Non-abused preschool children's perception of an anogenital examination

Gulla, Kari; Fenheim, Gred Eva; Myhre, Arne Kristian; Lydersen, Stian

doi:10.1016/j.chiabu.2007.03.017

Cited by 24 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The perception of non-abused children (boys and girls, 5–6 years of age) of the anogenital examination was examined by Gulla and colleagues (2007). They found that the anogenital examination was perceived (somewhat) negative by only 7.7% of the examined children and neutral positive by 92.2% (but significantly more distressing than examination of ears or mouth) [ 12 ]. However, according to parents and nurses, about one third of the children showed some distress in relation to the examinations; in the great majority of children, some minor symptoms of distress were expressed.…”

Section: Discussionmentioning

confidence: 99%

Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

et al. 2017

View full text Add to dashboard Cite

So far, a recognizable pattern of clinical symptoms for child sexual abuse (CSA), especially in young male children, is lacking. To improve early recognition of CSA, we reviewed physical complaints, physical examination, and tests on sexually transmitted infections (STIs) in confirmed victims (predominantly preschool boys) of CSA from the Amsterdam sexual abuse case (ASAC). We retrospectively analyzed the outcomes of the primary assessment using mixed methods: descriptive analysis of physical complaints, physical exams, and STI tests from medical files and a qualitative analysis on expert’s interpretations of physical complaints and children’s behavior during physical examination. We included 54 confirmed CSA victims, median age 3.2 (0–6) years, 43 boys (80%), and 11 girls (20%). Physical complaints were reported in 50%, of which gastrointestinal and anogenital complaints were most common. None of the children showed CSA-specific genital signs at physical examination. Most prominent finding during physical examination was a deviant behavioral response (anxiety, withdrawal, too outgoing) in 15 children (28%), especially in children who experienced anal/vaginal penetration. Testing for STIs was negative. Conclusion: Physical complaints and physical signs at examinations were non-specific for CSA. Deviant behavioral reactions during physical examination were the most prominent finding. Precise observation of a child’s behavior during physical examination is needed. What is known • Child sexual abuse (CSA) affects many children on both the short and the long term but remains unrecognized in most cases. • So far, there is a lack of studies on symptom patterns of CSA in male, preschool children. What is new • None of the children showed CSA-specific findings at physical and anogenital examination; STIs were not found in the confirmed victims of CSA. • The most prominent finding was the deviant behavioral response of the children examined, especially in children who experienced anal/vaginal penetration; therefore, precise observation of a child’s behavior during physical examination is a crucial part of the evaluation of suspected CSA. Electronic supplementary materialThe online version of this article (10.1007/s00431-017-2996-7) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Gullay and colleagues 76 found that of nonabused preschool children, only 7.7% rated the anogenital examination as somewhat negative even though it was significantly more distressing than the examination of the ears or mouth. The examination should never be forced or involve restraints.…”

Section: Medical Examination and Interaction With Child Abuse Teammentioning

confidence: 97%

“…Gully 76 developed the Genital Examination Distress Scale (GEDS) to measure the emotional distress during genital examinatiion. GEDS is a simple-to-use scale for children age 1 to 17 that uses verbally expressed and physiological responses to gauge the distress of the child during the examination.…”

Section: Medical Examination and Interaction With Child Abuse Teammentioning

confidence: 99%

Psychological Impact and Treatment of Sexual Abuse of Children

Keeshin¹,

Corwin²

2011

Child Abuse and Neglect

View full text Add to dashboard Cite

“…The majority of non-abused children perceives the anogenital examination as neutral or expresses some minor symptoms of distress [19]. Two other studies found that the anogenital examination was not perceived negative by the examined children [32, 42].…”

Section: What Makes It So Difficult To Recognize Csa In Children?mentioning

confidence: 99%

Clinical practice: recognizing child sexual abuse—what makes it so difficult?

et al. 2018

View full text Add to dashboard Cite

Recognizing child sexual abuse (CSA) in children is difficult, as there can be many hurdles in the assessment of alleged CSA. With this paper, we try to improve the recognition of CSA by discussing: (1) the difficulties regarding this matter and (2) the diagnostic evaluation of alleged CSA, combining both practical clinical recommendations based on recent research. Children are restrained to disclose CSA due to various reasons, such as fears, shame, and linguistic or verbal limitations. Associations between CSA and urogenital or gastrointestinal symptoms, internalizing and externalizing behavioral problems, post-traumatic stress symptoms, and atypical sexual behavior in children have been reported. However, these symptoms are non-specific for CSA. The majority of sexually abused children do not display signs of penetrative trauma at anogenital examination. Diagnosing a STI in a child can indicate CSA. However, other transmission routes (e.g., vertical transmission, auto-inoculation) need to be considered as well.Conclusion: The assessment consists of medical interview and child interview (parents and child separate and together) with special attention to the child’s development and behavior (problems), psychosocial situation and physical complaints, the child’s mental health, and the child’s trauma history; anogenital examination should be done in all cases of alleged CSA. The examination should be documented by photo or video graphically. Recent research suggests that videography may be the preferred method, and testing on STIs. The assessment should be done multidisciplinary by experienced professionals. Health-care professionals who care for children need to know how child protective agencies and law enforcement are organized. In case there are concerns about a child’s safety, the appropriate authorities should be alarmed.What is Known:• Sexual abuse in children often remains unrecognized in the majority of cases.What is New:• Research suggests that videographic documentation is preferred above photographic documentation for anogenital examination; observations of children’s behavioral reactions during examinations might be valuable in the evaluation of suspected sexual abuse; nucleic acid amplification testing can be used on vaginal swabs or urine samples for chlamydia and gonorrhea; the CRIES-13 and the CAPS-CA can be used to assess trauma-symptoms in children after sexual abuse.

show abstract

Non-abused preschool children's perception of an anogenital examination

Cited by 24 publications

References 23 publications

Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

Psychological Impact and Treatment of Sexual Abuse of Children

Clinical practice: recognizing child sexual abuse—what makes it so difficult?

Contact Info

Product

Resources

About