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Background: 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 1998 to 2007 with possible physical abuse or neglect with no identified concern regarding sexual abuse. Fisher's exact test (two-tailed) was performed to ascertain the significance of differences for individual signs between cases and controls. To explore the potential role of confounding, logistic regression was used to produce odds ratios adjusted for age and gender.
Results: A total of 184 cases (105 boys, 79 girls), average age 98.5 months (range 26 to 179) were compared with 179 controls (94 boys, 85 girls) average age 83.7 months (range 35-193). Of the cases 136 (74%) had one or more signs described in anal abuse, compared to 29 (16%) controls. 79 (43%) cases and 2 (1.1%) controls had >1 sign. Reflex anal dilatation (RAD) and venous congestion were seen in 22% and 36% of cases but
Conclusions: 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.
The main symptom of rectal prolapse is the protrusion of part or all of the rectum's lining through your child's anal sphincter. You may notice a dark red mass protruding from the anus, sometimes accompanied by blood or mucus, particularly when your child is straining. Rectal prolapse isn't usually painful, but it can cause discomfort. Other symptoms may include:
Sexually Transmitted Diseases (STDs) have been rising among gay and bisexual men, with increases in syphilis being seen across the country. In 2014, gay, bisexual, and other men who have sex with men accounted for 83% of primary and secondary syphilis cases where sex of sex partner was known in the United States. Gay, bisexual, and other men who have sex with men often get other STDs, including chlamydia and gonorrhea infections. HPV (Human papillomavirus), the most common STD in the United States, is also a concern for gay, bisexual, and other men who have sex with men. Some types of HPV can cause genital and anal warts and some can lead to the development of anal and oral cancers. Gay, bisexual, and other men who have sex with men are 17 times more likely to get anal cancer than heterosexual men. Men who are HIV-positive are even more likely than those who do not have HIV to get anal cancer.
The simple fact of the matter is that there are nerve endings in your anus. It feels good to have stimulation there. But the only way anal play defines your sexuality is if you want another guy to stimulate your anus and you choose to identify yourself as gay.
Women should know that bareback sex increases the risk of getting HIV and other STIs for them too. The rectal lining is more delicate than the vagina, making it easier to transmit HIV through cuts or anal fissures that can happen from anal sex.
Some strains of this virus cause warts, including genital and anal warts. Other strains are responsible for cervical cancer, anal cancer and some cancers of the penis, vagina, vulva, urethra, tongue and tonsils.
Dr David Templeton of SPANC (Study for the Prevention of Anal Cancer) study said that its purpose was to see if routine screening of gay men for anal lesions would be worth doing to prevent anal cancer.
David Templeton told the conference that anal cancer is rare in the general population, with about one case per 100,000 people per year. Previous surveys indicate it is between five to 20 times more common in HIV-negative gay men, ten times more common in HIV-positive people who are not gay men, and 50 to 100 times more common in HIV-positive gay men (roughly one in a thousand men a year).
HPV is extremely contagious and spread through almost any contact with the mucous membranes lining the anus, cervix or mouth, but the immune system usually clears single infections within a year or two. Only certain subtypes of the more than 100 HPV varieties cause cancer, of which HPV16 is the most common, and one of the four varieties that the Gardasil HPV vaccine now given to adolescents in many countries prevents. The reason for the higher rates in gay men and in HIV-positive people is that HPV infection is already more frequent in people who have anal sex, and infections are also cleared more slowly by people with impaired immunity (transplant patients, who have artificially depressed immunity, also have higher rates).
SPANC recruited 617 gay and bisexual men aged 35 or over between September 2009 to May 2018. They had anal swabs and examinations taken at the start of the study, six months later, and one, two and three years after recruitment.
There are several ways of grading anal and cervical cancer, to do with the appearance of cells and the area of tissue they cover. They are classed as low-grade or high-grade squamous intraepithelial lesions (LSIL or HSIL) in terms of cellular appearance and AIN (anal intraepithelial neoplasia) grades 1, 2, or 3 in terms of the thickness of tissue affected. HSIL+AIN3 is the highest-risk combination of grades in terms of cancer risk.
However, while clearance of HPV16 infection meant that HSIL clearance was 74% more likely, only 14% of men with persistent HPV16 infection (defined as two subsequent positive HPV16 tests) cleared HSIL per year. This shows why persistent HPV16 infection is such a red flag for anal cancer.
There was, however, only once new (incident) case of anal cancer in the whole study, in an HIV-negative man, representing one case in 444 person-years, or one in 241 HIV-negative men. There were two other cases diagnosed but it is thought that these men already had anal cancer when they entered the study, so they cannot be counted as incident infections. It is very difficult to calculate a population incidence from one case but this does seem to be out of line with the very high incidence rates quoted for gay men and especially HIV-positive gay men in previous studies. Linkage to larger cohort studies may provide more robust figures.
Templeton D J et al. The natural history of anal high grade squamous intraepithelial lesions in HIV-positive and HIV-negative gay and bisexual men. 17th European AIDS Conference, Basel, abstract PS6/1, 2019.
Freud believed that when a child grew to realize that they could manage and restrict their bowel movements that the stage would be set for them to potentially develop either an anal-retentive personality or anal expulsive personality.
In common usage, a person who is said to have an anal personality would generally be considered to have a personality quirk. On the other hand, a person with OCPD would be considered to have a mental disorder that interferes with their daily life.
Like many bottoms, my gay friend George* has a harrowing story about using an enema before anal sex. "I had met a guy on Grindr," he said. "I get to his place and ring the doorbell. As he opened the door to say hi, I coughed and shat out a load of poo water into my underwear. Loudly. I had to run into his flat, straight to the toilet, and throw my underwear away. It was all down my legs. It killed the mood, needless to say. And, yes, I left the dirty underwear there."
Dr. Evan Goldstein, who founded the gay men's sexual wellness practice Bespoke Surgical (and is one of the country's foremost anal rejuvenators), provided a helpful hypothetical. "Imagine if you line up ten guys, and you're going to top them all," he said, describing a modest Thursday evening at The Eagle. "Even if they haven't prepared, nine out of ten would be completely stool-free."
Dr. Goldstone points out that douching too often can lead to other, long-lasting problems, too. "If you're doing it every day, there are a lot of issues with enemas. You can lengthen your colon, and that can lead to constipation later in life," he said. Yep, your worst fears are true: the constant pushing required to expel all of that water-logged poop can blow out the anal sphincters that keep it in, causing irreparable harm that can mess up bowel movements down the road. Dr. Goldstone said symptoms of that damage aren't often evident until it's too late.
This means that lube is really, really important for any anal play. First, to stop damage to the internal lining of your arse. Second, to make bottoming (and topping!) more pleasurable. And third, to help protect it from infections.
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Novel signs seen significantly more commonly in cases were anal fold changes, swelling and twitching. Erythema, swelling and fold changes were seen most commonly within 7 days of last reported contact; RAD, laxity, venous congestion, fissure and twitching were observed up to 6 months after the alleged assault.
If present, anal signs may be used in children with a disclosure of CSA to provide corroboration for court proceedings, but it is not currently clear how much reliance can be placed on which signs. There is even less certainty about the extent to which anal signs seen in children with no disclosure or suspicion should raise concern about possible CSA and the need for further investigation.
This study aimed to compare the prevalence of anal findings as assessed by specialist forensically trained paediatricians in a group of children where the history included a statement by the child of anal abuse with a group of children with a history solely of non-sexual physical abuse or neglect and with no concerns re sexual abuse.
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