Although the detection of sexual abuse is of unquestionable importance, a mistaken diagnosis can be traumatizing to the child, family, and persons who are suspected of abuse. This determination is critical in addressing the safety needs of a child and providing appropriate treatment. Clinicians are challenged to differentiate symptoms or findings attributable to sexual abuse from physiologic, skin, or other conditions. 8 Alternatively, they may be asymptomatic, and a clinician may uncover suspicious findings during the anogenital examination. The children may present with anogenital symptoms or signs, including bleeding, pain, inflammation, and vaginal discharge. Sexual abuse of children is sometimes detected in clinical settings. 3, 4 The accurate detection of findings associated with sexual abuse also depends on a familiarity with variations in anogenital anatomy that have been described in children who have not been abused. Detecting sexual abuse is challenging because many children do not disclose their abuse, 2 and physical findings tend to be absent or nonspecific. 1 Medical evaluations are commonly requested in children who are suspected victims of sexual abuse. The evaluation of children with anogenital symptoms and signs should include a consideration of alternative conditions and causes not directly related to sexual abuse.ĬHILD SEXUAL abuse is a common pediatric problem affecting approximately 12% of girls younger than 14 years. Children with anogenital symptoms but without a disclosure or suspicion of sexual abuse are unlikely to have examination findings suggestive of abuse.
Common examination findings included anogenital erythema, enhanced vascularity of the hymen or vestibule in prepubertal girls, labial adhesions, and culture-negative vaginitis.Ĭonclusions Few children are referred for sexual abuse evaluations based on physical signs or symptoms alone. Only patients with the presenting symptom of lesions had an increased likelihood of a sexual abuse diagnosis. Seventy-two patients had normal examination findings.
Although 85 patients had examination findings that corroborated the presenting symptom(s), 70 had nonspecific examination findings or a diagnosis other than sexual abuse. We used a standardized classification system and determined that 25 patients (15%) had examination findings in the sexual abuse clinic that were suggestive of or probable or definitive for sexual abuse. Of 184 complaints, the most common presenting symptom or sign was anogenital bleeding or bruising (29.3%), followed by irritation or redness (21.7%), abnormal anogenital anatomy (20.7%), vaginal discharge (18.4%), lesions (6.5%), and "other" symptoms or signs (3.3%). Most (75%) referrals were from medical clinics. Results A medical records review of 3660 cases was done 157 cases were identified for study. Setting Child and adolescent ambulatory care sexual abuse clinic. Objective To determine whether children referred to a sexual abuse clinic because of anogenital symptoms or signs have examination findings that are suggestive of or probable or definitive for sexual abuse. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.
Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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