Anorectal malformations in females—facts for the gynaecologist

Anorectal malformations in females are characterized by an abnormal position of the anal orifice, anterior to the normal site. In such children, there is a close association between the anorectum and the genitourinary systems, with possible gynaecologic and obstetric implications. The malformations include a spectrum of defects, ranging from the least severe, where the anus opens on the perineum, to the most severe—the common cloaca. Here the urinary, genital and alimentary systems open into a common orifice. There is a high incidence of genital and urinary anomalies associated with the cloaca. At times, the vagina may have to be reconstructed. The surgery of anorectal anomalies is usually done through the posterior sagittal approach. This approach allows for good visualization and access to the anorectal and genital region. Frequently, it is possible to observe, but not correct the associated genital anomalies, which are usually asymptomatic in childhood. However, on attaining menarche, such anomalies may be manifest. Also, these anomalies may be of significance at the time of conception and childbirth.