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Journal Article


Myhre AK, Adams JA, Kaufhold M, Davis JL, Suresh P, Kuelbs CL. Child Abuse Negl. 2013; 37(7): 465-474.


University of California, San Diego School of Medicine and Chadwick Center for Children and Families, Rady Children's Hospital, San Diego, 3020 Children's Way, MC 5016 San Diego, CA 92123, USA; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology and Regional Resource Center, St. Olav's University Hospital, Schwach's Gate 1, 7030 Trondheim, Norway.


(Copyright © 2013, Elsevier Publishing)






Interpreting the significance of anal findings in child sexual abuse can be difficult. The aim of this study is to compare the frequency of anal features between children with and without anal penetration. This is a retrospective blinded review of consecutive charts of children seen for suspected sexual abuse at a regional referral center from January 1. 2005 to December 31. 2009 Based on predetermined criteria, children were classified into two groups: low or high probability of anal penetration. The charts of 1115 children were included, 84% girls and 16% boys with an age range from 0.17 to 18.83 years (mean 9.20 year). 198 children (17.8%) were classified as belonging to the anal penetration group. Bivariate analysis showed a significant positive association between the following features and anal penetration: Anal soiling (p=0.046), fissure (p=0.000), laceration (p=0.000) and total anal dilatation (p=0.000). Logistic regression analysis and stratification analysis confirmed a positive association of soiling, anal lacerations and anal fissures with anal penetration. Total anal dilation was significantly correlated with a history of anal penetration in girls, in children examined in the prone knee chest position and in children without anal symptoms. Several variables were found to be significantly associated with anal penetration, including the controversial finding of total anal dilatation. Due to limitations in the study design, this finding should still be interpreted with caution in the absence of a clear disclosure from the child.

Language: en


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