What tests diagnose rectovaginal septum endometriosis?

Rectovaginal septum endometriosis is usually evaluated with a combination of your symptom story, a targeted pelvic exam, and imaging that’s interpreted by clinicians who routinely look for deep endometriosis. On exam, we’re often looking for deep tenderness, thickening, or a firm nodule behind the vagina, and we correlate that with symptoms like deep pain with sex, pain with bowel movements, and cyclical rectal or pelvic pressure.

For “tests,” the most useful tools are expertly performed transvaginal ultrasound and pelvic MRI, which can help map suspected deep disease and plan surgery—but imaging still can’t reliably rule endometriosis out if it looks normal. If rectal wall involvement is a concern (which can sit right next to the rectovaginal septum), an endorectal ultrasound may be used in selected cases to better assess depth in the rectal wall layers.

The only way to definitively confirm endometriosis is surgery with biopsy (pathology), and ideally that confirmation happens during a procedure that’s also prepared to treat what’s found. If you’re trying to figure out whether your symptoms fit rectovaginal septum disease—and what testing will actually change your plan—our team can help you choose the right mapping approach and next steps based on your specific pattern.