1/5. A simulated "acquired" imperforate hymen following the genital trauma of sexual abuse.Imperforate hymen, a condition in which the hymen has no aperture, usually occurs congenitally, secondary to failure of development of a lumen. A case of a documented simulated "acquired" imperforate hymen is presented in this article. The patient, a 5-year-old girl, was the victim of sexual abuse. Initial examination showed tears, scars, and distortion of the hymen, laceration of the perineal body, and loss of normal anal tone. Follow-up evaluations over the next year showed progressive healing. By 7 months after the injury, the hymen was replaced by a thick, opaque scar with no orifice. patients with an apparent imperforate hymen require a sensitive interview and careful visual inspection of the genital and anal areas to delineate signs of injury. The finding of an apparent imperforate hymen on physical examination does not eliminate the possibility of antecedent vaginal penetration and sexual abuse.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/5. Empiric therapy of perianal lesions in a sexually abused child: medical and forensic implications.A two-year, eight-month-old boy was diagnosed clinically with perianal warts and treated with topical 5-fluorouracil, with subsequent resolution of the lesions. The child disclosed sexual abuse, and subsequent physical abuse was also documented. Attempts to identify the perpetrator have been hampered by the child's young age and resolution of the skin lesions. The forensic implications of this case are discussed.- - - - - - - - - - ranking = 0.092633203757953keywords = physical (Clic here for more details about this article) |
3/5. Lichen sclerosus, genital trauma and child sexual abuse.OBJECTIVE: To describe the clinical features of lichen sclerosus affecting the genitalia of three unrelated prepubertal girls in whom concerns of sexual abuse had been raised. CLINICAL FEATURES: three girls ranging from 4 to 9 years of age presented with similar genital and anal findings. Their labial skin was atrophic with pale opalescent patches and a variable amount of labial bruising, haemorrhagic blistering and bleeding. In two, the perianal skin was involved in a similar fashion. In each case the hymen was normal with no sign of acute or chronic trauma. CONCLUSIONS: Lichen sclerosus affecting the genitalia of prepubertal females is an uncommon condition that may be mistaken for trauma associated with sexual abuse. An awareness of its clinical features is essential not only for those doctors who examine children for physical signs of sexual abuse but also for primary care doctors who may be confronted with an apparently abused child. Early recognition of this disease should, in the absence of other concerns, prevent unnecessary intervention by police and child protection workers.- - - - - - - - - - ranking = 0.092633203757953keywords = physical (Clic here for more details about this article) |
4/5. Faecal incontinence with transitory absence of anal contraction in two sexually or physically abused women.OBJECTIVE: To report two cases of faecal incontinence caused by transitory absence of anal voluntary contraction without anal anomalies. patients: Two women referred to our gastroenterology department with faecal incontinence. One patient had been sexually abused by her father; the other had been physically abused by her husband. RESULTS: Clinical and manometric anal contraction was absent despite normal anal endosonography and normal electrophysiological perineal study. Anal contraction was completely normalized after biofeedback, and the patients recovered from the faecal incontinence. CONCLUSION: Transitory absence of anal contraction is very uncommon as the origin of faecal incontinence. It was observed in two abused women.- - - - - - - - - - ranking = 0.46316601878977keywords = physical (Clic here for more details about this article) |
5/5. Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax.BACKGROUND AND AIMS: Proctalgia fugax is a common problem, yet its pathophysiology is poorly understood. The objective was to characterise colorectal disturbances in a paraplegic patient with a 10 year history of proctalgia fugax that began two years after an attack of transverse myelitis. methods: Standard anorectal manometry and prolonged 33 hour ambulatory colonic manometry at six sites in the colon were performed together with myoelectrical recording of the anus. Provocative tests designed to simulate psychological and physical stress and two types of meals were included. RESULTS: Anorectal manometry showed normal internal sphincter tone and normal rectoanal inhibitory reflex but an inability to squeeze or to bear down or to expel a simulated stool. Rectal sensation (up to 360 ml inflation) was absent. pudendal nerve latency was prolonged (4.5 ms (normal < 2.2 ms). During colonic manometry, the patient reported 27 episodes of pain, of which 23 (85%) were associated with bursts (1-60 min) of a high amplitude (0.5 to > 3.2 mv), high frequency (5-50/min) anal myoelectrical activity, particularly after stress tests, meals, and at night. The myoelectrical disturbance only occurred with proctalgia. Intermittently, 16 bursts of 3 cycles/ min phasic rectal contractions were seen, but only six were associated with proctalgia. Colonic motility was reduced compared with normal subjects. CONCLUSIONS: The temporal association between a high amplitude, high frequency myoelectrical activity of the anal sphincter, and the occurrence of proctalgia suggests that paroxysmal hyperkinesis of the anus may cause proctalgia fugax.- - - - - - - - - - ranking = 0.092633203757953keywords = physical (Clic here for more details about this article) |