Assessments of Girls' Genital Findings and the Likelihood of Sexual Abuse

Paradise, Jan E.; Finkel, Martin A.; Beiser, Alexa; Berenson, Abbey B.; Greenberg, Donna; Winter, Michael

doi:10.1001/archpedi.1997.02170460021004

Cited by 38 publications

(5 citation statements)

References 17 publications

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“…However, inadequate or incomplete medical records of previous genital examination findings has made it impossible to determine the cause of these anomalies. [5][6][7] In the cases described in this report, examiners concluded that 2 of these children developed an imperforate hymen secondary to genital trauma from sexual abuse and 1 child had a congenital imperforate hymen before possible sexual abuse. The emergency department records and the records from the CARE program support the conclusion that the patient in case 1 had a normal vaginal introitus before April 1993.…”

Section: Discussionmentioning

confidence: 86%

Imperforate Hymen: Congenital or Acquired From Sexual Abuse?

Botash

Jean-Louis

2001

Pediatrics

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ABSTRACT. Imperforate hymen diagnosed beyond the newborn period may present a dilemma for the physician. Three case studies are reviewed in which children with the diagnoses of imperforate hymen presented for evaluation of suspected sexual abuse. Clear descriptions of genital anatomy documented at well-child visits may be critical to later interpretations of findings encountered during examinations for suspected sexual abuse. Pediatrics 2001;108(3). URL: http://www.pediatrics.org/ cgi/content/full/108/3/e53; sexual abuse, imperforate hymen, congenital anomaly.

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Section: Discussionmentioning

confidence: 86%

Imperforate Hymen: Congenital or Acquired From Sexual Abuse?

Botash

Jean-Louis

2001

Pediatrics

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“…It takes a solid knowledge base to complete a history and physical examination to evaluate for the possibility of abuse as well as conditions that might mimic abuse. The child maltreatment literature highlights differences in the knowledge base and competency of clinicians who have further training in abuse and those who do not [6,9,11,15].…”

Section: The Current 21mentioning

confidence: 99%

“…Literature supports the recommendation that child maltreatment curricula ought to comprehensively address how clinicians can best assess children suspected of child abuse, better identify cases of abuse, and then intervene to treat and protect a child [10]. Studies have shown that clinicians are not consistent in correctly identifying genital anatomic structures that are important to know when evaluating a child suspected of sexual abuse [5,7,11,12]. This article reviews the research that highlights the skills necessary to identify the anatomic structures of the external genitalia in children and to assess the timing and yield of forensic evidence collection.…”

Section: Introductionmentioning

confidence: 99%

Back to Basics: The Identification of Genital Anatomic Structures and Forensic Evidence Collection Kits in Cases of Suspected Child Sexual Abuse

Donaruma‐Kwoh¹,

Giardino²,

Giardino³

2016

MEDJ

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Background: The genitalia examination and collection of forensic evidence are essential components of the medical evaluation when sexual abuse is suspected. In addition to a complete history/interview, the medical visit for a suspected child sexual abuse victim usually includes a detailed examination of external genitalia and anus as well as, if indicated, the collection of forensic evidence. It is important that medical and nursing professionals are able to correctly identify normal genital and anal structures before they can identify abnormal physical findings in either the prepubertal or adolescent patient. Additionally, medical and nursing professionals are expected to accurately collect and preserve forensic evidence when possible. Methods: A topical review of literature that examines: 1) if physicians and nurse practitioners could identify basic anatomic structure of external genitalia, and 2) the timing and yield of forensic evidence collection kits. Results: Physicians vary in their ability to correctly identify prepubertal genital anatomic structures. Over a series of studies, on the same photograph of female prepubertal genitalia, 59 to 64% of physicians correctly identified the hymen from; 76 to 90% correctly identified the labia minora, and 63 to 78%correctly identified the urethra. On a second photo, deemed more clear, 71% of pediatric chief residents correctly labeled the hymen. Pediatric nurse practitioners performed similarly to the physicians correctly identifying the hymen 59%, labia minora 88% and urethra 81%. Looking at photographs of male prepubertal genitalia, 93% of pediatric chief residents correctly identified the basic structures while only 22% correctly recognized hypospadias. Literature reviewed on forensic evidence collection kits support an extended window for evidence collection of up to 96 hours after suspected sexual contact especially of clothing and other non-body surfaces. Conclusion: Medical and advanced practice nursing professions have to improve the educational processes of clinicians who evaluate and treat children suspected of abuse. Physicians and nurse practitioners experienced difficulty in correctly labeling and identifying basic external genital structures on a photograph of a prepubertal child’s genitalia. Additionally, extending the time frame from suspected sexual contact to examination to a window of up to 96-hours post assault may increase the yield of recovering forensic evidence in both pre and post-pubertal patients.

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“…Several studies have demonstrated that case history can influence inexperienced examiners, leading to an overinterpretation of the examination results indicating trauma. 7 Examiners may also misinterpret physical findings, leading to overdiagnosing child sexual abuse based solely on inaccurate medical findings. 7–14…”

Section: Introductionmentioning

confidence: 99%

“…7 Examiners may also misinterpret physical findings, leading to overdiagnosing child sexual abuse based solely on inaccurate medical findings. 7–14…”

Section: Introductionmentioning

confidence: 99%

A Standardized Peer Review Program Improves Assessment and Documentation of Child Sexual Abuse

Starling

Frasier

2022

Pediatric Quality &Amp; Safety

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Introduction: The objective was to assess the impact of interventions associated with ongoing expert peer review on the quality of child abuse medical providers’ written and photograph documentation in child sexual abuse cases. Methods: Pediatricians participated in a HIPAA compliant blind peer review process on a web platform developed to provide the American Board of Pediatrics maintenance of certification. Participants submit sequential photograph and written documentation of child sexual abuse examinations over 1 year. Documentation includes genital examination descriptions and interpretation of findings. Reviewers evaluate the photographic quality and written documentation of examination findings utilizing a numerical rating system. Each case cycle is reviewed by one of four experts in child abuse who received training in a uniform evaluation process. Reviewers follow each case throughout three cycles of documentation, selecting from several interventions that have been customized to address the quality issues noted. The third and final cycle includes summary comments from the reviewer. Results: Forty-one participants completed the program at the time these data were collected. A paired t test analysis of the combined scores of the three measures, such as Image Quality, Quality of Written Documentation, and Accuracy of Exam Interpretation, showed a statistically significant improvement (P < 0.001) between the first and last sets. In addition, each of the individual measures was statistically significant between the first and last case sets with a P value of <0.05 for each. Conclusion: Peer review with interventions customized to address quality issues improved the quality of the assessment and documentation of child sexual abuse evaluations.

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Assessments of Girls' Genital Findings and the Likelihood of Sexual Abuse

Cited by 38 publications

References 17 publications

Imperforate Hymen: Congenital or Acquired From Sexual Abuse?

Imperforate Hymen: Congenital or Acquired From Sexual Abuse?

Back to Basics: The Identification of Genital Anatomic Structures and Forensic Evidence Collection Kits in Cases of Suspected Child Sexual Abuse

A Standardized Peer Review Program Improves Assessment and Documentation of Child Sexual Abuse

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