Our experience in the management of 16 enterovaginal fistulas complicating Crohn's disease leads us to believe that such fistulas usually arise from active rectal disease and, despite being evident clinically, are difficult to confirm endoscopically or radiologically. Patients with few symptoms can be managed conservatively. Surgical repair protected by diversion may have a place in management, but most with severe symptoms will require excision of the intestine from which the fistula is arising.