This episode explores the essential post-pubertalgynecologic evaluation and management of patients with anorectal malformations. We discuss the clinical importance of starting annual gynecologic visits near menarche (typically between ages 13 and 15) to evaluate menstrual health, screen for Müllerian anomalies, and check for menstrual outflow obstruction using tools like transabdominal pelvic ultrasound. The conversation highlights strategies for managing acute complications like hematometrocolpos with pain control, menstrual suppression, or urgent decompression, while emphasizing why patient readiness, bodily autonomy, and multidisciplinary collaboration are vital to optimizing long-term gynecologic and sexual health outcomes.