... Documentation of fistula as a direct consequence of violent sexual assault Increasingly, fistula is being cited as one of the potential consequences of violent sexual assault, particularly in conflict ... USAID and managed by EngenderHealth, in partnership with the Adventist Development and Relief Agency International (ADRA), CARE, IntraHealth International, Inc., the Meridian Group International, ... it states: “If indicated, do a recto-vaginal examination and inspect the rectal area for trauma, recto-vaginal tears or fistulas, bleeding and discharge” (WHO & UNHCR, 2005). • A statement...