Medical diagnosis of the sexually abused child

The Evaluation of Sexual Abuse in Children

“…In addition, instruments that magnify and illuminate the genital and rectal areas should be used. 22,23 Speculum or digital examinations should not be performed on the prepubertal child unless under anesthesia (eg, for suspected foreign body), and digital examinations of the rectum are not necessary. Because many factors can influence the size of the hymenal orifice, measurements of the orifice alone are not helpful in assessing the likelihood of abuse.…”

L’évaluation des signalements à la Direction de la protection de la jeunesse : étude des facteurs qui influencent les décisions prises par les intervenants

“…D'autre part, même à l'étape de l'évaluation, les allégations d'abus sexuels demeurent souvent plus ardues à démontrer, en particulier lorsqu'il s'agit de jeunes enfants. Il est rare que les abuseurs reconnaissent spontanément ce type d'abus ou qu'on puisse disposer de preuves médicales (Waterhouse et Carnie, 1992 ;Bays et Chadwick, 1993 ;Berliner et Conte, 1993 ;Haskett et al, 1995). Si dans certains cas les informations recueillies lors de l'évaluation permettent d'écarter la présomption d'abus, dans d'autres cas toutefois, l'incertitude persiste.…”

Guidelines for the Evaluation of Sexual Abuse of Children: Subject Review

“…These include the degree of relaxation of the child, the amount of traction (gentle, moderate) on the labia majora, and the position of the child (supine, lateral, or knee to chest). 17,18 The technique used is less important than maximizing the view and recording the method and results (see below for discussion of significance of findings). Speculum or digital examinations should not be performed on the prepubertal child.…”

“…Instruments that magnify and illuminate the genital and rectal areas should be used. 16,17 Signs of trauma should be carefully documented by detailed diagrams illustrating the findings or photographically. Specific attention should be given to the areas involved in sexual activity-the mouth, breasts, genitals, perineal region, buttocks, and anus.…”