A retrospective study on 23 male children referred for suspected anal sexual abuse between 2020-2023 in county legal medicine service of Brasov, Romania

Abstract

Introduction: Child anal sexual abuse poses important clinical and legal implications and accurate interpretation of anogenital examination findings is essential. This study aimed to determine the prevalence of male children referred for suspected anal sexual abuse between 2020-2023 to the County Legal Medicine Service of Brasov, Romania. Material and Methods: Abnormalities of the anal region were classified into three categories: normal-appearing area, nonspecific findings (abnormalities that could have been caused by anal intercourse but also are observed in pathological conditions) and specific findings (strongly suggestive of sexual abuse). Results: A total of 23 cases were included, who presented a history of sexual assault to the police (n=21 cases) or who came directly to our center to evaluate evidence of anal sexual intercourse (n=2 cases). The mean age of the children in the study group was 9,00 years (range 1 to 15 years). Anal injuries were described in 3/23 cases and consisted of anal fissures or tears, along with anal dilatation, laxity, or reduced tone of the anal sphincter, inflammation (redness, hemorrhagic infiltrate). These were considered specific findings for anal sexual abuse. The ages of the victims were 8, 14, and 15 years old. Data about the perpetrator was known in only one case, a known person to the victim. None of the children showed evidence of chronic anal sexual abuse. None of them presented extra anogenital traumatic injuries. Conclusions: This study assessed the prevalence and the pattern of anal injuries and factors associated with cases of anal sexual abuse in male children. It is important to distinguish between sexual abuse and abnormalities caused by pathological conditions.