BACKGROUND: Rectal and anal fistulae are frequently missed diagnoses. Symptoms of fistula-in-ano may mimic other chronic vulvar conditions.
CASES: Three patients presented with chronic symptoms including nonhealing ulcer, pruritus, dyspareunia, and discharge for 6–18 months. High clinical suspicion and rectal examination with concomitant perineal probing was useful in making a diagnosis. Once the diagnosis of fistula-in-ano was made, surgical correction was successful.
CONCLUSION: When evaluating persistent vulvar problems, the clinician's differential diagnoses should include less common causes. The goals of treatment for fistula-in-ano should be to eliminate the nidus of infection and to preserve the anal sphincter during the repair.
Fistula-in-ano is a potential cause of chronic vulvar pain, dyspareunia, ulceration, and persistent vaginal discharge.
From the 1Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri; and 2Department of Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, Rhode Island.
Corresponding author: Susan Hoffstetter, PhD, Saint Louis University Department of Obstetrics, Gynecology, and Women's Health, Division of Urogynecology, 6420 Clayton Road, Suite 290, St. Louis, MO 63117; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.