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There is uncertainty about the nature and specificity of physical signs following anal child sexual abuse. The study investigates the extent to which physical findings discriminate between children with and without a history of anal abuse. Controls: all children examined anally from to with possible physical abuse or neglect with no identified concern regarding sexual abuse. To explore the potential role of confounding, logistic regression was used to produce odds ratios adjusted for age and gender. A total of cases boys, 79 girls , average age Novel signs seen significantly more commonly in cases were anal fold changes, swelling and twitching. Anal findings are more common in children alleging anal abuse than in those presenting with physical abuse or neglect with no concern about sexual abuse. Multiple signs are rare in controls and support disclosed anal abuse. Physical evidence has been the subject of consensus statements [ 3 ] and systematic review [ 4 ]. Anal findings are described following CSA [ 5 - 13 ], in children selected for non-abuse [ 14 - 16 ] and those with medical conditions affecting the anus [ 17 - 21 ].
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