Female Intimacy & Reproductive Health
Girls with Anorectal Malformations can face a range of reproductive health challenges.
One of the most complex types of ARM is cloacal malformation, in which the urinary, genital, and intestinal tracts join into a single channel.
Girls born with this form are more likely to experience gynaecological, obstetric and renal problems. As females transition into adulthood, urologists and gynaecologists play an important role in supporting urinary and sexual health and assessing fertility and reproductive outcomes.
Puberty
Girls with ARM generally develop like other girls.
On average breast buds form around 10 years old and menstruation starts around 12.4 years old.
Breast budding means oestrogen has started increasing, so menstruation will usually follow within around 2 years.
Menstrual outflow obstruction.
In some girls menstrual blood cannot exit the body normally.
Instead, it may accumulate in the vagina or uterus.
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Period pain without bleeding
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Delayed/absent menstruation
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Ongoing pelvic pain
These symptoms may indicate obstructed or blocked menstruation, which can be associated with Müllerian anomalies, (abnormal development of the uterus, cervix, or vagina).
All girls with ARM should undergo evaluation around early puberty to identify and manage any menstrual or reproductive tract issues.
If untreated, retained menstrual blood can cause:
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Severe pelvic pain
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Infection
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Damage to reproductive organs
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Future fertility problems
Urgent review by a gynaecologist is advised.
Further information:
Doctor Veronica Alaniz (Department of Obstetrics and Gynaecology, Division of Paediatric and Adolescent Gynaecology, University of Colorado) advices assessment and ultrasound evaluation 6 months after breast budding.
This early assessment ensures that any menstrual outflow obstruction is identified and corrected before periods start.
Sexual Health & Fertility
Nerve and muscle development: The nerves that control bowel, bladder, and sexual function, and the muscles themselves, may develop differently in people with ARM. This can affect sensation, control, or how the body responds to certain signals.
Surgery or scar tissue: Scar tissue from surgery or naturally tight muscles around the bowel, bladder, or genital area can change how the muscles move or feel. This can sometimes make activities like toileting, erections or sexual development feel different.
Pelvic structure differences: These may influence bladder and/or bowel control.
Pregnancy and Delivery
Women can have successful pregnancies, but delivery will need special planning. Previous ARM surgery can affect the muscles around the bowel and bladder.
Women can have a vaginal birth, but some may need a C-section, especially if they had complex repairs or reconstructions.
Obstetricians may work with urogynaecologists or colorectal surgeons to make a safe birth plan.
Post delivery care may include pelvic floor exercises and assessment / monitoring of bowel and bladder function
Lifelong, Team-Based Care. The best outcomes happen when care includes:
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Urology
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Gynaecology
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Colorectal specialists
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Mental health support
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Family planning guidance
If you have concerns about kidney function, menstruation, sexual health, or fertility, speak with your healthcare provider.
Further information:
Sexual Health Resource ARM & Hirschsprung’s
A dedicated online support website developed for individuals with ARM and related conditions addressing intimacy, sexuality, and quality-of-life concerns. https://www.sexuality-arm-hd.com/
Max’s Trust
UK charity providing support, information, and community for adults, children, and families affected by anorectal malformations. Offering networking opportunities, events, and access to specialist expertise.
https://www.maxtrust.org/
ERN eUROGEN-Anorectal Malformation - Patient Journey
DISCLAIMER:
By using our website you acknowledge that you are accessing information and peer support only and not professional medical healthcare advice.
If you are unsure about any aspect of your health or treatment, please consult a healthcare professional immediately.