Sexuality and fertility issues become increasingly important during and after puberty in patients with BEEC. Around 80% of women are sexually active, 90% have orgasms, pregnancy is possible, and most are delivered by cesarean section. Uterine prolapse is one of the most serious complications and is difficult to treat. 30–50% of men are dissatisfied with the appearance of their genitals. Most studies show some erectile dysfunction; ejaculation is not normal, but most patients report some form of ejaculation. Fertility is impaired, and most patients require assisted reproductive techniques. Education about sexual development in BEEC and the provision of psychological and sexual therapy support are strongly recommended.