Rectovaginal septum and influencing factors in its morphology

Abstract

Introduction The rectovaginal septum (RVS) is a layer of dense fibro‐connective tissue, smooth muscle, and elastic and collagen fibers containing a neurovascular bundle of the inferior hypogastric plexus, providing support, innervation, and irrigation. It allows for mobility between the rectum and vagina and helps in limiting the spread of infections or tumors, as well as a guide for several types of surgeries. Any damage may predispose to rectocele, enterocele, fistula, constipation, incontinence, or sexual dysfunction. Currently, there is no consensus regarding the morphology (thickness or length). The objective of this study was to determine morphometric characteristics and variations in correlation to the number of pregnancies, method of delivery, parity and estrogenic exposure. Materials and methods An observational, cross‐sectional, retrospective, descriptive and comparative study was performed. Pelvic RMIs of Hispanic women from the northeast of México were obtained, with an age of 15 years and older. Those with gynecological pathology were excluded. Age, obstetrics and gynecology history was registered and the population was categorized by the number of pregnancies (nulligravida, 1–3 pregnancies, or ≥ 4 pregnancies), type of delivery (vaginal, cesarean section, or mixed), parity (primiparous or multiparous) and estrogen exposure (premenopause and postmenopause). Results A total of 102 RMIs were included, the mean age was 41.03 ± 15.23 years (range 15 to 77). A quarter (24.5%) of the patients were nulligravida, the rest (75.5%) being primi‐ or multigravida. Of those with previous pregnancies, vaginal delivery was the most common type (49.35%); 16.88% had a cesarean section, and 31.17% had a history of both types of delivery. Within the women who had a vaginal delivery, 19.6% were primipara and 41.2% were multipara; only 25.5% were postmenopause. The mean RVS length was 73.16 mm, with a thickness of 2.76, 2.24, and 2.53 mm for the upper, middle and lower thirds. In women with vaginal delivery, multiparous had a statistically significant longer RVS than primiparous (p 0.011), as well as a tendency of higher thickness, although the latter without statistical significance. Pre‐menopause women had statistically significant longer RVS (p 0.031) with a tendency to lose thickness towards post‐menopause. Conclusion The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births and estrogenic exposure.