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Anal Findings

The other area of contention in medical examination is the physical signs of anal abuse. In particular, the argument centers around a phenomenon of anal gaping called reflex anal dilatation (RAD). Briefly, this involves gently parting the buttocks and observing the anus for half a minute. Usually, the sphincter on the outside of the anus will contract and then dilate, as pressure is maintained. Sometimes the inside sphincter will then also relax giving a view right into the rectum. It is this response that has been named RAD.

British pediatricians Drs Hobbs and Wynne reported that RAD was present in 42% of anally abused children they examined, and claimed that it was an important indicator of abuse (Hobbs & Wynne, 1986, 1989). They stated that they had not witnessed RAD in nonabused children. They also claimed that splits or fissures around the anus are very rare in the nonabused child.

These findings became the basis of a belief in some circles that RAD is proof of anal abuse. More recent studies and observations, however, refute Hobbs and Wynne's findings. One study observed the phenomenon in nearly half of the nonabused children they examined (McCann et al, 1989). It also appears to be more common when a child is constipated and has feces sitting higher in the bowel (Sunderland, 1987; Royal College of Physicians, 1991). Many doctors also report that they have commonly seen anal fissures in nonabused children (Freeman, 1989; Kean, 1989; Royal College of Physicians, 1991).

Unfortunately, Hobbs and Wynne's theories regarding the relevance of anal reflex dilatation was taken to be established fact by a number of doctors examining children. In some centers it became policy for all children to undergo genital and anal examinations, no matter what medical problem they had come with.

This practice resulted in the false epidemic of sexual abuse cases in Cleveland, England, which was to receive worldwide attention from the media. In 1987, two pediatricians working at the Middlesbrough General Hospital in Cleveland, Drs. Marietta Higgs and Geoffrey Wyatt, diagnosed 121 cases of alleged sexual abuse of children in the space of five months. Their diagnoses were made largely from medical examination findings of reported hymenal irregularities and RAD. Many of these children had come to the hospital for treatment of complaints such as asthma, and there was no other evidence suggesting that they had been abused (Bernard, 1988; Woods, 1988). Dr.

Higgs held the view that one in ten children are sexually abused, and sincerely believed that her findings proved the abuse.

The process was. and the evidence coming forward from a number of reputable medical sources regarding the unreliability of relying on medical signs. La Fontaine. distressed parents sought media and political support. Dr. The Cleveland inquiry. and the children and their parents did not emerge unscathed by the experience. . however. 1990) present the view that the allegations in the Cleveland case were founded. Despite the findings of the inquiry. Package swabs and slides. such as RAD. 1988). initially to a hospital and later into care by the social services. label. Optional—smear swabs on microscopic slides. place in envelope. any additional examinations or tests involving the anus should be conducted. despite overwhelming evidence that abuse was not substantiated in the vast majority of the cases. many agencies still maintain their use is valid. according to jurisdictional policy. At this time. As the numbers escalated. [28] Avoid contact with external skin surfaces. and the children were returned to their families (Butler-Sloss. 1988. and initial the seal. Eventually a public inquiry was called. to diagnose abuse. seal. headed by Lord Justice Butler-Sloss. Some books written about the Cleveland affair (Campbell. Higgs still has many supporters within the field who believe her diagnoses were justified. Anal/rectal sample[27] Collect swabs from the anal cavity. found that most of the allegations were unfounded. Air-dry swabs and slides. very traumatic to all concerned.Despite denials from bewildered and distraught parents. the children were immediately taken from their homes.