Authors’ reply to Goodyear, Merli and colleagues, and Waters and Dewsnap

Goodyear and Merli and colleagues comment on coercion, instrumentation, sexually transmitted disease, and sensitive engagement by all relevant specialties.123

Goodyear asserts iatrogenic instrumentation carries a very low risk of anal trauma. Circular staplers are more analogous to the erect penis. This procedure is known to cause internal sphincter damage4 and contributes to the faecal leakage seen in low anterior resection syndrome.

There was equal male and female participation in Markland and colleagues. Faecal incontinence rates were higher among those reporting anal intercourse and anal intercourse remained a predictor of faecal incontinence in women.5

Goodyear questions our focus on young women. Our clinical experience indicates this is an under-recognised problem and …