Aim: The aim of this study was to examine the prevalence of sexual dysfunction and distress and to assess whether sexual functioning could be predicted by psychosocial factors in childhood and adolescence in patients with an anorectal malformation or Hirschsprung disease. Material and methods: In 1998 patients completed a psychosocial questionnaire: The Self-Perception profile. To assess the prevalence of sexual distress and sexual functioning in adulthood (2015) the Female Sexual Function Index (FSFI), The Female Sexual Distress Scale (FSDS) and the International Index of Erectile Functioning (IIEF) were used. Results: In total 74 patients returned the questionnaires (26.2%). 36.8% of women reported sexual dysfunction and 45% experienced sexual distress. In our male sample 8.8% reported mild to moderate erectile dysfunction. In females perceived self-competence in adolescence was associated with sexual distress (p <.01). In male adolescents associations were found between perceived self-competence in romantic relations (p <.01) and in close friendships (p <.05) and sexual desire in adulthood. Conclusion: Pediatric surgeons should be more aware of sexual problems patients may face at older age as a result of their congenital disease and treatment. More standardized care and follow-up are needed. Prognosis study–Level II.