Inspection

Inspection

The buttocks are gently parted to allow inspection of the anus and perineum: the presence of any skin lesions and whether they are confined to the perineum or evident elsewhere on general examination, e.g. psoriasis, lichen planus, or on genital examination, e.g. warts, candidiasis, lichen sclerosus, the vesi - cles of herpes simplex virus (HSV); evidence of anal leakage; whether the anus is closed or patulous; and the position of the anus and perineum at rest and on bearing down (the latter may reveal prolapse of haemorrhoids or ev en the rectum). Pain on parting the buttocks, perhaps together with the presence of a sentinel tag, may indicate the presence of an underlying fissure, but may also prompt the need for endoluminal examination under anaesthesia to exclude more suspicious pathology , for example squamous cell carcinoma (SCC) of the anal canal.