It is often caused by childbirth (in which case it is known as an obstetric fistula), where in a prolonged labor baby head presses against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotize (die), leaving a hole where bladder and vagina communicate which leads to urinary leakage.

Vaginal fistulas can also result from violent rape or gynecological or rectal surgery where ureter or bladder is injured and may lead to communication between vagina with ureter or bladder

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