Background <p>Infertility counseling for women after genital fistula repair presents unique medical, emotional, and social challenges. This study aims to explore the counseling strategies employed by fistula care providers in Uganda, the challenges they face, and to identify implications for practice.</p> Methods <p>This qualitative study involved in-depth interviews with 30 fistula care providers in Uganda. The interviews focused on their experiences, strategies, and challenges in providing infertility counseling to women who had undergone genital fistula repair. The data were analyzed thematically to identify key themes and insights.</p> Results <p>The study identified various counseling strategies, including providing emotional support, setting realistic expectations, and referring patients to specialists. Providers have employed individualized approaches, particularly considering patients’ hysterectomy status, with additional counseling sessions for those affected. Cultural attitudes toward infertility influence the counseling process, and financial constraints significantly impact patients’ options. Providers reported emotional challenges in discussing sensitive issues and managing patients’ responses, highlighting a need for better training and support.</p> Conclusions <p>Infertility counseling for women after genital fistula repair requires a comprehensive approach addressing medical, emotional, and social dimensions. Our findings highlight significant provider challenges, including the emotional toll of counseling, lack of specific training, and systemic barriers such as patient financial constraints and limited access to specialist care. Enhancing training for fistula care providers in counseling skills and integrating psychosocial support can improve care quality and address these challenges effectively.</p>