Physicians' documentation of sexual abuse of children

Article Abstract:

Certain factors appear to improve the quality of documentation resulting from evaluations for possible sexual abuse of children. High quality documentation is important to legal and social agencies investigating possible sexual abuse. Researchers reviewed up to five records from North Carolina doctors who had performed evaluations for suspected sexual abuse of a child during 1992-1993. Overall, 548 records were reviewed. In addition 113 of the 145 participating doctors completed a survey of knowledge of the issues of sexual abuse in children. Reviewers rated 27% of the histories and 32% of the physical examinations as not good or poor. The factors that were associated with better quality histories were the child's disclosure of abuse, a structured record format, a woman doctor, an older child, having taken a course on sexual abuse, and scoring high on the survey of sexual abuse knowledge. Factors associated with better quality physical examinations were the same excepting child's age and disclosure.

Evaluation, Medical history taking

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Indications for Neisseria gonorrhoeae cultures in children with suspected sexual abuse

Article Abstract:

It may not be necessary to test children suspected of having been sexually abused for gonorrhea if they have no vaginal or urethral discharge. A total of 316 children aged 12 or under were brought to an emergency room over a two-year period with signs of suspected sexual abuse. Doctors took vaginal, urethral, oral, and rectal samples to test for gonorrhea. Seven children had positive cultures. Every child culturing positive had a vaginal or urethral discharge. These results conflict with other studies that have found positive cultures in asymptomatic children. This could be because longer periods elapsed between the abuse and examination, which allowed gonorrhea to progress to an asymptomatic phase or because there were more cases of penetration, which increases the risk of infection.

Gonorrhea

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Genital findings in adolescent girls referred for suspected sexual abuse

Article Abstract:

Adolescent girls who have been sexually abused may not have telltale genital findings that conclusively point to abuse. Researchers took gynecologic photographs of 204 girls ages nine to 17 years who were suspected of being sexually abused. Only 32% of the girls had suspicious genital appearances. Abnormal genital findings were more likely if abuse occurred within 72 hours of the examination, or if bleeding or pain occurred during sexual assault. The appearance of the hymen was not an accurate indicator of sexual abuse. Hymen rim width should not be used as evidence of sexual abuse.

Medical examination, Physiological aspects, Teenage girls, Vulva

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