Adenocarcinoma of the lower rectum can be resected with a sphincter-sparing procedure but exposure of the lower pelvis may be difficult and sphincter function may be compromised. We have performed a low anterior resection for rectal cancer in a 69-year-old woman with mobilisation of the tumour and anastomosis performed transvaginally without a covering stoma. This way we could get good exposure of the lower rectum and anal sphincters. The patient made an uneventful recovery and was fully continent after surgery. Transvaginal low anterior resection is an alternative route which may be useful in cases of difficult exposure of low rectal cancer.