Anal Sphincter Tone

The forensic practitioner may be asked about the effects that a single episode or repeated episodes of anal penetration have on anal sphincter tone and subsequent continence of feces. In terms of single anal penetrative acts, partial tears and complete disruptions of the anal sphincters have been described after a single traumatic sexual act (187,188); one case was caused by pliers and the others by brachioproctic intercourse (fisting). However, it is not clear from these case reports whether the sexual practices were consensual or nonconsensual. The two patients who were described as having complete disruption of the sphincters both developed fecal incontinence. There is a case report of "multiple ruptures" of the internal anal sphincter with resultant fecal incontinence after nonconsensual anal penetration with a penis and fist (189).

Regarding repeated acts of anal penetration, the studies are conflicting. A study of 129 heterosexual women who gave a history of anal intercourse found no reports of "gross fecal incontinence" (64). Similarly, Chun et al. (190) found that although the 14 anoreceptive homosexual males studied had significantly lower resting anal canal pressures when compared with the control group (10 nonanoreceptive heterosexual males), there were no complaints of fecal incontinence by the study subjects. In contrast, Miles et al. (191) found a significant increase in fecal incontinence or urgency (requiring immediate defecation to avoid incontinence) in anoreceptive individuals. In addition, they found an inverse relationship between the maximum resting sphincter pressure and the estimated number of acts of anal intercourse. Not surprisingly, they also found that the more traumatic forms of anoreceptive practices, such as brachioproctic intercourse (fisting), were more likely to result in objective sphincter dysfunction. Both the Chun and Miles studies used special equipment to measure the sphincter tone, and nei ther comments on whether sphincter laxity was apparent clinically in any of the subjects.

Interestingly, reflex anal dilatation (that is, dilatation of the external and internal anal sphincters when the buttocks are gently separated for 30 s), which many authors have said is associated with anal intercourse, was not seen in any of the anoreceptive subjects in the Miles' study group (191).

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