Vesicovaginal fistula: an unexpected consequence of changing sexual practices?

Vesicovaginal fistula (VVF) is commonly associated with obstetric trauma, but in developed nations it is typically iatrogenic. To date, there have been no published reports of VVF resulting from consensual sexual activity with sex toys. A 19-year-old gravida 0 presented with leakage of clear urine from the vagina following repetitive use of a sex toy with her female partner. The fistula was repaired in the operating room using a vaginal approach and a layered closure. This is the first case report of a VVF caused by consensual sex toy use between same-sex partners. As sex toy use increases, counselling providers will need to be aware of possible adverse sequelae.