Poppi Worthington died as a result of horrific sexual and physical abuse, a doctor has revealed.
Pathologist Dr Alison Armour, who examined the toddler's body after she died, told the inquest into hear death today that she found no possible cause of natural death.
Among the traumatic injuries suffered by the toddler was damage to her internal and reproductive organs, as well as tears and bruising to her bottom.
Dr Armour, told the hearing in Kendall, Cumbria: 'In entirety, the likely cause in my view is the injuries were from a penis or a penis shaped object.'
'There was no evidence of impacted faeces or constipation and no evidence of anything internal in Poppi to explain these findings.
'My findings are that there was penetration of Poppi before her death.'
Dr Armour also told the inquest that Poppi suffered severe bruising, cuts and a leg fractured in two places.
The first pictures ever published of Poppi's home emerged, showing the double bed where she was found unresponsive and bleeding after her father 'probably' sexually abused her.
The bed is shown strewn with towels, pillows and kitchen paper with a half-drunk baby bottle on the bedside table, in Barrow-in-Furness in 2012.
Last week Poppi's father Paul avoided 252 questions about her death – including why her DNA was found on his genitals - but chose to answer one to describe the 13-month-old as a 'bully'.
Mr Justice Peter Jackson said last year the toddler suffered 'a penetrative sexual assault' before her sudden death and 'the only person who could realistically have done this to her was her father'.
Dr Armour said today Poppi's post-mortem examination showed the 13-month-old had reddened inner thighs and bruising and small tears to her rectum, Kendal Coroner's Court heard.
Dr Armour stood in front of post-mortem photos of the youngster's body, shown on a large TV monitor in court, to explain her findings.
She said she was given a verbal briefing by police before the post-mortem examination began and was aware that Poppi had leg injuries before her death from earlier X-rays.
Alison Hewitt, counsel to the inquest, asked the witness: 'Do you recall whether you expressed any view as to whether this is a case of child abuse?'
Dr Armour said there was no record of any accident to explain the leg injuries, which were only picked up after Poppi's death.
She added: 'I was very concerned about the healing fractures to the right tibia and fibula and my remarks were made to that effect - 'This is strongly suspicious of child abuse'.'
Her post-mortem examination also found bruising to the back of Poppi's throat and external and internal injuries to her anus and rectum area.
Mr Worthington was accused of sexually abusing 13-month-old Poppi shortly before her tragic death in 2012 - but he escaped prosecution amid claims of a bungled police investigation.
Last week he avoided 252 questions about her death – but chose to answer one to describe the 13-month-old as a 'bully'.
Paul Worthington, who is accused of sexually assaulting the toddler before she died, sobbed as he refused to say why the toddler's DNA was found on his genitals.
He dodged 183 questions at the inquest into Poppi's death – in addition to the 69 he refused to answer.
But he did respond when asked to describe his daughter, saying: 'Lively. Bubbly. The happy one out of the siblings. Bully, in her own little way.'
The inquest, which started last week, heard that, in the early hours of December 12 2012. Poppi's mother was asleep downstairs when she heard a scream which was followed by Mr Worthington coming down to fetch a clean nappy.
Shortly afterwards Mr Worthington he rushed back downstairs holding his lifeless daughter and shouting to his ex-partner to call for an ambulance.
This second inquest into Poppi's death was ordered after the controversial first hearing - held by a different coroner - was shrouded in secrecy and lasted just seven minutes.
Later, in a fact-finding judgment as part of care proceedings involving Poppi's siblings, family court judge Mr Justice Peter Jackson, now Lord Justice Peter Jackson, said Poppi's 'significant bleeding' within 15 minutes of the 999 call made from the family home could only be explained sensibly as the result of penetrative trauma.
Mr Worthington, who gave evidence screened from the public and flanked by police officers armed with Tasers, became agitated last week as he was asked about events in the hours before Poppi died.
Alison Hewitt, counsel to the inquest, asked why the toddler's DNA was found on his genitals on the day of her death, but he refused to answer.
The father previously told a family court hearing that his fingers were in Poppi's mouth and that he then went to the toilet.
He was asked whether he 'penetrated' his daughter himself or with an object. He again dodged the question.
Poppi's mother, who cannot be named for legal reasons, sat in the hearing in Kendal, Cumbria, with her head in her hands for much of her former partner's testimony before leaving.
Coroner David Roberts made a final appeal for answers before Mr Worthington finished his evidence. He said: 'You were an adult in this house, as well as Poppi's father, so you are well placed to give me information if you want to. This is an opportunity for you to tell me anything that may... help me find how your daughter came by her death.
'I don't want you to go without having that opportunity. Is there anything else you would like to tell me?' Mr Worthington replied: 'No, sir.'
Poppi's father answered 40 questions put to him, but dodged the rest by citing 'Rule 22', which allows witnesses at inquests to avoid incriminating themselves.
A family court judge has previously ruled that Mr Worthington probably sexually assaulted his daughter before she collapsed at home in Barrow-in-Furness, Cumbria, on December 12, 2012.
But the former supermarket worker escaped prosecution because of a bungled police investigation. Key evidence, including Poppi's last nappies, the pyjama bottoms she was wearing and a computer Mr Worthington used to watch pornography, were lost.
Former police officer Lindsey Bolton told the hearing that the laptop Mr Worthington used to watch 'adult X-rated' porn in bed on the night Poppi died was never recovered by police and there were no 'proactive' attempts by officers to trace it.
Mr Worthington told her he had sold the laptop to a man in nearby Millom and he would try to get it back. Asked if he had made any efforts to retrieve it, Miss Bolton replied: 'Not to my knowledge.'
Poppi's mother told the inquest earlier this week that she was asleep downstairs when she heard a scream. Minutes later Mr Worthington rushed in holding his lifeless daughter and shouting to his ex-partner to call for an ambulance. Poppi died just over an hour later at Furness General Hospital.
In a fact-finding judgment as part of care proceedings involving Poppi's siblings, family court judge Mr Justice Peter Jackson, now Lord Justice Peter Jackson, said Poppi's 'significant bleeding' could only be sensibly explained as being the result of penetrative trauma.
Mr Worthington has never been charged and denies responsibility for his daughter's death. The inquest continues.
Poppi Worthington died after suffering 'penetrative' sexual abuse, doctor reveals as coroner releases images of the unmade bed where her father 'probably attacked' the toddler before she collapsed Martin Robinson, Uk Chief Reporter For Mailonline and Tom Witherow For The Daily Mail 4 December 2017
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