Pouch-vaginal fistulae affect 6% of women after ileal pouch-anal anastomosis. Such fistulae significantly impact on the patient's quality of life and present a technical challenge to the surgeon. Although several operative approaches have been described, results from a number of case series are variable and associated with significant rates of failure. As a result, there remains a lack of consensus in the literature with regard to the management of this troublesome problem. The purpose of this article is to review the results of surgical intervention and to provide a clinical algorithm that gives a structured approach to the management of pouch-vaginal fistulae.