Rectal and anal fistulae are frequently missed diagnoses. Symptoms of fistula-in-ano may mimic other chronic vulvar conditions.
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.
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: email@example.com.
Financial Disclosure The authors did not report any potential conflicts of interest.