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After the external genitalia are inspected, a focused neurologic examination should be conducted to test the integrity of perineal sensation, pudendal reflex arcs (clitoral and anal wink responses), and pelvic floor muscle strength. Anal wink a visible puckering at the margin of the external anal sphincter, evoked by stroking the perianal skin with a pin absence of an anal wink reflex suggests a defect in either sensory or motor nerves or in the central pathways that mediate this reflex. The rectum begins at the termination of the sigmoid colon about 12 cm from the anal verge (figure 97. Two muscle bundles, known as the internal and external anal sphincters, participate in defecation.).   examine the anus for the presence of any fissures, fistulae, or hemorrhoids. To elicit an anal wink, stroke the perianal skin with a pin or probe. It seems like some information should be included about the anal wink test here, which was a test used to determine if a child had been sexually molested as was used as such in at least some court cases in the satanic panic of the late 1980s. It was later determined to be unrelated to having been abused. A noxious or tactile stimuli will cause a wink contraction of the anal sphincter muscles and also flexion. The stimuli is detected by the nociceptors in the perineal skin to the pudendal nerve, where a response is integrated by the spinal cord sacral segments s1-s3. The absence of this reflex indicates that there is an interruption of the reflex arc, which may be in the sensory afferent limb.   case report a 41 year old woman was referred for assessment of worsening bladder and bowel dysfunction. At the age of 17 years she had suffered a traumatic fracture-subluxation of t12l1 following a trampoline accident in which she fell heavily on to her back. She immediately lost sensation below the waist but this returned over several days. The anal wink reflex, or perineal reflex, is related to anal sphincter injury. According to a study published in the journal obstetrics & gynecology, anal sphincter disruption is common in women with pelvic floor disorders and likely plays a significant role in the development of anal incontinence in this population. The anal wink test is a reflex test much like the knee jerk reflex. In my practice a large percentage of my patients have weak or absent anal wink reflexes. Usually in my experience, this is associated with tightness in the palvic floor muscles, and nothing more.