Reflex anal dilatation

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Reflex anal dilatation refers to a clinical marker associated with anal sexual assault in children[1] and adults. In reflex anal dilation, the anus reflexively opens to a diameter larger than 2cms.

Anal dilation has been described in both abused children with a history of chronic anal sexual assault[2][3] and non-abused children with chronic constipation.[4]

Whilst experts do not agree on the significance of reflex anal dilation in sexual assault assessments,[5] reflex anal dilation is generally considered an indeterminate sign that should be considered as suggestive of sexual assault in the absence of other predisposing factors (such as chronic constipation, sedation, anesthesia, neuromuscular conditions)[6] and alongside other physical findings of sexual assault, and/or the disclosure of the child.[7][8]

[edit] References

  1. ^ Read NW, Sun WM (June 1991). "Reflex anal dilatation: effect of parting the buttocks on anal function in normal subjects and patients with anorectal and spinal disease". Gut 32 (6): 670–3. PMID 2060876. 
  2. ^ C. Hobbs and J. Wynne, Buggery in childhood – a common syndrome of child abuse, Lancet 2 (1986), pp. 792–796
  3. ^ J. Adams, K. Harper and S. Knudson et al., Examination findings in legally confirmed cases of child sexual abuse: it's normal to be normal, Pediatrics 94 (1994), pp. 310–317
  4. ^ G. Clayden, Reflex anal dilatation associated with severe chronic constipation in children, Arch Dis Child 63 (1988), pp. 832–836
  5. ^ David Bernard, Melissa Peters, Kathi Makoroff, "The Evaluation of Suspected Pediatric Sexual Abuse", Clinical Pediatric Emergency Medicine, Volume 7, Issue 3, September 2006, Pages 161-169
  6. ^ Joyce A. Adamns, "Medical Evaluation of Suspected Child Sexual Abuse", The Journal of Pediatric and Adolescent Gynecology, Vol 17, 2005, pp 191–197J
  7. ^ Marilyn Strachan Peterson, Michael Durfee, Kevin Coulter, Child abuse and neglect: Guidelines for Identification, Assessment, and Case Management, Volcano Press, 2003, ISBN: 1884244211
  8. ^ Joyce A. Adams, Rich A. Kaplan, Suzanne P. Starling, Neha H. Mehta, Martin A. Finkel, Ann S. Botash, Nancy D. Kellogg and Robert A. Shapiro, Guidelines for Medical Care of Children Who May Have Been Sexually Abused, Journal of Pediatric and Adolescent Gynecology, Volume 20, Issue 3, June 2007, Pages 163-172

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[edit] External links

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