Journal of Reproductive Health and Contraception

In a paediatric surgery practise, children with anorectic malformations (ARM) are a prominent category. It is critical to examine the presence of gynaecologic anomalies in female cases of anorectal malformations, especially at the time of definitive repair. When caring for patients with cloacal anomalies, it is crucial to evaluate the relationship of such gynaecologic anomalies. If such anomalies are not discovered, a chance to identify and cure them may be lost, with potentially detrimental consequences for future reproductive capacity. Surgeons can give better care for girls and essential counselling for parents if they are aware of the underlying malformations and long-term consequences. Knowing about reproductive difficulties in females with cloaca allows the paediatric surgeon to provide the best surgical care in infancy, childhood, and young adulthood, as well as collaborate medically and surgically with an expert gynaecologist in patients with more complex anatomic variants.

Anecdotally, many paediatric surgeons claim that, with the exception of a cloaca, they routinely repair most ARM without assessing for the existence of a gynaecologic abnormalities. Most paediatric surgeons, on the other hand, are aware of the strong link between gynaecologic anomalies and cloacal anomalies, which affects 53–67% of female patients with uterovaginal defects. It's critical to know what kind of reproductive aberration you have and what impacts you might expect in the short and long run. Because non-obstructive uterovaginal abnormalities do not cause acute problems throughout puberty, treatment can be postponed. Obstructive abnormalities should be discovered and treated early in adolescence because probable menstruation obstruction might have disastrous implications in patients with complicated cloaca. It is crucial to segregate the urinary and colorectal systems from the reproductive tract in cloacal anomalies; nevertheless, understanding the uterovaginal architecture is also necessary to avoid poor puberty results. During the initial rectum repair, a vaginal septum can be efficiently corrected. This can be done with only one anaesthetic exposure, with appropriate surgical exposure, and without the need for any additional procedures. In adolescence, there are psychological problems linked with such a procedure.

Before or during the ultimate repair of any complex ARM, all girls should have a vaginoscopy. This can be done under the same anaesthetic as the PSARP, with the intention of doing vaginal septum excision if necessary. An assessment under anaesthesia using both cystoscopy and vaginoscopy can often be advantageous for surgical planning in more difficult abnormalities like the cloaca. Endoscopy can be performed with any other recommended surgical treatments during childhood if girls or young women were treated in infancy without a comprehensive gynaecologic examination. The goal is to gather as much information as possible about reproductive anatomy so that a solid plan can be put in place around the time menarche arrives. Accurate awareness of the reproductive anatomy lets parents and providers to plan ahead of time for pubertal changes and schedule any necessary surveillance or interval procedures.