Natural orifice specimen extraction surgery (NOSES) enables abdominal wall auxiliary-incision-free resection. Transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) is mainly used in female patients with colorectal cancer, which can overcome the limitations of transanal NOSES in the removal of large volume specimens. The operation is limited by gender, specific complications and insufficient high-level evidence, and the clinical promotion is still controversial. A literature search was conducted to collect domestic and international clinical studies regarding transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) for colorectal cancer published from 2014 to 2026. This narrative review summarizes evidence from the perspectives of technical evolution, key surgical procedural points, indications and contraindications, short-term perioperative efficacy, oncological safety, procedure-specific complications, existing challenges and future research directions.Tv-NOSES confers minimally-invasive benefits in strictly screened female patients with colorectal cancer, which can reduce abdominal incision-related complications, but there are specific risks such as pelvic infection, rectovaginal fistula, and vaginal incision-related injury. Currently, high-quality multicenter randomized controlled trials are lacking, and available evidence is mostly derived from single-center retrospective cohort studies. Clinical practice should strictly comply with relevant guidelines, prioritize oncological radicality, optimize preoperative assessment, and obtain adequate informed consent. Future high-quality clinical investigations with unified outcome measures are warranted to further clarify the genuine benefit-risk profile of Tv-NOSES and facilitate its standardized and individualized application.