Rectovaginal endometriosis occurs when tissue similar to endometrial tissue grows outside of the uterus and into the rectum, vagina, or the structures between them.

Rectovaginal endometriosis is one of the most severe presentations of endometriosis. It can cause chronic pelvic pain and gastrointestinal problems, and it sometimes contributes to infertility.

Doctors classify rectovaginal endometriosis as endometriosis stage 4. It is a deep infiltrating endometriosis.

In this article, learn more about rectovaginal endometriosis, including its symptoms, risk factors, and diagnosis. This article also covers the treatment options.

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Rectovaginal endometriosis occurs when tissue that shares features with endometrial tissue develops around the rectum, vagina, or the areas between them.

Because of this, rectovaginal endometriosis can affect the vagina, rectum, and other nearby tissues. It can also interfere with bowel functioning.

The pieces of tissue that attach to areas outside of the uterus are called endometriosis lesions. This tissue is similar to the endometrium, which is the lining of the womb.

These lesions can form large, painful growths that interfere with organ function. Some people may experience internal injuries that can cause infections and bleeding.

Doctors use four stages to describe endometriosis. The stage they assign depends on how severe the condition is and how much tissue has formed outside of the uterus.

Rectovaginal endometriosis is uncommon. It affects fewer people than ovarian or peritoneal endometriosis.

What are endometriosis adhesions? Learn more here.

Symptoms of endometriosis can include:

  • heavy periods
  • bleeding between periods
  • severe cramps
  • pain during sex
  • bladder pain
  • incontinence
  • infertility

People with rectovaginal endometriosis may also experience:

Not everyone with rectovaginal endometriosis will experience symptoms.

Also, the severity of a person’s endometriosis symptoms does not necessarily indicate how the condition will affect them. Some people experience chronic pain with mild endometriosis, while others have only mild symptoms with severe rectovaginal endometriosis.

How does endometriosis affect fertility, and what treatments are available? Find out here.

Usually, the endometrial tissue that lines the uterus sheds with each period. In endometriosis, however, pieces of endometrial tissue grow outside of the uterus to form lesions.

These respond to hormones and may bleed, but they cannot exit the body as regular endometrial tissue can. They can also stick organs and structures together. This can cause pain and other symptoms.

Doctors do not know why some people develop endometriosis. It sometimes runs in families, suggesting that genetic factors may play a role.

Other factors that may play a role in endometriosis, including rectovaginal endometriosis, include:

  • Retrograde menstrual flow: This happens when the tissue shed during a period flows backward through the fallopian tubes instead of out of the body.
  • Autoimmune conditions: Normally, the immune system should locate and remove any endometrial tissue outside of the uterus, leading some researchers to believe that immune system disorders may cause endometriosis.
  • Traumatic injuries: Some research suggests that trauma to the uterus or nearby structures can move endometrial tissue and cause endometriosis. For example, people who have had cesarean deliveries are more likely to develop endometriosis.
  • Hormones: Having too much estrogen or a problem with the balance between estrogen and other hormones may also play a role in rectovaginal endometriosis.

Is endometriosis hereditary? Find out here.

A doctor may suspect endometriosis if a person’s symptoms include pain, bloating, or irregular bleeding. They may ask about the person’s medical history or perform a pelvic exam to check for pain and unusual growths.

Some people do not discover that they have endometriosis until they visit a doctor for fertility issues.

An ultrasound scan or laparoscopy can sometimes help locate endometriosis lesions. However, imaging techniques cannot always detect them.

If a person has rectovaginal endometriosis and other treatments do not alleviate their symptoms, a doctor may recommend surgery to remove the lesions.

There is currently no cure for rectovaginal endometriosis, but treatments for endometriosis can help a person manage the symptoms.

Hormonal treatment

Hormonal birth control pills contain progesterone, which can help prevent the accumulation of endometrial tissue.

Hormone treatments improve symptoms in about two-thirds of people with rectovaginal endometriosis. However, they can also cause unpleasant side effects, such as bloating, headaches, and weight gain.

Also, people who want to become pregnant should not use hormonal treatments, as they prevent pregnancy.

When hormone treatments are not an option or are not providing relief from symptoms, surgery can help.

Surgery to remove tissue

Severe endometriosis often requires the surgical removal of the adhesions to prevent serious complications.

A specialist can perform laparoscopic surgery. This is a type of minimally invasive surgery that uses small incisions and a camera to see inside the body and remove the adhesions.

During surgery, the surgeon can also look for other endometriosis adhesions and assess the severity of the condition.


People who do not want to get pregnant may opt for a hysterectomy if other treatments do not work. A hysterectomy removes the uterus, and a doctor may recommend having the ovaries removed as well.

Hysterectomies are not a cure for endometriosis, but they can relieve symptoms in some people. Others may continue to have symptoms even after a hysterectomy, especially if the surgeon does not remove all of the adhesions or if the ovaries are still intact.

Pain relief

Taking pain relievers can help with pelvic pain and other symptoms of endometriosis, but this will not treat the underlying cause.

Taking pain medications and hormones can help with some symptoms, but this may not be an effective long-term strategy for severe forms of endometriosis, such as rectovaginal endometriosis.

Treating the complications

A person may need additional treatments to address any complications of endometriosis.

In rare cases, a person with endometriosis may experience an intestinal obstruction. They may need antibiotics, intravenous fluids, or further surgery if this occurs.

Can herbal remedies help manage endometriosis? Find out here.

Rectovaginal endometriosis is a chronic condition in which tissue that resembles endometrial tissue forms adhesions around the rectum, vagina, and the structures between them.

Surgery can remove these adhesions and may increase fertility. According to one 2013 review, surgery can improve 70% of symptoms in people with rectovaginal endometriosis.

Even following successful surgery, however, symptoms can reappear. Many people take hormonal medications after surgery to slow down the development of new adhesions.

People with endometriosis or those who think that they might have it should work with a doctor who specializes in the condition.

Having ongoing medical evaluations, a flexible treatment plan that meets one’s needs, and a doctor who listens can help make endometriosis feel more manageable.