Ok, I’m NOT going to be a ton of help here on some of your questions but I have had 4 rectovaginal fostulas in the last 6 years and we just discovered another that started as pinpoint size just a couple weeks ago and has already grown large enough I’m likely going back into an ileostomy for the jpouch to heal for a few months after repair! So, YES, they can grow and they can get worse with sex but that totally depends on where the fistula is.... your dr should be able to tell you if you need to be concerned about sex and the location of your fistula. I’ve personally had no luck letting them heal on their own and they’ve always ended up tearing all the way through eventually when left alone and surgical repair has been our preference at this point because I’ve got so much scar tissue from the other repairs. The way I look at it is, I’d rather go back to an ileostomy NOW and for a short time than be stuck in it permanently because the fistula became irreparable and caused more damage than would allow to do a takedown and to go back into my jpouch. I talked to a lot of people when I started having to make the hard choices and looking into what worked for others and for ME personally (and I repeat personally because everyone has an opinion and we are all entitled to them) I have decided to stay on the surgical repair route each time anymore.... also, might I add that one of the biggest issues that I have discovered and that many others told me too was the long term damage that can be done tot the kidneys due to the fact they are generally always being infected (uti/kidney infections) when you have a fistula that is leaking and left to leak. I’ve had kidney stones a few times and they are literally worse than the natural childbirth of my twin daughters!! I’ve had to have a stent placed in the kidneys for 6 months twice now. I’m literally just getting out of the hospital from another 2.5 week stay from what started as a uti/kidney infection from the fistula leaking.... which I ended up catching influenza B and a blood infection all because my immune system sucks like all of us In this position and it’s all because of a leaking fistula.... sooo, in my opinion, don’t take your fistula lightly!! But, again, it’s my opinion and my experiences and we all know each one of our experiences and path is different! Good luck and keep us posted how you are doing! Didn’t mean to scare you if I did, lol! I just don’t mess with fistulas and don’t know anyone who’s had any luck trying to let them heal on their own.....