Spectrum of anorectal anomalies in the female

Spectrum of anorectal anomalies in the female. The arrows mark the normal anal location. These anomalies can be categorized as complex (in which the fistula connecting the rectum with the urogenital tract is above the puborectalis muscle or there is persistent cloaca) or non-complex (in which the fistula opens in the perineum at a site other than the anatomical anal opening, or the fistula connecting the rectum with the urogenital tract is below the puborectalis muscle in males).

(A) Normal anatomy with anus in normal location and perineal body between anus and vagina.

Complex defects:
(B) Severe anomaly with rectum ending high in the vagina.
(C) Persistent cloaca (in this case, with a short common channel).

Non-complex defects:
(D) Anal opening positioned in the fourchette or vestibule.
(E) Rectoperineal fistula (sometimes described as an anteriorly displaced anus).