertiary healthcare level in organization of a caesarean section at the appropriate time. Genital fistula is the only major public health problem where prevention and treatment is surgery which is highly specialized.