Cover

Pediatric and Adolescent Gynecology

Evidence-Based Clinical Practice

Editor(s): Sultan C. (Montpellier) 
Table of Contents
Vol. 22, 2012
Section title: The Prepubertal Girl
Sultan C (ed): Pediatric and Adolescent Gynecology. Evidence-Based Clinical Practice. 2nd, revised and extended edition. Endocr Dev. Basel, Karger, 2012, vol 22, pp 112–137
(DOI:10.1159/000326635)

Sexual Abuse in Prepubertal Children and Adolescents

Herrmann B. · Navratil N.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Medical involvement in the diagnosis and treatment of child sexual abuse (CSA) has a well-defined role within a multidisciplinary concept. Due to the increasingly high rate of normal anogenital findings in victims of CSA, forensic aspects are of limited value in establishing the diagnosis. In selected cases however, medical findings may play an important role in corroborating a child’s history. Correct evaluation of normal and abnormal findings, normal variations and several differential diagnoses requires sound knowledge in pediatric gynecology. In some cases, physical consequences of CSA (injuries, infections, and pregnancy) need to be diagnosed and treated (prevented) accordingly. The majority of abused children have an altered and distorted body image. It is of paramount importance to reassure the child that its body is normal, physically undamaged, intact or that it will heal (‘primary therapeutic aspect of the medical examination’). Thus, the medical examination has an enormous potential to incorporate a therapeutic message into the diagnostic procedure if performed in a qualified and sensitive manner. By communicating with the psychosocial und jurisdictional systems, physicians may initiate proper child protection and therapy. Therefore, medical evaluation of sexually abused children must always be integrated into a multiprofessional concept of child protection.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Bays J, Chadwick D: Medical diagnosis of the sexually abused child. Child Abuse Negl 1993;17:91-110
  2. Navratil F: The genital examination in suspected child sexual abuse: a diagnostic dilemma. Ann NY Acad Sci 1997;816:414-421
  3. Kerns D: Establishing a medical research agenda for child sexual abuse. Child Abuse Negl 1998;22:(special issue)453-660
  4. Atabaki S, Paradise JE: The medical evaluation of the sexually abused child: Lessons from a decade of research. Pediatrics 1999;104:(suppl)178-186
  5. Girardet RG, Lahoti S, Parks D, McNeese M: Issues in pediatric sexual abuse -what we think we know and where we need to go. Curr Probl Pediatr Adolesc Health Care 2009;32:216-246
  6. Sapp MV, Vandeven AM: Update on childhood sexual abuse. Curr Opin Pediatr 2005;17:258-264
  7. Berkoff MC, Zolotor AJ, Makoroff KL, Thackeray JD, Shapiro RA, Runyan DK: Has this prepubertal girl been sexually abused?. JAMA 2008;300:2779-2792
  8. Kellogg N: Committee on Child Abuse and Neglect: The evaluation of sexual abuse in children: American Academy of Pediatrics Clinical Report. Pediatrics 2005;116:506-512
  9. Kaufman M: Committee on Adolescence: American Academy of Pediatrics: Care of the adolescent sexual assault victim. Pediatrics 2008;122:462-470
  10. McCann J, Kerns D: The anatomy of child and adolescent sexual abuse. A CD-ROM Atlas/Reference InterCorp, St. Louis, 1999;www.intercorpinc.com/sabuse.html
  11. Herrmann B, Dettmeyer R, Banaschak S, Thyen U: Kindesmisshandlung. Medizinische Diagnostik, Intervention und rechtliche Grundlagen, 2revisedHeidelberg, Springer, 2010;
  12. Finkel MA: Medical aspects of prepubertal sexual abuse. (eds) Reece RM, Christian CW (eds): Child Abuse: Medical Diagnosis and Management 3Elk Grove Village, American Academy of Pediatrics, 2009;S269-320
  13. Finkel MA, Giardino AP: Medical Evaluation of Child Sexual Abuse 3Elk Grove Village, American Academy of Pediatrics, 2009;
  14. Kaplan R, Adams JA, Starling SP, Giardino AP: Medical response to child sexual abuse: a resource for professionals working with children and families. St. Louis, STM Learning, 2011;
  15. Kerns DL: Cool science for a hot topic. Child Abuse Negl 1989;13:177-178
  16. Kellogg N: Committee on Child Abuse and Neglect: The evaluation of sexual abuse in children: American Academy of Pediatrics Clinical Report. Pediatrics 2005;116:506-512
  17. Friedrich WN: Behavioral manifestations of child sexual abuse. Child Abuse Negl 1998;22:523-531
  18. Finkelhor D: Current information on the scope and nature of child sexual abuse. Future Child 1994;4:31-53
  19. Leventhal JM: Epidemiology of sexual abuse of children: old problems, new directions. Child Abuse Negl 1998;22:481-492
  20. American Academy of Pediatrics: Committee on Child Abuse and Neglect and Committee on Children with Disabilities: Assessment of maltreatment of children with disabilities. Pediatrics 2001;108:508-512
  21. Kellogg ND: Committee on Child Abuse and Neglect: Clinical report - the evaluation of sexual behaviors in children. Pediatrics 2009;124:992-998
  22. American Academy of Pediatrics: Stirling J, Jr: Committee on Child Abuse and Neglect and Section on Adoption and Foster Care; American Academy of Child and Adolescent Psychiatry, Amaya-Jackson L; National Center for Child Traumatic Stress: Amaya-Jackson L: Understanding the behavioral and emotional consequences of child abuse. Pediatrics 2008;122:667-673
  23. Beitchman JH, Zucker KJ, Hood JE, DaCosta GA, Akman D: A review of the short term effects of child sexual abuse. Child Abuse Negl 1991;15:537-556
  24. Beitchman JH, Zucker KJ, Hood JE, DaCosta GA, Akman D, Cassavia E: A review of the long-term effects of child sexual abuse. Child Abuse Negl 1992;16:101-118
  25. Drach KM, Wientzen J, Ricci LR: The diagnostic utility of sexual behavior problems in diagnosing sexual abuse in a forensic child abuse evaluation clinic. Child Abuse Negl 2001;25:489-503
  26. Summit RC: The child sexual abuse accommodation syndrome. Child Abuse Negl 1983;7:177-193
  27. Everson MD: Understanding bizarre, improbable and fantastic elements in children's accounts of abuse. Child Maltreatment 1997;2:134-149
  28. Adams JA, Harper K, Knudson S, Revilla J: Examination findings in legally confirmed child sexual abuse: it's normal to be normal. Pediatrics 1994;94:310-317
  29. Muram D: Child sexual abuse: relationship between sexual acts and genital findings. Child Abuse Negl 1989;13:211-216
  30. Berenson A, Chacko M, Wiemann C: et al.: A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol 2000;182:820-824
  31. Heger A, Ticson L, Velasquez O, Bernier R: Children referred for possible sexual abuse: Medical findings in 2384 children. Child Abuse Negl 2002;26:645-659
  32. Kelly P, Koh J, Thompson JM: Diagnostic findings in alleged sexual abuse: Symptoms have no predictive value. J Pediatr Child Health 2006;42:12-117
  33. Kellogg ND, Menard SW, Santos A: Genital anatomy in pregnant adolescents: ‘Normal’ doesn't mean ‘nothing happened’. Pediatrics 2004;113:e67-e69
  34. Pillai M: Genital findings in prepubertal girls: what can be concluded from an examination?. J Pediatr Adolesc Gynecol 2008;21:177-185
  35. Slaughter L, Henry T: Rape: when the exam is normal. J Pediatr Adolesc Gyn 2009;22:7-10
  36. McCann J, Voris J, Simon M: Genital injuries resulting from sexual abuse: a longitudinal study. Pediatrics 1992;89:307-317
  37. McCann J: The appearance of acute, healing, and healed anogenital trauma. Child Abuse Negl 1998;22:605-616
  38. McCann J, Miyamoto S, Boyle C, Rogers K: Healing of hymenal injuries in prepubertal and adolescent girls: a descriptive study. Pediatrics 2007;119:e1094-e1106
  39. Britton H: Emotional impact of the medical examination for child sexual abuse. Child Abuse Negl 1998;22:573-580
  40. Hornor G, Scribano P, Curran S, Stevens J: Emotional response to the ano-genital examination of suspected sexual abuse. J Forensic Nurs 2009;5:124-130
  41. De San Lazaro C: Making paediatric assessment in suspected sexual abuse a therapeutic experience. Arch Dis Child 1995;73:174-176
  42. Gully KJ, Britton H, Hansen K, Goodwill K, Nope JL: A new measure for distress during child sexual abuse examinations: the genital examination distress scale. Child Abuse Negl 1999;23:61-70
  43. Marks S, Lamb R, Tzioumi D: Do no more harm: the psychological stress of the medical examination for alleged child sexual abuse. J Paediatr Child health 2009;45:125-132
  44. Coulborn Faller K: Interviewing the prepubertal child for possible child sexual abuse. (eds) Reece RM, Christian CW (eds): Child Abuse: Medical Diagnosis and Management 3American Academy of Pediatrics, Elk Grove Village, 2009;257-268
  45. Horowitz DA: Physical examination of sexually abused children and adolescents. Pediatr Rev 1987;9:25-29
  46. Christian C, Lavelle J, Dejong A, Loiselle J, Brenner L, Joffe M: Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics 2000;106:100-104
  47. Palusci VJ, Cox EO, Shatz EM, Schultze JM: Urgent medical assessment after child sexual abuse. Child Abuse Negl 2006;30:367-380
  48. Young KL, Jones JG, Worthington T, Simpson P, Casey PH: Forensic laboratory evidence in sexually abused children and adolescents. Arch Pediatr Adolesc Med 2006;160:585-588
  49. Boyle C, McCann J, Miyamoto S, Rogers K: Comparison of examination methods used in the evaluation of prepubertal and pubertal female genitalia: a descriptive study. Child Abuse Negl 2008;32:229-243
  50. Adams JA: Guidelines for medical care of children evaluated for suspected sexual abuse: an update for 2008. Curr Opin Obstet Gynecol 2008;20:435-441
  51. Muram D, Arheart KL, Jennings SG: Diagnostic accuracy of colposcopic photographs in child sexual abuse evaluations. J Pediatr Adolesc Gynecol 1999;12:58-61
  52. McCann J, Miyamoto S, Boyie C, Rodgers K: Healing of nonhymenal genital injuries in prepubertal and adolescent girls: a descriptive study. Pediatrics 2007b;120:1000-1011
  53. Santucci KA, Nelson DG, McQuillen KK, Duffy SJ, Linakis JG: Wood's lamp utility in the identification of semen. Pediatrics 1999;104:1342-1344
  54. Makoroff K, Desai M, Benzinger E: The role of forensic materials in sexual abuse and assault. (eds) Reece RM, Christian CW (eds): Child Abuse: Medical Diagnosis and Management 3American Academy of Pediatrics, Elk Grove Village 2009;377-388
  55. Berenson AB: Normal anogenital anatomy. Child Abuse Negl 1998;22:589-596
  56. Berenson AB, Heger A, Andrews S: Appearance of hymen in newborns. Pediatrics 1991;87:458-465
  57. Berenson AB, Heger A, Hayes JM, Bailey RK, Emans SJ: Appearance of hymen in prepubertal girls. Pediatrics 1992;92:387-394
  58. Berenson AB: Appearance of hymen at birth and one year of age: a longitudinal study. Pediatrics 1993;91:821-825
  59. Berenson AB, Somma-Garcia A, Barnett S: Perianal findings in infants 18 months of age or younger. Pediatrics 1993;91:838-840
  60. Berenson AB: A longitudinal study of hymenal morphology in the first 3 years of life. Pediatrics 1995;95:490-496
  61. Berenson AB, Grady JJ: A longitudinal study of hymenal development from 3 to 9 years of age. J Pediatr 2002;140:600-607
  62. McCann J, Wells R, Simon M, Voris J: Perianal findings in prepubertal children selected for nonabuse: a descriptive study. Child Abuse Negl 1989;13:179-193
  63. McCann J, Wells R, Simon M, Voris J: Genital findings in prepubertal girls selected for nonabuse: a descriptive study. Pediatrics 1990;86:428-439
  64. Paradise JE: Predictive accuracy and the diagnosis of sexual abuse: a big issue about a little tissue. Child abuse Negl 1989;13:169-176
  65. Berenson AB, Chacko MR, Wiemann CM, Mishaw CO, Friedrich WN, Grady JJ: Use of hymenal measurements in the diagnosis of previous penetration. Pediatrics 2002;109:228-235
  66. Ingram DM, Everett VD, Ingram DL: The relationship between the transverse hymenal orifice diameter by the separation technique and other possible markers of sexual abuse. Child Abuse Negl 2001;25:1109-1120
  67. Berkowitz CD, Elvik SL, Logan MK: A simulated ‘acquired’ imperforate hymen following the genital trauma of sexual abuse. Clin Pediatr 1987;6:307-309
  68. Botash AS, Jean-Louis F: Imperforate hymen: congenital or acquired from sexual abuse?. Pediatrics 2001;108:e53
  69. Emans SJ, Woods ER, Allred EN, Grace E: Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity. J Pediatr 1994;125:153-160
  70. Myhre AK, Berntzen K, Bratlid D: Perinanal anatomy in non-abused preschool children. Acta Pædiatr 2001;90:1321-1328
  71. Finkel MA: Anogenital trauma in sexually abused children. Pediatrics 1989;84:317-322
  72. McCann J, Voris J: Perianal injuries resulting from sexual abuse: a longitudinal study. Pediatrics 1993;91:390-397
  73. Heppenstall-Heger A: McConnell G, Ticson L, Guerra L, Lister J, Zaragoza T: Healing patterns in anogenital injuries: a longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics 2003;112:829-837
  74. Berkowitz CD, Elvik SL, Logan MK: Labial fusion in prepubescent girls: a marker for sexual abuse?. Am J Obstet Gynecol 1987b;156:16-20
  75. Hobbs CJ, Wynne JM: Sexual abuse of English boys and girls: the importance of an anal examination. Child Abuse Negl 1989;13:195-200
  76. Ernst AA, Green E, Ferguson MT, Weiss SJ, Green WM: The utility of anoscopy and colposcopy in the evaluation of male sexual assault victims. Ann Emerg Med 2000;36:432-437
  77. Myhre AK, Berntzen K, Bratlid D: X Genital anatomy in non-abused preschool children. Acta Paediatr 2001;92:1453-1462
  78. Ricci LR: Reviewers note on: Adams JA: Evolution of a classification scale: medical evaluation of suspected child sexual abuse. Child Maltreatment 2001;6:31-36
  79. CDC: Sexually transmitted diseases treatment guidelines. MMWR 2010;59:RR-12
  80. Siegel RM, Schubert CJ, Myers PA, Shapiro RA: The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics 1995;96:1090-1094
  81. Hammerschlag MR: Use of nucleic acid amplification tests in investigating child sexual abuse. Sex Trans Infect 2001;77:153-157
  82. Beck-Sague CM, Solomon E: Sexually transmitted diseases in abused children and adolescent and adult victims of rape: review of selected literature. Clin Infect Dis 1999;28:S74-S83
  83. Dowd MD, Fitzmaurice L, Knapp JF, Mooney D: The interpretation of urogenital findings in children with straddle injuries. J Pediatr Surg 1994;29:7-10
  84. Bond GR, Dowd MD, Landsman I, Rimsza M: Unintentional perianal injury in prepubescent girls: a multicenter, prospective report of 56 girls. Pediatrics 1995;95:628-631
  85. Boos SC: Accidental hymenal injury mimicking sexual trauma. Pediatrics 1999;103:1287-1289
  86. Kellogg ND, Frasier L: Conditions mistaken for child sexual abuse. (eds) Reece RM, Christian CW (eds): Child Abuse: Medical Diagnosis and Management 3Elk Grove Village, American Academy of Pediatrics, 2009;S389-426
  87. Herrmann B, Crawford J: Genital injuries in prepubertal girls from inline skating accidents. Pediatrics 2002;110:e16
  88. Corwin DL, Berliner L, Goodman G, Goodwin J, White S: Child sexual abuse and custody disputes: no easy answers. J Interpers Violence 1987;2:91-105
  89. Mogielnicki NP, Schwartzman JD, Elliott JA: Perineal group A streptococcal disease in a pediatric population. Pediatrics 2000;106:274-281
  90. Warrington S: de San Lazaro C: Lichen sclerosus et atrophicus and sexual abuse. Arch Dis Child 1996;75:512-516
  91. Herrmann B, Veit S, Neises M: Lichen sclerosus et atrophicus. Wichtige Differentialdiagnose zu sexuellem Missbrauch von Kindern. Pädiatr Prax 1998;55:319-324


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50