Question

The most common cause of vesico-vaginal fistula in India is:

• A. Gynae surgery
• B. Irradiation
• C. Obstructed labour
• D. Trauma

Hint:

In India, delayed access to obstetric care makes obstructed labour, not surgery, the leading cause of VVF.

Answer 1

The Correct Option is C

Vesico-vaginal fistula causes a woman to leak urine constantly through the vagina, because the wall between bladder and vagina has broken down. The main cause depends heavily on where in the world the woman lives.

1. Gynae surgery: a bladder injury during hysterectomy is the top cause in high income countries with wide access to surgery, but surgical rates and settings differ in India, so this is not the leading cause here.
2. Irradiation: radiotherapy for cervical cancer can damage the bladder wall over months, but this accounts for only a small share of cases overall.
3. Obstructed labour: in India, many women in rural areas cannot reach a hospital quickly when labour stalls. The fetal head presses on the bladder and vaginal tissue against the pelvic bone for hours or days, cutting off blood supply. The tissue later sloughs and a fistula opens up. This obstetric route is by far the most frequent cause in India.
4. Trauma: direct injury is possible but rare compared with the obstetric route.

Let's summarize:

• Developed countries: gynae surgery (hysterectomy) is the top cause of VVF.
• India and other low resource settings: prolonged obstructed labour is the top cause, due to delayed access to emergency obstetric care.

So the most common cause of VVF in India is obstructed labour.