Rectovaginal fistula (RVF) arose in the patient as a result of sexual assault in childhood with an extensive injury to the perineum. After two unsuccessful attempts at repair, a complex RVF developed associated with the old laceration of Dam IV. degree, with complete loss of the perineal body, central tendon and absence of the rectovaginal septum. The patient reported the passage of fecal material through the vagina. Magnetic resonance imaging of the pelvis showed an incomplete posterior vaginal wall 3.4 cm long from the lower vaginal segment to the vaginal introitus. Definitive repair was successfully performed in a one-stage procedure by a multidisciplinary team of gynecology, colorectal surgery and anesthesiology. Psychological support and specialized nursing care improved treatment adherence and postoperative recovery. The case highlights the success of a coordinated multidisciplinary approach in complex RVFs.