Recurrent Pelvic Inflammatory Disease and Resistant Balanoposthitis Secondary to a Variant Low Female Anorectal Malformation: An Unusual Cause of Primary Infertility in an Adult Couple

Abstract

Primary infertility in adult couples is most commonly attributed to ovulatory dysfunction, tubal pathology, or male factor abnormalities. Rarely, congenital Anorectal Malformations (ARMs) persisting into adulthood may create atypical urogenital contamination pathways, predisposing both partners to recurrent genital infections. We report an unusual case of a married couple presenting with recurrent Pelvic Inflammatory Disease (PID) in the female partner and chronic, treatment‑resistant balanoposthitis in the male partner. After extensive evaluation, the underlying cause was identified as a previously unrecognised variant low anorectal malformation in the woman, resulting in a concealed recto‑vestibular fistulous tract. Surgical correction led to complete resolution of infections in both partners and subsequent spontaneous conception. This case highlights the importance of considering congenital anorectal variants in adults with unexplained recurrent genital infections and infertility.

Keywords: Primary Infertility; Pelvic Inflammatory Disease; Balanoposthitis; Anorectal Malformation; Anovestibular Fistula; Congenital Anomaly; Anterior Sagittal Anorectoplasty; Enteric Contamination; Recurrent Genital Infections; Adult Presentation of ARM

Citation

Govani DR, Mehta AR, Midha PK, Govani ND, Panchasara NG, Patel RR, et al. Recurrent Pelvic Inflammatory Disease and Resistant Balanoposthitis Secondary to a Variant Low Female Anorectal Malformation: An Unusual Cause of Primary Infertility in an Adult Couple. wjog.2026.a2802. https://doi.org/10.5281/zenodo.18463247