Genital and anal conditions confused with child sexual abuse trauma

Article Abstract:

A variety of anal or genital diseases in children may have an appearance that suggests the child was sexually abused. It is essential that a careful physical examination be performed and the possibility of causes other than child abuse be considered. There are serious consequences for the child, the family and the suspected person when a diagnosis of child abuse is made. Sexual abuse may be confused with congenital defects, infections, injuries and skin disorders. Seven cases are presented in which the child was referred for evaluation of possible child abuse, however the observed condition was due to other causes. A review of the literature on conditions mistaken for child abuse injuries is presented. Various skin disorders and symptoms such as erythema (redness) and excoriations (abrasions) may be caused by conditions other than child abuse. Congenital abnormalities of the genitals may be mistaken for genital or anal scars; it is advised to be cautious in diagnosing midline lesions of the genitals or anus, as these may actually be congenital malformations. Accidental injury may be mistaken for child abuse. In African and Middle Eastern children where female circumcision is performed, there may be unusual genital scarring. When genital infections are present it is necessary to obtain a detailed history in order to distinguish innocent actions from sexual abuse. Urethral conditions that involve bleeding may have causes other than child abuse, such as urethral prolapse, hemangioma, and polyps. It is important for physicians to be aware of other potential diagnoses when these abnormalities are discovered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Abnormalities, Diseases, Child abuse, Reproductive organs, Genitalia

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The use of anatomically correct dolls in the evaluation of sexually abused children

Article Abstract:

For many years, dolls have been used as a part of play therapy. Within the last 10 years, anatomically correct dolls have been created for use in the diagnosis and treatment of children who may have been sexually abused; a review of research on this topic is presented. Using these dolls, a significant difference in play behavior has been noted between sexually abused and nonabused children. It has been suggested that for normal children, exposure to anatomically correct dolls is not threatening or sexually stimulating, nor does it promote aggression; however the sample size of this particular study was small. There is controversy in both the courts and the field of child psychiatry over the use of anatomically correct dolls in evaluating whether children have been sexually abused. It is believed by some that dolls can be used in assessment but that they do not prove or disprove sexual abuse. Others feel that use of these dolls prompts talk about sex and may plant new information that changes currently stored memory and thus ruins the child as a witness. There are many variables that may influence a child's play behavior with these dolls; these factors need to be explored further. The interviewer must be trained and the format of the interview must be standardized. The child's background needs to be taken into consideration, as well as the child's comfort level with the interviewer and the setting. It is concluded that these dolls may be helpful tools when used by trained professionals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Equipment and supplies, Dolls, Play therapy

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Vaginal opening measurement in prepubertal girls

Article Abstract:

An opening of the vagina measuring more than four mm (0.16 inches) across in prepubescent girls is considered unusual. Some studies have stated that an opening larger than four millimeters can indicate a history of sexual abuse. Although this measurement is stated in many gynecological text books, many physicians question these results. The normal vaginal openings of prepubertal girls were measured during a routine examination of 273 girls. Measurements were made while the girls were lying on their backs in two positions, frog-leg and knee-chest. Vaginal openings increased with age and were larger in the knee-chest position. The number of girls with vaginal openings greater than four millimeters was extremely small. The causes of openings greater than four millimeters were not determined. Openings less than four millimeters do not rule out sexual abuse. It is recommended that vaginal opening measurements should be included in the routine examination of prepubertal girls. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Vagina

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