Most classifications are based on size, localization, and etiology. No generally accepted classification of rectovaginal fistulas exists. Rectovaginal fistula, surgery, incontinence, postpartal trauma, rectal cancer, German guideline Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature. Given the low evidence level, this guideline is to be considered of descriptive character only. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient.Ĭonclusion: In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. In higher fistulas, abdominal approaches are used as well. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle) or biologically degradable materials. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. The most common procedure involves a transrectal approach with endorectal suture. Various surgical procedures have been described. Persistent rectovaginal fistulas generally require surgical treatment. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction). Other pathologies should be ruled out by endoscopy, endosonography or tomography. Results: Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Methods: A systematic review of the literature was undertaken. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease. The most common causes are obstetric trauma, local infection, and rectal surgery. (Also see Blowing into the vagina Looking at a sexual organ Semen Effeminate Sexual intercourse Sodomy).Background: Rectovaginal fistulas are rare, and the majority is of traumatic origin. If a woman’s vagina turns into iron or into any metal in the dream, it means that she has lost all hope in accomplishing her aspirations, satisfying her desires or needs. If a woman sees water entering her vagina in a dream, it means that she will conceive a child. In this sense, capturing a bird, or looking inside a bird’s nest in a dream means getting married. Avagina in a dream also represents a shameless and an insolent worker, or it could represent a bird’s nest. Ifone reenters the womb of a woman through her vagina in a dream, it means his death.Ī vagina in a dream also could represent a blood sucker, a murderer, or a deceitful person who portrays piety during the day, then shows his teeth at night. ![]() Seeing the vagina of an elderly woman in a dream means loss of business. If one is facing an opponent, it means that he will conquer him. If one has to appear in court, it means that he will win his case. ![]() Ifa prisoner finds himselfhaving a vagina in a dream, it means his release from prison, and for someone who is depressed, it means relief from his depression. Ifa woman looks at a man’s sexual organ in a dream, it represents her strength and manlike drive. If a man looks at a woman’s vagina in a dream, it represents his wicked state of mind, needs, desires, humiliation, or it could represent the high standard a woman has achieved in his eyes. It also could mean satisfaction of one’s needs, fulfillment of one’s desire, marriage, partnership, exposing a secret, working with minerals, protecting women’s chastity, imprisonment, the house entrance, the front door, travels, the prayer niche inside a mosque, one’s innermost secret, running water, heat, an oven, a garment, a canyon, discovering a cure for an illness and feeling happy about it, finding an elixir, feeling relief after having sexual relationship with one’s spouse, a grave, distress, one’s wife, fire, a burning desires, family reunion, having children, dispelling doubt about what is right and what is wrong, clearly identifying true from false, finding guidance, or heeding admonition. A vagina in a dream signifies relief for someone who is experiencing hardship, pressure, or sorrow.
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