Rectovaginal Septum

septum rectovaginale

The rectovaginal septum (rectovaginal fascia, Denonvilliers fascia in females) is the condensed connective tissue layer between the posterior vaginal wall and the anterior rectal wall, extending from the perineal body inferiorly to the peritoneal reflection (Pouch of Douglas) superiorly. It provides structural support to the posterior vaginal wall and separates the rectum from the vagina.

Anatomical Data

Boundaries & Contents

Location	Female pelvis, between the posterior vaginal wall and the anterior rectal wall
Boundaries	Above: the floor of the rectouterine pouch (pouch of Douglas) Below: the perineal body Laterally: blends with the pelvic sidewall fascia and the uterosacral ligaments

Biomechanics

Function & Actions

Separates and supports the posterior vaginal wall and the rectum; defects in it allow a rectocele.

Clinical Relevance

Clinical Notes

Disruption or attenuation of the rectovaginal septum produces a posterior vaginal wall prolapse (rectocele), where the rectum bulges anteriorly through the thinned vaginal wall. Posterior colporrhaphy plicates the pararectal fascia to restore posterior wall support. Rectovaginal fistula repair requires dissection in the rectovaginal septum plane to allow tension-free flap closure. In abdominoperineal resection, the rectovaginal septum plane is the surgical dissection plane to separate the anterior rectal mesentery from the posterior vagina.

Pathology

Common Injuries & Conditions

Posterior Vaginal Wall Prolapse from Septum Disruption

Attenuation of the rectovaginal septum from childbirth, chronic straining, or connective tissue laxity produces a posterior vaginal wall prolapse (rectocele) with anterior rectal bulging into the vaginal canal causing a feeling of incomplete evacuation; managed by posterior colporrhaphy with or without levator plication.

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