**Core Concept**
A rectovaginal fistula is an abnormal connection between the rectum and vagina, often resulting from injury, surgery, or infection. Initial treatment aims to manage symptoms and prevent complications, such as incontinence and infection.

**Why the Correct Answer is Right**
The initial treatment for a rectovaginal fistula typically involves conservative management with a focus on bowel habits, dietary modifications, and local measures to promote healing. **High-fiber diet** and **bowel regularity** can help reduce symptoms and prevent complications. **Local application of antibiotics** and **fistula plugs** may also be used to promote healing and reduce the risk of infection.

**Why Each Wrong Option is Incorrect**
**Option A:** Surgical intervention, such as fistulotomy or fistulectomy, may be necessary for complex or refractory cases, but is not the initial treatment.
**Option B:** Hormone replacement therapy may be used to manage symptoms associated with vaginal atrophy, but is not a primary treatment for rectovaginal fistula.
**Option C:** Radiotherapy may be used to treat underlying conditions, such as cervical cancer, but is not a primary treatment for rectovaginal fistula.

**Clinical Pearl / High-Yield Fact**
The key to managing rectovaginal fistula is to maintain bowel regularity and promote local wound healing, which can be achieved with a high-fiber diet, bowel regularity, and local application of antibiotics.

**Correct Answer:** A.