When it comes to the etiology of rectovaginal fistula, there are two main categories: injurious and non-injurious. The common clinical causes of rectovaginal fistula are: (1) obstetric delivery injury: the occurrence of rectovaginal fistula is very closely related to obstetric delivery, and it has been reported that there are 25 cases of rectovaginal fistula for every 20,500 vaginal deliveries. (2) Trauma: including surgical trauma and trauma. In the past, the main cause was rectovaginal fistula caused by various surgeries, but in recent years the cause of rectovaginal fistula has changed, especially the increase in the use of anastomosis in rectal surgery has made rectovaginal fistula occur repeatedly. When end-to-end anastomosis of the intestine is performed in rectal surgery, it is too close to the vagina, and if the vagina is affected or the anastomosis is poorly healed, tissue necrosis can lead to rectovaginal fistula. (3) Inflammatory injury: including bacterial inflammation, chemical drugs and inflammatory injury of radioactive origin. Inflammatory bowel disorders, such as perianal abscesses can lead to rectovaginal fistula. Rectovaginal fistulas can occur when radiation therapy for vaginal cancer, cervical cancer, or intrapelvic cancer involves improper placement of radiation sources in the vagina or excessive doses that cause local tissue cauterization. Non-invasive rectovaginal fistulas include congenital rectovaginal fistulas and cancerous fistulas, which will not be discussed here. The clinical diagnosis of rectovaginal fistula is generally not difficult. The diagnosis of rectovaginal fistula is 74% based on history and anorectovaginal palpation or probe examination, while some very small fistulas are diagnosed with the aid of anal ultrasound. The nature, size and location of rectovaginal fistulas must be clearly defined when making a clinical diagnosis. Complex fistulas are often secondary to tumors, radiation therapy, inflammatory bowel disease, and surgical anastomoses. All rectovaginal fistulas require surgical treatment. The choice of surgical approach can be determined by the location and nature of the fistula and the surgeon’s proven surgical skills. The success rate of a single surgical repair has been reported to vary widely, ranging from 70% to 97%. Due to the local anatomical characteristics of rectovaginal fistula, surgery is prone to failure, and re-repair after one failed surgery increases the difficulty of surgery and can easily lead to another failure, with a reported success rate of 55% after 3 repairs, so surgery should strive for one successful outcome.