The course will cover strategies for diagnosis and management of difficult cases that are encountered in everyday practice but may be challenging. The course will include thematic blocks of lectures, panels and small group workshops. Case-based discussions will review problems such as inadequate examinations, recurrent and persistent disease, discerning perianal disease from dermatologic conditions as well as other common problems found during HRA. Attendees will have the opportunity to present difficult cases from their practice for discussion and review by faculty. Sample topics: difficult external and internal exam, post anal cancer HRA, sex after ablation.