The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair.

Using the descriptions of Uhlenhuth, and Milley and Nichols, we have been able to identify a sheet of strong connective-type tissue between the rectum and vagina. This layer has been named the rectovaginal septum, referred to, by some, as the rectovaginal fascia. As it is considered to be analogous to the rectovesical septum in men, first described by Denovilliers, some refer to it as Denonvilliers' fascia in the female. This layer is immediately beneath the vaginal mucosa and clearly is what many would consider part of the vaginal wall. Its principal attachments are peripheral--it merges superiorly with the cardinal/uterosacral complex, fuses laterally with the fascia over the levator muscle, and merges distally into the perineal body. Histologically, it contains collagen that is quite dense in places, some strands of smooth muscle, and a very dense network of heavy elastin fibers. It is this layer that acts as a supporting structure for the perineal body and prevents the rectum from bulging into the vagina. Rectoceles represent a defect in this layer that allows the rectum to bulge inward. The defects are usually isolated breaks that can be repaired directly with excellent and predictable results.