A fistula is an abnormal, tube-like passage from a normal cavity or tube to a free surface or to another cavity. In this case, it refers to an opening between the rectum and vagina.

Fistulas may be caused by abscesses, injuries, inflammation such as Crohn's disease, radiotherapy, malignancy, previous surgery, or from congenital malformation.

Manifestations may include: recurrent abscesses, intermittent or constant discharge, infection, and one or more secondary openings visible on examination.

Physical and pelvic examinations, and probing of the passage may be done to determine the direction and extent of breakdown. Cultures, laboratory studies, or sigmoidoscopy may also be indicated.

Treatment depends on the size and location of the rectovaginal fistula. Treatment may consist of surgery, e.g., fistulectomy, medication for infection, drainage of abscesses, sitz baths, debridement of necrotic tissue, gauze packing, or the placement of drains. Placement of a permanent ostomy may be required in some cases.

Abscesses may recur. There may be social isolation. There may be a need for protective pads or undergarments.

• None.

• Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
• When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation.
• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).