<h3>Purpose</h3> Interstitial brachytherapy (ISBT) is an important treatment technique in the treatment of gynecologic cancers. However, there are concerns about potential complications from needle intrusion of visceral organs. The purpose of this study is to evaluate the rates of acute and late complications from needle intrusion of the bladder or bowel. <h3>Materials and Methods</h3> Records from thirteen patients with gynecological cancers treated with ISBT at a single institution from July 2020 to April 2022 were reviewed. Post-procedure CT images were reviewed to identify cases that had radiographic evidence of bladder or bowel needle intrusion. Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 was used to grade complications/toxicities. <h3>Results</h3> Median follow-up was 7.6 months; the crude local control rate was 92%. One patient (8%) had local recurrence, one patient (8%) had regional recurrence, and two patients (15%) had distant recurrences. In total, four patients (31%) had radiographic evidence of needle intrusion(s). Three patients (23%) had evidence of needle intrusion into the bowel and one patient (8%) had evidence of needle intrusions into both the bladder and bowel. Radioactive source dwell times were minimized in these areas. A total of one toxicity (8%) from needle intrusion was noted: acute grade one hematuria in the patient with bladder needle intrusion. There were no grade ≥2 acute or late toxicities from needle intrusion(s) found. One patient developed a vesicovaginal fistula from disease recurrence; there was no bladder needle intrusion in this patient. One patient developed a colovaginal fistula from disease recurrence; there was bowel needle intrusion in this patient. <h3>Conclusions</h3> ISBT is an effective treatment for gynecologic cancers. Despite occasional radiographic evidence of bladder/bowel needle intrusion, the rates of organ complications are low; disease recurrence represents the major cause of morbidity. These data suggest that needle intrusion of visceral organs in the absence of radioactive source loading is associated with a low risk of morbidity; this is in accordance with the existing literature.