title: Gynecologic problems following abdominoperineal resection of the anus and rectum - the post-miles syndrome.
abstract: BACKGROUND
  : Abdominoperineal resection is a surgical technique used to treat a variety of colorectal diseases. Although there are several published studies describing long-term pelvic floor functioning in women who have undergone this procedure, little is known specifically about gynecologic problems that may develop after surgery.
  
  
  METHODS
  : We describe a series of 3 patients all presenting with similar gynecologic complaints status-post abdominoperineal resection, including copious vaginal discharge, dyspareunia, and difficulty on the part of their health care providers in seeing the cervix during speculum examinations. The presenting syndrome is felt to be due to a reduction in vaginal caliber and steep angulation of the upper vagina due to the plication of the levator ani during the typical closure of the pelvic floor at the completion of surgery. Successful therapy has been achieved with conservative measures as well as surgical treatment.
  
  
  CONCLUSIONS
  : Abdominoperineal resection may result in a syndrome of gynecologic complaints. Medical and/or surgical therapies are effective in controlling symptoms.
authors.affiliation: From the *Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; and †Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA.
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Berger
authors.forename: Rebecca U
authors.initials: RU
authors.lastname: Margulies
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner