The doujinshi was released in 2000 by a member of the Zettai Shoujo circle named RAITA. The idea for the game stemmed from a bonus page of a hentai doujinshi based on the manga Nausicaä of the Valley of the Wind, titled Schuppen Harnische. He ceased posting until September 2008 when he stated he had a new job and the young girl was living with him. Users gave them the honorific names Nurse-kun and Ampu-tan, posting fan art of the two.
He began posting in December 2006 making fun of the girl, but over the course of the next six months, he built a relationship with his patient. This game was based on a story told by a poster dubbed Nurse-kun, an anonymous poster who claimed to be a registered nurse taking care of a seven-year-old orphan who lost both of her legs, her right arm, and right eye in a car crash. Previous to Katawa Shoujo, 4chan users came together to publish the visual novel Scarred, released in 2007.
