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.