Rectovaginal

Rectovaginal is a coastal of terms used to describe the relationship between the rectum and the vagina in the female pelvis. It can refer to anatomical structures such as the rectovaginal septum or rectovaginal fascia, as well as to conditions that involve these areas, including rectovaginal fistula and rectovaginal endometriosis.

Anatomy: The rectovaginal septum or fascia forms a fibrous partition between the posterior vaginal wall and the anterior rectal wall, creating the rectovaginal space. This region is bounded by pelvic fascia and pelvic floor muscles and lies near the rectouterine space. The area is clinically relevant for surgical access, staging of disease, and procedures in the pelvis.

Common conditions: Rectovaginal fistula is an abnormal passage between the rectum and vagina, potentially causing fecal matter or gas to pass through the vagina. It can arise from obstetric injury, inflammatory bowel disease (such as Crohn’s disease), radiation therapy, infection, or surgeries. Symptoms include vaginal discharge containing stool and recurrent infections. Rectovaginal endometriosis involves endometrial tissue located in the rectovaginal septum, often producing pelvic pain, dyschezia, and dyspareunia.

Diagnosis and treatment: Evaluation typically includes pelvic examination, speculum or rectal examination, and imaging or endoscopic studies (MRI, CT, or endoscopy) to define the fistula or extent of disease. Treatment depends on cause and size: small fistulas may be managed conservatively in some cases, while others require surgical repair. Repair approaches include transvaginal or transanal fistula closure, sometimes with interposition tissue such as a gracilis or omental flap, and temporary fecal diversion in selected cases. Endometriosis may be treated with hormonal therapy or surgical excision.

Prognosis and research: Outcomes vary by etiology and repair technique, with recurrence possible. Ongoing research focuses on minimally invasive approaches, tissue interposition methods, and optimizing timing of repair to preserve continence and fertility.