- Reflex anal dilatation
Reflex anal dilatation refers to a clinical marker associated with anal sexual assault in childrencite journal |author=Read NW, Sun WM |title=Reflex anal dilatation: effect of parting the buttocks on anal function in normal subjects and patients with anorectal and spinal disease |journal=Gut |volume=32 |issue=6 |pages=670–3 |year=1991 |month=June |pmid=2060876 |doi= |url=http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=2060876] and adults. In reflex anal dilation, the anus reflexively opens to a diameter larger than 2 cm.
Anal dilation has been described in both abused children with a history of chronic anal sexual assault [C. Hobbs and J. Wynne, Buggery in childhood – a common syndrome of child abuse, Lancet 2 (1986), pp. 792–796] [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] and non-abused children with chronic constipation. [G. Clayden, Reflex anal dilatation associated with severe chronic constipation in children, Arch Dis Child 63 (1988), pp. 832–836]
Whilst experts do not agree on the significance of reflex anal dilation in sexual assault assessments, [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] 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) [Joyce A. Adamns, "Medical Evaluation of Suspected Child Sexual Abuse", The Journal of Pediatric and Adolescent Gynecology, Vol 17, 2005, pp 191–197J] and alongside other physical findings of sexual assault, and/or the disclosure of the child. [Marilyn StrachanPeterson, Michael Durfee, Kevin Coulter, Child abuse and neglect: Guidelines for Identification, Assessment, and Case Management, Volcano Press, 2003, ISBN: 1884244211] [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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