sexual abuse should be considered if a girl or boy has dysuria (discomfort on passing urine) or ano-genital discomfort that is persistent or recurrent and does not have a medical explanation (for example, worms, urinary infection, skin conditions, poor hygiene or known allergies)

Screening for these conditions can be offered by a SARC, by a regular genitourinary medicine (GUM) clinic, or by your GP. These tests may need to be repeated - eg, after 3-4 weeks for chlamydia and 12 weeks for HIV. This is because testing at an early stage may give a false negative result. Preventative treatment to stop you from developing these diseases is available in many cases. See the separate leaflet called Sexually Transmitted Infections for more details. What are the chances of acquiring HIV through rape and sexual assault? It's important to have the swabs taken as soon as possible, as forensic evidence will wear and wash away. Feeling afraid: this is normal. If you were raped or sexually assaulted by a stranger you may be afraid of being alone or in any situation like the one where it happened. If you were raped or sexually assaulted by a person you knew, it may be very damaging to your personal life. It can make you wary of other friends. You may fear that your other friends may choose to believe the rapist rather than you. You may worry that you cannot trust other friends.Counselling helps recovery. It will help you to explore the issues that trouble you. Many of the long-term effects of rape and sexual assault come from the internalised feelings of self-blame, discussed below. Such self-blame may occur particularly from feelings that what happened to you was deserved, or that what was said to you was true. What is self-blame and why does it matter?

Surgery is often very effective at treating anal fissures, but it does carry a small risk of complications, such as temporary or permanent loss of bowel control ( bowel incontinence). Anger: this is a positive feeling. Sometimes it does not come until later, if at all. However, feeling angry at your rapist at last begins to shift the way you see the responsibility for what happened, from you to them. The Physical signs of Child Sexual Abuse: An evidence based review and guidance for best practice. 2008, London: Royal College of Paediatrics and Child Health If someone said yes to tea then passed out whilst still drinking it, don't keep pouring it down their throat. Make sure they're safe. Unconscious people don't want tea.having unusually tight anal sphincter muscles, which can increase the tension in your anal canal, making it more susceptible to tearing 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 <1% of controls (likelihood ratios (LR) 40, 60 respectively), anal fissure in 14% cases and 1.1% controls (LR 13), anal laxity in 27% cases and 3% controls (LR 10). 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. Medical condition potentially affecting the anus e.g. Crohn’s disease, severe chronic constipation, myotonic dystrophy

Sexually transmitted infections (STIs): one reason why it is so important to seek medical help after rape is that it allows doctors to assess the risk of STI and give you preventative treatment. This includes preventative treatment for HIV (see below). If you have been raped or sexually assaulted and you need urgent medical care, call 999/112/911 and ask for an ambulance to take you to the nearest A&E department. Once they have dealt with any urgent medical problems they will offer to refer you to the police and/or a SARC if you wish them to do so. They can also offer many sexual health services, including emergency contraception and medication for prevention of HIV (see below). Seeing your own GP 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 Periods and urination: rape and sexual assault include more problematic periods and pain on passing urine in women. sexual abuse should be suspected if a girl or boy has an anal fissure, and constipation, Crohn's disease and passing hard stools have been excluded as the cause

Working towards better sex: Enjoying becoming aroused

The term sexual assault is given to any sexual act that a person has not consented to, or does not consent to. It includes rape (vaginal or anal penetration) and other non-consensual sexual offences, such as groping, kissing, torture of a person in a sexual manner, and child sexual abuse. These are all considered forms of sexual violence, and they can happen to people of all ages.

Examinations were undertaken by paediatricians specially trained in assessment of suspected CSA working in a team. Specialist paediatric registrars in training were supervised by an experienced forensically trained consultant paediatrician.

Reardon W, Hughes HE, Green SH, Lloyd Woolley V, Harper PS: Anal abnormalities in childhood myotonic dystrophy: a possible source of confusion in child sexual abuse. Arch Dis Child. 1992, 67: 527-528. 10.1136/adc.67.4.527. This can include laxatives to help you poo more easily and painkilling ointment that you put directly on your anus. If you sweat a lot, avoid wearing tight-fitting underwear. Wear cotton undergarments. You may use talcum powder to absorb moisture, but don't use cornstarch. Cornstarch may cause a skin infection. Before you put on talcum powder, dry your rectal area with a hair dryer set on low. If you've been spiked but have not been sexually assaulted, call 111 for urgent medical advice if you have any symptoms you're worried about. Relationships: rape and sexual assault can affect how you feel about your friends and family. It can make you avoid people. You may not feel able to do things that you did formerly, particularly if they involve acting independently or alone.