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 urethra and vagina.

Fistulas may be caused by abscesses, injuries, trauma, inflammation, radiotherapy, malignancy, previous surgery, or from congenital malformation.

Signs and symptoms may include: inability to urinate; blood in the urine; pain in the lower abdomen; urinary strictures; vaginal drainage; and urinary leakage, frequency, stinging or burning.

Physical and pelvic examinations, and probing of the passage may be done to determine the direction and extent of breakdown. Urinalysis and cultures, laboratory studies, x-ray or cystoscopy may also be indicated.

Treatment may consist of surgery, e.g., fistulectomy; medication for infection; drainage of abscesses; sitz baths; debridement of necrotic tissue; gauze packing; insertion of a catheter; or the placement of drains.

There may be residual scarring and narrowing of the urethra. There may be a need for protective pads or undergarments. There may be social isolation.

• 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).