The purpose of this study was to contribute to a description of physical findings in remote anal abuse. Cases reported were examined over a 7 year period. In all cases there was both a judicial conviction and an explicit or implicit admission by the perpetrator of anal abuse. There was a wide cross section of cases accumulated mainly in Northern and Central Italy. Children of all ages were represented, with a female/male ratio of 3 to 1. The results show that in many cases physical signs of abuse were only detected anally, while in others, mainly girls, genital signs were present. Three cases (6 percent) showed no abnormality in the anal area even though anal abuse was admitted. This condition results probably from the compliance of the child, or care on part of the perpetrator to leave minimal signs that heal rapidly. Cases with no abnormal findings mainly involved older children (11 to 14 years). The most frequent signs were anal scars and tags (either single or multiple) present, respectively, in 84 and 32 percent of the cases. In some cases scars extended to the perianal region. Other signs included reflex anal dilatation (RAD) and venous congestion (VC) found, separately or associated with other signs, in over 33 percent of the cases. The results confirm earlier reports that physical signs, including scars, tags, RAD, funneled anus, and extensive venous congestion, are often present in abused children, singly or in combination, and that anal examination should be undertaken even months after a known or suspected sexual assault. In the legal setting these physical signs are viewed in association with anal abuse and support the child’s statement. But they do not per se provide proof of abuse. 4 tables, 1 figure, 24 references