title: Fistula-in-ano: an uncommon cause of chronic vulvar symptoms.
abstract: BACKGROUND
  Rectal and anal fistulae are frequently missed diagnoses. Symptoms of fistula-in-ano may mimic other chronic vulvar conditions.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri; and Department of Obstetrics and Gynecology, Alpert Medical School at Brown University, Providence, Rhode Island.
authors.forename: Cherie
authors.initials: C
authors.lastname: LeFevre
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Erekson
authors.forename: Susan
authors.initials: S
authors.lastname: Hoffstetter
authors.forename: Mary
authors.initials: M
authors.lastname: McLennan
mesh_terms: D000328:Adult; D004414:Dyspareunia / Q000209:etiology; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012003:Rectal Fistula / Q000150:complications* / Q000601:surgery; D016038:Skin Transplantation; D013536:Suture Techniques; D014845:Vulvar Diseases / Q000209:etiology* / Q000601:surgery