Objective: Hirschsprung is a congenital disorder affecting the gastrointestinal tract. However, pelvic colorectal surgery in infancy has been hypothesised to impact gynaecological outcomes in later life. Describe sexual function and fertility outcomes in women with Hirschsprung disease compared to population controls. Assess factors associated with poor outcomes (sexual dysfunction and subfertility). Design: International multicentre cross-sectional cohort study with population-matched controls Setting: Status post-discharge from paediatric services Population: Female patients aged > 20 years Methods: Validated questionnaire based survey with linkage to patient medical records. Comparison with controls using Mann-Whitney and Fisher’s Exact tests. Multivariable logistic regression using outcomes of sexual dysfunction and subfertility. Main Outcome Measures: Sexual Dysfunction (Female Sexual Function Index; FSFI ≤ 26), Subfertility at 1 and 2 years. Results: Sexual dysfunction as per the FSFI was more common in patients and associated with poor functional outcomes; sexual abstinence seemed to associate even moreso with poor bowel outcomes. Subfertility was higher in patients compared to controls (1 year: 21/45 (47%) vs 38/178 (21%), p=0.0008; 2 years: 12/45 (27%) vs 17/178 (10%), p=0.004). There was an increased proportion of patients who had accessed fertility services (20/45 (44%) vs 43/178 (24%); p=0.009), however the proportion of successful pregnancies in patients attempting to conceive with IVF (11/17 (65%) vs 27/43 (63%); p=1.0) were similar. Conclusions: This novel data suggests that women with Hirschsprung disease who have undergone reconstructive surgery may be at risk for adverse sexual functional and fertility outcomes.