Rectovaginal fistulae must be divided into two groups. The first group consists of those that occur secondary to obstetric or gynecologic surgery for benign disease. The second group consists of those that are associated with radiation therapy for pelvic malignancy. Rarely is a diverting colostomy needed for fistulae from benign disease. A transverse colostomy is always needed, however, for pelvic cancer patients who have rectovaginal fistulae secondary to irradiation. An outside blood supply, such as a muscular flap, is not required for the repair of small rectovaginal fistulae secondary to obstetric or gynecologic surgery, unless there is excessive scarring or repeated attempts at closure have been unsuccessful. Patients with rectovaginal fistulae associated with pelvic irradiation, however, require a vascular flap to improve blood supply to the irradiated tissues