When a health issue turns into a stigma: a presentation of a rare case of delayed diagnosis of vestibular anus in a 42-Year-Old woman during childbirth

When a health issue turns into a stigma: a presentation of a rare case of delayed diagnosis of vestibular anus in a 42-Year-Old woman during childbirth | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report When a health issue turns into a stigma: a presentation of a rare case of delayed diagnosis of vestibular anus in a 42-Year-Old woman during childbirth Fatemeh Darsareh, Vahid Mehrnoush, Mozhgan Saffari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7323926/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In developing countries, the identification of anorectal malformations frequently occurs late. In this case we present a delayed diagnosis of vestibular fistula. Case presentation A 42-year-old G1P0 woman was diagnosed with vestibular anus at the onset of labor. The sole issue she encountered was dyspareunia, which never prompted her to see a doctor. She got married a year prior to her pregnancy and did not disclose a sexual relationship before her marriage. She has never been seen by a gynecologist. During the vaginal exam, the cervix was dilated three centimeters. Given the thinness of the rectovaginal wall and worries about potential injury and significant tearing during labor, it was decided to perform a cesarean section. The most significant aspect was the patient's determination to keep the information from her husband. Since she thought that her husband's awareness of the genital malformation could affect their married life. Given that they had experienced no issues with their sexual relationship prior to the diagnosis, she preferred her condition to stay confidential. Conclusion The case report provides insights for women's health care providers in low- and middle-income countries regarding the follow-up challenges caused by insufficient social support. What makes this case particularly compelling is not only the delayed diagnosis of a vestibular fistula in adulthood, but also the psychological and emotional burden the patient carried in order to preserve the appearance of normalcy. Anorectal malformations Vestibular anus Stigma Case report Figures Figure 1 Introduction Anorectal malformations (ARM) represent a range of congenital defects that impact both males and females, involving the distal anus and rectum along with the urinary and genital systems. ARM happens in roughly 1 in 5000 live births and is more frequent in females [1]. Timely identification and proper treatment of ARM are essential for attaining positive results, particularly during developmental phases when sphincter muscles are flexible and responsive to intervention. In this important period, interventions can aid in the incorporation of somatosensory input, a skill that generally declines with growing older [2]. In developing countries, the identification of ARM frequently occurs late, with individuals showing up in their teenage years or later. This has been linked to various factors, such as lack of knowledge, financial hardship, and fragile social support networks [3]. Vestibular anus is the most prevalent form of ARM observed in females. The occurrence of this malformation in adults is uncommon. This is a case of an adult with ARM presenting with a vestibular fistula in a 42-year-old female, who was diagnosed during childbirth. Case Presentation A 42-year-old G1P0 woman at 39 weeks of gestation arrived at the hospital's delivery ward experiencing labor contractions. During the vaginal examination, we observed an opening at the lower part of the vaginal orifice. After careful observation, we determined that there was no anus in the perineum and concluded that this opening could be the anus. The patient was diagnosed with vestibular anus. (Figure 1) The patient did not report any past occurrences of repeated urinary tract infections or bowel issues. The sole issue she encountered was dyspareunia, which never prompted her to see a doctor. She got married a year prior to her pregnancy at the age of 40. She did not disclose a sexual relationship before her marriage. She has never been seen by a gynecologist. She provided routine prenatal care at maternal health facilities. During the vaginal exam, the cervix measured approximately three centimeters in dilation. The wall between the rectum and vagina was thin. Given the thinness of the rectovaginal wall and worries about potential injury and significant tearing in this area during labor, it was decided to perform a cesarean section. The patient's situation was clarified for her, and with her consent, the choice to carry out a cesarean section was made. The most significant aspect was the patient's determination to keep the information from her husband. Since she thought that her husband's awareness of the genital malformation could affect their married life. Given that they had experienced no issues with their sexual relationship prior to the diagnosis, she preferred her condition to stay private. The decision made by the patient was honored. The baby girl was born via cesarean section, and the mother left the hospital in stable overall condition. The mother did not express any particular concerns during her postpartum recovery. Eight weeks after delivery, the mother was contacted again and advised to return for further evaluation, but she insisted that the diagnosis remain confidential and did not want further diagnostic and therapeutic follow-up to affect her life. Discussion At birth, any newborn should undergo a general examination that includes the perineum. In the girl, the diagnosis depends on the look of the perineum. Typically, three noticeable openings exist — the anterior one is the urethra, succeeded by the vagina, both located within the vestibule. Located behind the perineal body is the anus. The existence of three openings, where the anus is not located in its typical position, suggests a perineal fistula, previously known as the anterior perineal anus. A vestibular fistula is identified when the third opening is observed in the vestibule [4]. A vestibular anus, also known as a vestibular fistula, is a rare type of ARM refers to a congenital condition where the anus is located in the vestibule behind the vaginal opening. It has a shared wall that separates the vagina from the rectum. Along with an unusual appearance, it causes repeated episodes of urinary tract and vaginal infections. In adult women, it results in dyspareunia [5]. Such abnormalities are typically observed at birth or in early childhood. If neglected at this moment, they are typically seen throughout the course of pregnancy [6]. A patient facing this complication, as in our case, may fail to identify this abnormality due to having adequate sphincter control, not encountering dyspareunia or repeated urinary tract infections. Wright (1947) describes a case involving a 53-year-old woman with vestibular anus who had one normal delivery without needing perineal sutures, which went unnoticed until she presented with cervical cancer [7]. A delayed diagnosis of vestibular anus can result in social and emotional challenges stemming from issues related to bowel control and sexual performance. Consequently, people might suffer from social seclusion, which could result in sadness and a drop in self-worth. Women may experience challenges and negative results during pregnancy and the childbirth experience [8]. In this case, the fear of impacting marital relationships led to the diagnosis being concealed, preventing the patient from pursuing additional diagnostic evaluation to rule out other comorbidities. If the diagnosis had been accurately determined during childhood, which appears to be a rather straightforward process, the patient might not have inevitably encountered new diagnostic challenges later in life. This case serves as a strong example of how entrenched sociocultural beliefs can affect women's health choices, particularly regarding personal relationships and essential medical treatment. The choice of the patient to keep details of her congenital anomaly from her husband — even while in a sexual relationship and nearing childbirth — illustrates the widespread fear of stigma, judgment, and possible harm to marital stability. What makes this case especially compelling is not only the late identification of a vestibular fistula in adulthood, but also the psychological and emotional weight the patient bore to maintain an appearance of normalcy. It highlights how, in numerous low- and middle-income contexts, women might feel pressured to choose confidentiality over obtaining care or assistance, particularly when concerns involve sexuality or reproductive health. Rather than a clinical anomaly, this case should be viewed through a social medicine and gender studies lens, where structural barriers and internalized stigma shape both the health outcomes and lived experiences of women. Conclusion Any genitourinary anomaly of embryonic origin must be examined carefully for new insights that aid in comprehending the defects. The case report provides insights for women's health care providers regarding the handling of vestibular anus when presented late. It outlines follow-up challenges in low- and middle-income countries caused by insufficient social support. What makes this case particularly compelling is not only the delayed diagnosis of a vestibular fistula in adulthood, but also the psychological and emotional burden the patient carried in order to preserve the appearance of normalcy. Declarations Authors' contributions The case report was written by MS and FD. VM evaluated and revised the final manuscript. All authors examined the manuscript rigorously for significant intellectual contributions and agreed on the final version. Conflict of interest None. Funding None. Consent for publication The written permission from the patient on whom the report is based has been obtained. References Levitt MA, Pena A. Imperforate anus and cloacal malformations. In: Holcomb GW III, Murphy JP, editors. Ashcraft's Pediatric Surgery. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010. pp. 468–90. Bokhari I, Ali SU, Farooq AR, Khan A. Late presentation of a patient with an anorectal malformation (ARM). J Coll Physicians Surg Pak. 2010 Dec;20(12):825-7. Mokaila ME, Mabitsela ME, Tshifularo N. Management and outcomes of vestibular anorectal malformations in a low-income country hospital. Pan Afr Med J. 2024 Mar 18;47:121. doi: 10.11604/pamj.2024.47.121.42919. Zwink N, Jenetzky E, Brenner H. Parental risk factors and anorectal malformations: systematic review and meta-analysis. Orphanet J Rare Dis. 2011 May 17;6:25. doi: 10.1186/1750-1172-6-25. Abdelmohsen SM, Abdelazeem B. Vestibular anus, a surgical dilemma. Japanese J Gastroenterol Res. 2021; 1(6): 1027. van den Hondel D, Sloots CE, Gischler SJ, Meeussen CJ, Wijnen RM, IJsselstijn H; Surgical Long-term Follow Up team. Prospective long-term follow up of children with anorectal malformation: growth and development until 5years of age. J Pediatr Surg. 2013 Apr;48(4):818-25. doi: 10.1016/j.jpedsurg.2012.09.068. STEPHENS FD. Imperforate rectum; a new surgical technique. Med J Aust. 1953 Feb 7;1(6):202-3. PMID: 13036524. Haider N, Fisher R. Mortality and morbidity associated with late diagnosis of anorectal malformations in children. Surgeon. 2007 Dec;5(6):327-30. doi: 10.1016/s1479-666x(07)80083-7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7323926","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":561332114,"identity":"4e82f763-7b20-49de-86fb-1aa982c729a2","order_by":0,"name":"Fatemeh Darsareh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBAC9gYgwQNhszF8YGBIIKiF5wCSFsYZJGth5iFKC/vpxA9vau7Z888+fOyxbZtdHj97A+OHjzl4tPDkbpacc6w4cca5tHTj3LbkYsmeA8ySM7fh1mLPkLtBmoctIYHhDI+ZdG4bc+KGGwlszLx4tPDwv938m+dfgr38Gf5v0pZt9URokcjdJs3blsC44QwPmzRj22FitLzdZjm3LyFx4xk2M8mec8cTZ/YcbMbrFx7+3M033nxLsJc7w/xM4kdZdWI/e/PBDx/xaEEFjGxgsoFY9SDwhxTFo2AUjIJRMFIAALTpURiTGy40AAAAAElFTkSuQmCC","orcid":"","institution":"Hormozgan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Darsareh","suffix":""},{"id":561332115,"identity":"6d31b4ed-8e55-4059-a2f3-a1984d65fdef","order_by":1,"name":"Vahid Mehrnoush","email":"","orcid":"","institution":"Hormozgan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Vahid","middleName":"","lastName":"Mehrnoush","suffix":""},{"id":561332116,"identity":"e9091102-7fd7-44c0-89d0-6e0bf253cef2","order_by":2,"name":"Mozhgan Saffari","email":"","orcid":"","institution":"Hormozgan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mozhgan","middleName":"","lastName":"Saffari","suffix":""}],"badges":[],"createdAt":"2025-08-08 06:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7323926/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7323926/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98779071,"identity":"0d34cb3a-6bea-4c53-a372-fe44c3902631","added_by":"auto","created_at":"2025-12-22 12:29:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":895446,"visible":true,"origin":"","legend":"\u003cp\u003eVestibular anus in a 42-years-old female diagnosed during labor.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7323926/v1/795862951c7d980216b8f4e3.png"},{"id":98783242,"identity":"b7d9bef1-23a2-4c13-b98b-dde6f52cb9db","added_by":"auto","created_at":"2025-12-22 12:41:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1548959,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7323926/v1/0194a200-ad48-4424-a4b9-ce00390f889a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"When a health issue turns into a stigma: a presentation of a rare case of delayed diagnosis of vestibular anus in a 42-Year-Old woman during childbirth","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnorectal malformations (ARM) represent a range of congenital defects that impact both males and females, involving the distal anus and rectum along with the urinary and genital systems. ARM happens in roughly 1 in 5000 live births and is more frequent in females [1]. Timely identification and proper treatment of ARM are essential for attaining positive results, particularly during developmental phases when sphincter muscles are flexible and responsive to intervention. In this important period, interventions can aid in the incorporation of somatosensory input, a skill that generally declines with growing older [2].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In developing countries, the identification of ARM frequently occurs late, with individuals showing up in their teenage years or later. This has been linked to various factors, such as lack of knowledge, financial hardship, and fragile social support networks [3]. Vestibular anus is the most prevalent form of ARM observed in females. The occurrence of this malformation in adults is uncommon. This is a case of an adult with ARM presenting with a vestibular fistula in a 42-year-old female, who was diagnosed during childbirth.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 42-year-old G1P0 woman at 39 weeks of gestation arrived at the hospital\u0026apos;s delivery ward experiencing labor contractions. During the vaginal examination, we observed an opening at the lower part of the vaginal orifice. After careful observation, we determined that there was no anus in the perineum and concluded that this opening could be the anus. The patient was diagnosed with vestibular anus. (Figure 1)\u003c/p\u003e\n\u003cp\u003eThe patient did not report any past occurrences of repeated urinary tract infections or bowel issues. The sole issue she encountered was dyspareunia, which never prompted her to see a doctor.\u0026nbsp;She got married a year prior to her pregnancy at the age of 40. She did not disclose a sexual relationship before her marriage. She has never been seen by a gynecologist. She provided routine prenatal care at maternal health facilities.\u003c/p\u003e\n\u003cp\u003eDuring the vaginal exam, the cervix measured approximately three centimeters in dilation. The wall between the rectum and vagina was thin. Given the thinness of the rectovaginal wall and worries about potential injury and significant tearing in this area during labor, it was decided to perform a cesarean section. The patient\u0026apos;s situation was clarified for her, and with her consent, the choice to carry out a cesarean section was made. The most significant aspect was the patient\u0026apos;s determination to keep the information from her husband. Since she thought that her husband\u0026apos;s awareness of the genital malformation could affect their married life. Given that they had experienced no issues with their sexual relationship prior to the diagnosis, she preferred her condition to stay private. The decision made by the patient was honored. The baby girl was born via cesarean section, and the mother left the hospital in stable overall condition. The mother did not express any particular concerns during her postpartum recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEight weeks after delivery, the mother was contacted again and advised to return for further evaluation, but she insisted that the diagnosis remain confidential and did not want further diagnostic and therapeutic follow-up to affect her life.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt birth, any newborn should undergo a general examination that includes the perineum. In the girl, the diagnosis depends on the look of the perineum. Typically, three noticeable openings exist \u0026mdash; the anterior one is the urethra, succeeded by the vagina, both located within the vestibule. Located behind the perineal body is the anus. The existence of three openings, where the anus is not located in its typical position, suggests a perineal fistula, previously known as the anterior perineal anus. A vestibular fistula is identified when the third opening is observed in the vestibule [4]. A vestibular anus, also known as a vestibular fistula, is a rare type of ARM refers to a congenital condition where the anus is located in the vestibule behind the vaginal opening. It has a shared wall that separates the vagina from the rectum. Along with an unusual appearance, it causes repeated episodes of urinary tract and vaginal infections. In adult women, it results in dyspareunia [5]. Such abnormalities are typically observed at birth or in early childhood. If neglected at this moment, they are typically seen throughout the course of pregnancy [6]. A patient facing this complication, as in our case, may fail to identify this abnormality due to having adequate sphincter control, not encountering dyspareunia or repeated urinary tract infections. Wright (1947) describes a case involving a 53-year-old woman with vestibular anus who had one normal delivery without needing perineal sutures, which went unnoticed until she presented with cervical cancer [7]. A delayed diagnosis of vestibular anus can result in social and emotional challenges stemming from issues related to bowel control and sexual performance. Consequently, people might suffer from social seclusion, which could result in sadness and a drop in self-worth. Women may experience challenges and negative results during pregnancy and the childbirth experience [8]. In this case, the fear of impacting marital relationships led to the diagnosis being concealed, preventing the patient from pursuing additional diagnostic evaluation to rule out other comorbidities. If the diagnosis had been accurately determined during childhood, which appears to be a rather straightforward process, the patient might not have inevitably encountered new diagnostic challenges later in life.\u003c/p\u003e\n\u003cp\u003eThis case serves as a strong example of how entrenched sociocultural beliefs can affect women\u0026apos;s health choices, particularly regarding personal relationships and essential medical treatment. The choice of the patient to keep details of her congenital anomaly from her husband \u0026mdash; even while in a sexual relationship and nearing childbirth \u0026mdash; illustrates the widespread fear of stigma, judgment, and possible harm to marital stability. What makes this case especially compelling is not only the late identification of a vestibular fistula in adulthood, but also the psychological and emotional weight the patient bore to maintain an appearance of normalcy. It highlights how, in numerous low- and middle-income contexts, women might feel pressured to choose confidentiality over obtaining care or assistance, particularly when concerns involve sexuality or reproductive health. Rather than a clinical anomaly, this case should be viewed through a social medicine and gender studies lens, where structural barriers and internalized stigma shape both the health outcomes and lived experiences of women.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAny genitourinary anomaly of embryonic origin must be examined carefully for new insights that aid in comprehending the defects. The case report provides insights for women\u0026apos;s health care providers regarding the handling of vestibular anus when presented late. It outlines follow-up challenges in low- and middle-income countries caused by insufficient social support. What makes this case particularly compelling is not only the delayed diagnosis of a vestibular fistula in adulthood, but also the psychological and emotional burden the patient carried in order to preserve the appearance of normalcy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe case report was written by MS and FD. VM evaluated and revised the final manuscript. All authors examined the manuscript rigorously for significant intellectual contributions and agreed on the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe written permission from the patient on whom the report is based has been obtained.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLevitt MA, Pena A. Imperforate anus and cloacal malformations. In: Holcomb GW III, Murphy JP, editors. Ashcraft\u0026apos;s Pediatric Surgery. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010. pp. 468\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eBokhari I, Ali SU, Farooq AR, Khan A. Late presentation of a patient with an anorectal malformation (ARM). J Coll Physicians Surg Pak. 2010 Dec;20(12):825-7.\u003c/li\u003e\n\u003cli\u003eMokaila ME, Mabitsela ME, Tshifularo N. Management and outcomes of vestibular anorectal malformations in a low-income country hospital. Pan Afr Med J. 2024 Mar 18;47:121. doi: 10.11604/pamj.2024.47.121.42919.\u003c/li\u003e\n\u003cli\u003eZwink N, Jenetzky E, Brenner H. Parental risk factors and anorectal malformations: systematic review and meta-analysis. Orphanet J Rare Dis. 2011 May 17;6:25. doi: 10.1186/1750-1172-6-25.\u003c/li\u003e\n\u003cli\u003eAbdelmohsen SM, Abdelazeem B. Vestibular anus, a surgical dilemma. Japanese J Gastroenterol Res. 2021; 1(6): 1027.\u003c/li\u003e\n\u003cli\u003evan den Hondel D, Sloots CE, Gischler SJ, Meeussen CJ, Wijnen RM, IJsselstijn H; Surgical Long-term Follow Up team. Prospective long-term follow up of children with anorectal malformation: growth and development until 5years of age. J Pediatr Surg. 2013 Apr;48(4):818-25. doi: 10.1016/j.jpedsurg.2012.09.068.\u003c/li\u003e\n\u003cli\u003eSTEPHENS FD. Imperforate rectum; a new surgical technique. Med J Aust. 1953 Feb 7;1(6):202-3. PMID: 13036524.\u003c/li\u003e\n\u003cli\u003eHaider N, Fisher R. Mortality and morbidity associated with late diagnosis of anorectal malformations in children. Surgeon. 2007 Dec;5(6):327-30. doi: 10.1016/s1479-666x(07)80083-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anorectal malformations, Vestibular anus, Stigma, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7323926/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7323926/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eIn developing countries, the identification of anorectal malformations frequently occurs late. In this case we present a delayed diagnosis of vestibular fistula.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation \u003c/strong\u003eA 42-year-old G1P0 woman was diagnosed with vestibular anus at the onset of labor. The sole issue she encountered was dyspareunia, which never prompted her to see a doctor. She got married a year prior to her pregnancy and did not disclose a sexual relationship before her marriage. She has never been seen by a gynecologist. During the vaginal exam, the cervix was dilated three centimeters. Given the thinness of the rectovaginal wall and worries about potential injury and significant tearing during labor, it was decided to perform a cesarean section. The most significant aspect was the patient's determination to keep the information from her husband. Since she thought that her husband's awareness of the genital malformation could affect their married life. Given that they had experienced no issues with their sexual relationship prior to the diagnosis, she preferred her condition to stay confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThe case report provides insights for women's health care providers in low- and middle-income countries regarding the follow-up challenges caused by insufficient social support. What makes this case particularly compelling is not only the delayed diagnosis of a vestibular fistula in adulthood, but also the psychological and emotional burden the patient carried in order to preserve the appearance of normalcy.\u003c/p\u003e","manuscriptTitle":"When a health issue turns into a stigma: a presentation of a rare case of delayed diagnosis of vestibular anus in a 42-Year-Old woman during childbirth","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:52:42","doi":"10.21203/rs.3.rs-7323926/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"53a98089-d3f8-45f2-bc51-076e7058022b","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T09:52:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 09:52:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7323926","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7323926","identity":"rs-7323926","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}