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

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.