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Introduction: Colo-vaginal fistulas represent 20% of all fistulas occurring as a complication of chronic and recurrent diverticulitis and can be encountered usually in older women who have undergone total hysterectomy. Case: This article describes the case of a 69-year-old female who had a known history of diverticular disease, primarily in the descending and the sigmoid colon and who had repeated episodes of diverticulitis. She presented with malodorant fecal discharge from her vagina and was examined by a gynecologist. She was then referred to the current authors' outpatient surgical clinic for possible existence of a colo-vaginal fistula. A computed tomography scan of her abdomen and a colonoscopy were performed, which confirmed the diagnosis of a colovaginal fistula. Results: The patient underwent surgical removal of the sigmoid colon and anastomosis in one stage. Here postoperative course was uneventful, and she was discharged from the hospital on the eighth postoperative day. At a 1-year follow-up, she was symptom-free. Conclusions: Colo-vaginal fistulas are not considered to be very common complications of diverticulitis. Yet, their treatment is imperative, because they can deteriorate a patient's quality of life by causing various infections. Moreover, underlying malignancy should always be suspected and considered in the differential diagnosis of colo-vaginal fistulas. Treatment of choice is surgical resection of the diseased colon and anastomosis in one stage. ( J GYNECOL SURG 31:119)