Reflex anal dilation

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Reflex anal dilation (RAD) is the reflexive dilation of the human anus to a diameter greater than two centimeters in response to the parting of the buttocks or anal stimulation, such as brushing with a medical instrument. RAD was theorized to be a clinical marker associated with anal sexual assault in children,[1] and has been associated with other signs of sexual assault[2] but also appears in children with severe chronic constipation and those subject to invasive medical treatments of the anus.[3] The finding of RAD alone is not considered indicative of sexual abuse,[4] and a normative sample of children not suspected of having been sexually abused found that a significant number of children showed anal dilation either continuously or intermittently.[5]

Used extensively in the Cleveland child abuse scandal, it was discredited during the trial as the sole indication of sexual abuse, determined to be considered a sign of sexual assault by a tiny minority of British physicians.[6] RAD is now considered discredited.[7]

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  1. ^ Read NW, Sun WM (June 1991). "Reflex anal dilation: effect of parting the buttocks on anal function in normal subjects and patients with anorectal and spinal disease". Gut 32 (6): 670–3. doi:10.1136/gut.32.6.670. PMC 1378886. PMID 2060876. 
  2. ^ Bruni M (November 2003). "Anal findings in sexual abuse of children (a descriptive study)". J. Forensic Sci. 48 (6): 1343–6. PMID 14640283. 
  3. ^ Clayden, G (1988). "Reflex anal dilation associated with severe chronic constipation in children". Arch Dis Child 63 (7): 832–836. doi:10.1136/adc.63.7.832. PMC 1779059. PMID 3415302. 
  4. ^ Brittain, Charmaine; American Medical Association (2006). Understanding the medical diagnosis of child maltreatment: a guide for nonmedical professionals. Oxford [Oxfordshire]: Oxford University Press. pp. 126. ISBN 0-19-517217-5. 
  5. ^ McCann J, Voris J, Simon M, Wells R (1989). "Perianal findings in prepubertal children selected for nonabuse: a descriptive study". Child Abuse Negl 13 (2): 179–93. doi:10.1016/0145-2134(89)90005-7. PMID 2743179. 
  6. ^ Ashenden, S (2004). Governing child sexual abuse: negotiating the boundaries of public and private, law and science. Routledge. pp. 144–153. ISBN 0-415-15894-X. 
  7. ^ Liz Bonner; Mandy Wells (2007). Effective Management of Bladder and Bowel Problems in Children. Class Publishing. pp. 75. ISBN 1-85959-165-5. 

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