A child who has been sexually assaulted may have an anal lesion that can be detected months after the event. Examination of the anus should be part of any evaluation of sexual assault in a child.


Lesions that may occur as a result of sexual assault:

(1) scarring of the anus and/or perianal skin, which can result in stenosis

(2) anal tags

(3) perianal venous congestion

(4) reflex anal dilatation

(5) funneled anus (shape fixed in the shape of a funnel)

(6) fissure or tear


The presence of an anal lesion is not proof of abuse.


The presence of anal gonorrhea or other sexually transmitted disease is good evidence for abuse.


The absence of an anal lesion does not mean that abuse did not occur.


Factors affecting the amount of damage caused:

(1) amount of force involved

(2) discrepancy between the size of the anal opening and the item inserted

(3) use of a foreign object with a sharp edge

(4) number of times penetration occurred

(5) previous episodes


Differential diagnosis:

(1) chronic constipation

(2) Crohn's disease

(3) trauma from other sources, including surgery

(4) history of chemotherapy


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