Anal and perianal abnormalities in prepubertal victims of sexual abuse.
We describe anal and perianal findings in 310 prepubertal children who were determined to be victims of sexual abuse; 206 (66%) had perinea that appeared normal. Abnormal findings were present in 104 children (34%): anal gapping in 61 children; skin tags in 44; rectal tears in 33; sphincter tears in 15; human papillomavirus lesions in 4; perineal scarring in 2; and bite marks in 1. Normal-appearing perianal and anal regions were noted in 150 of 175 children (85%) who denied anal assault, and in 11 of 70 (16%) who described such assault. In comparison, anal and perianal abnormalities were observed in 59 of the 70 children (84%) who gave a clear history of anal assault, but in only 25 of 175 (15%) who denied such abuse. Failure to document perianal abnormalities in almost two thirds of the patients demonstrates the limitations of the medical evaluation in validating allegations of sexual abuse.
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103.
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D000367:Age Factors; D001003:Anal Canal / Q000293:injuries*; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010502:Perineum / Q000293:injuries*; D013714:Tennessee