Metrics details. There is uncertainty about the nature and specificity of physical signs following anal child sexual abuse. The study investigates the extent to which physical findings discriminate between children with and without a history of anal abuse. Controls: all children examined anally from to with possible physical abuse or neglect with no identified concern regarding sexual abuse. To explore the potential role of confounding, logistic regression was used to produce odds ratios adjusted for age and gender.
A total of cases boys, 79 girls , average age Novel signs seen significantly more commonly in cases were anal fold changes, swelling and twitching. Erythema, swelling and fold changes were seen most commonly within 7 days of last reported contact; RAD, laxity, venous congestion, fissure and twitching were observed up to 6 months after the alleged assault.
Anal findings are more common in children alleging anal abuse than in those presenting with physical abuse or neglect with no concern about sexual abuse.
Multiple signs are rare in controls and support disclosed anal abuse. Peer Review reports. Physical evidence has been the subject of consensus statements [ 3 ] and systematic review [ 4 ]. Anal findings are described following CSA [ 5 β 13 ], in children selected for non-abuse [ 14 β 16 ] and those with medical conditions affecting the anus [ 17 β 21 ].
There have been two previous studies where anal signs in different groups of children were compared [ 10 , 11 ]. If present, anal signs may be used in children with a disclosure of CSA to provide corroboration for court proceedings, but it is not currently clear how much reliance can be placed on which signs. There is even less certainty about the extent to which anal signs seen in children with no disclosure or suspicion should raise concern about possible CSA and the need for further investigation.
