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Fistula-in-Ano: An Uncommon Cause of Chronic Vulvar Symptoms

LeFevre, Cherie MD1; Erekson, Elisabeth A. MD2; Hoffstetter, Susan PhD, WHNP1; McLennan, Mary MD1

doi: 10.1097/AOG.0b013e3181b5c7bd
Case Reports

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:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists