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The anal wink, anal reflex, perineal reflex, or anocutaneous reflex is the reflexive contraction of the external anal sphincter upon stroking of the skin around the anus. 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 next step of the rectal examination involves the assessment of neuromuscular integrity. First, each side of the buttocks is scratched with the gloved finger to elicit the superficial anal reflex (the anal wink), a function of l 1 and l 2. a reaction of the external anal sphincter muscle when the adjacent skin is briefly and briskly stimulated. A normal reflex is a contraction of the sphincter also known as anal wink. 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 can be elicited by gently touching a cottontipped applicator lateral to the external anal sphincter and observing its contraction.