Rectoceles are a common anatomical finding which does not always require repair. This is replicated in many studies that an anatomical correction does not translate into functional success and correction of all symptomatic dysfunctions. The pres­ence of multiple surgical strategies, exemplifies that there is not one best technique. While rectoceles can be seen and felt, the true underlying disorder is frequently a functional defecatory disorder or a hidden psychological affliction. Wh en symp­tomatic, the underlying disorders should be corrected first, maximal medical management should be exhausted, and physical therapy and frequently psy­chotherapy should be employed to optimize success, as surgical repair is not without its complications. Medical treatments have very little if any side effects and may offer good results. Since rectoceles, are the resultant sign of the primary disease, surgery will not be successful without treatment of the underlying root cause. When nonsurgical modalities fail, a thorough assessment of the cause of the symptoms must be undertaken. A frank discussion with the patient of whether repairing an anatomic condition will correct their symptoms is essential. Restoring anatomy does not equate to restoring function. The trade-off of dyspareunia needs a careful discussion with the women who are still sexually active. With these pre­cautions in mind, the numbers of rectoceles truly deserving surgical repair are probably much less than the incidence of repairs reported in the literature.