Reproductive and Sexual Outcomes After Anorectal Malformation Repair in Childhood

Abstract

PURPOSE Anorectal malformations (ARM) are a spectrum of anomalies. Sexual function and fertility may be impaired. This study looks at long-term outcomes. MATERIAL AND METHODS This was a cohort study of 75 adult patients with ARM. Participants completed questionnaires on urinary, bowel and sexual function. Medical records were retrieved for data on original diagnosis and associated anomalies. RESULTS The age range was 18-60 years with a median of 25 years. 18 associated genital anomalies were recorded in 14 women (31%), the commonest being double vagina (6/14) and bicornuate uterus (5/14). In 10 of the 24 (41.67%) males where paediatric medical records were available had 11 documented genital anomalies, the commonest being cryptorchidism (6/24). The mean age of sexual debut for the group was 17.65 years (range 14 – 65 years). Of the 75, 10 were not sexually active (13.3%). In the case of 2 females this was due to vaginal stenosis, both required surgery. 61% of male patients were very or mainly satisfied with their sex lives. Women scored significantly lower than men in terms of sexual esteem and satisfaction. Five males reported poor erections, and 5 reported difficulty in ejaculating. There were 16 pregnancies from 7 females, 10 resulted in live births. Four deliveries were vaginal and 6 Caesarean section. The male participants reported 11 pregnancies in partners resulting in 10 live births. CONCLUSIONS Anorectal malformations have adverse implications for fertility and sexual function. In young adults it is important that issues regarding sexual function and fulfilment are addressed openly.