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Perianal anatomy in non-abused preschool children
A K Myhre1, K Bemtzen, D Bratlid
1Department of Women's and Children's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim. arne.k.myhre@medisin.ntnu.no
Insights
Perianal anatomy in preschool children shows variations based on gender and examination position. Findings suggest these differences relate to anal muscle structure and tone.
Area of Science:
- Pediatric anatomy
- Forensic medicine
Background:
- Normal perianal anatomy in children is not well-defined.
- Understanding variations is crucial for non-abuse evaluations.
Purpose of the Study:
- Describe normal perianal anatomy in preschool children.
- Compare findings between left lateral position (LLP) and prone knee-chest position (KCP).
Main Methods:
- 305 children (103 boys, 202 girls) aged 5.13-6.75 years participated.
- Anal examinations performed in LLP and KCP using colposcopy and camera.
- Data analyzed for gender and position differences.
Main Results:
- Girls showed more venous congestion (LLP) and external anal dilatation (both positions).
- Boys had more midline depressions and smooth areas (both positions).
- KCP revealed more external/total anal dilatation, prominent anal verge, and midline smooth areas/depressions.
Conclusions:
- Significant gender and position-dependent variations in perianal anatomy were observed.
- These anatomical differences likely stem from variations in anal muscle structure and tone.
Unlabelled:
The purpose of this study was to describe the normal variation in perianal anatomy in preschool children, selected for non-abuse, and to compare the findings in two examination positions. A letter of invitation was sent to 3773 children, after which 305 children (103 boys and 202 girls) were recruited. Inclusion in the study was based on self-selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. The mean age of the children was 5.63 y (range: 5.13-6.75). An anal examination was performed in the left lateral position (LLP) and the prone knee-chest position (KCP), for approximately 30 s each. A colposcope and a camera were used. All data were systematically analysed for gender differences, and a paired sample test was used to compare findings in LLP and KCP. Venous congestion in LLP and external anal dilatation in both positions were significantly more common in girls, while midline depressions and smooth areas (both positions) were significantly more common in boys. External and total anal dilatation, midline smooth areas and depressions and the occurrence of a prominent anal verge were significantly more common in the KCP. The finding of total anal dilatation was rare.
Conclusion:
We observed several gender and position differences in perianal anatomy, and most of these findings seem to be related to structure and tone in the anal muscles.
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