Over the past few days, websites have been buzzing with a story about a pregnant woman who reportedly got pregnant by having anal sex. Before we go any further, let’s be clear in most cases a woman cannot get pregnant through anal sex; however this particular woman has an extraordinarily rare situation. Her pregnancy was the result of a condition known as cloacal malformation.
So what exactly is cloacal malformation?
Cloacal malformations encompass a wide array of complicated defects that occur during development of the female fetus during pregnancy. Cloacal malformations occur when failure of the urogenital septum to separate the cloacal membrane results in the urethra, vagina, rectum and anus opening into a single common channel instead of three separate openings: urethra, vagina, and anus. Additionally, the clitoris looks like a penis, causing gender confusion. Cloacal-related malformations and/or abnormalities can also result in multiple vaginas, a malformed anus, and other defects of the ureters and kidneys. The literature reports that the incidence rate of cloacal malformations is approximately 1 per 20,000-25,000 live births.
Cloacal malformations are discovered typically at the time of birth. Upon physical examination of the newborn, the physician discovers a single opening in the perineal area. The newborn may also have abdominal swelling. After the physician has made the physical diagnosis of cloaca, the full extent of the malformation is typically determined with a complete medical examination and advanced imaging. Patients may undergo many radiologic examinations such as X-rays, ultrasounds and MRI. Failure to identify a cloaca as being present in a newborn and repair immediately may result in serve complications.
Treatment of a cloacal malformation
Cloacal malformations require surgical repair, but the procedure depends on the type and extent of the abnormality. The goal for treatment of a female born with cloaca is to achieve bowel control, urinary control, and sexual function, which includes menstruation, intercourse, and possibly pregnancy. Repairing a cloacal malformation requires a collaborative effort by an experienced multidisciplinary team of surgeons. Special focus is given to separating the rectum, vagina and urethra while still maintaining urinary control, bowel functioning, and preserving sexual and reproductive capacity. While the initial goal is to stabilize the child and relieve blockages in the urinary and intestinal tract, the long range goals are directed at restoring anatomy and function. Great variation exists in anatomy and corrective efforts must be individualized.
Although a cloacal malformation may repair at birth, it is essential that adolescents with a cloacal malformation transition to specialist teams with appropriate expertise as they become adults to monitor any issues.
Sexual functioning in adult females with a cloacal malformation
Gynecological outcomes include menstruation, sexual function and fertility. The aim of reconstructive surgery should be to achieve sexual function, which includes those things. Although reconstructive surgery is used to correct the cloacal malformation, and for the most part the genitalia looks relatively natural, sexual challenges still may present. Sexual functioning can be affected by both physical and psychological factors including:
- vaginal stenosis
- scar tissue after the vaginal repair
- other co-existing medical conditions like renal failure
- bowel management
- fertility challenges
- premature birth
- reduced sexual sensitivity and sexual satisfaction
- body image issues
- lack of self-esteem
- lack of relationship satisfaction
- other mental health conditions
Once the cloacal malformation is surgically corrected and the patient is working collaboratively with a team of expert clinicians, an enjoyable sex life is possible. If vaginal and/or anal intercourse is unbearable as a result of the condition, working with a sexologist or sex therapist can help women explore alternative techniques and tools to enhance sexual pleasure. Additionally, it is extremely important that a female with a cloacal malformation establishes open, honest and consistent communication with sexual partner(s) regarding her condition. This open line of communication can help minimize anxiety and discomfort as well as increase support, intimacy and sexual pleasure.
Unfortunately, the cause of this condition is unknown and the lack of available long-term follow-up data for women with a cloacal malformation presents challenges within the medical community. Nevertheless, in order to optimize health outcomes, it is essential that adult women remain under the care of specialized multidisciplinary teams, including a gynecologist, urologist, internal medicine physician, sexologist or sex therapist that are familiar with the management of cloacal-related malformations and/or abnormalities.