Reflex anal dilatation

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Reflex anal dilatation (RAD) is a controversial and now largely discredited technique which at one time was widely used as an indicator of child sexual abuse. Its use led to the Cleveland child abuse scandal where misdiagnosis of widespread abuse was made, with highly unfortunate results.

RAD itself involves parting the buttocks of the patient and observing the anus over a period of about thirty seconds to a minute. The anus will reflexively close, then relax. Gradually the outer and inner sphincters will relax, which in many people will cause the anus to gape open. This effect occurs in some people but not others.

RAD was heralded as a new diagnostic technique for detecting anal sexual abuse in children, as studies appeared to indicate that the gaping effect occurred only where abuse had taken place. Non-abused children did not exhibit the gaping effect, according to studies. Unfortunately, later studies found these results to be highly unreliable, but not before its veracity as a technique was assumed by some examining doctors. Some of these doctors were called upon as expert witnesses in a number of sexual abuse trials, and it is this that led to the Cleveland scandal.