Physical signs of sexual abuse in children.

Abstract

Roberts, while worried about many of the same issues, fears that the reforms may "depoliticise" and therefore weaken the NHS: "The fact that the government takes a position at all is exactly what makes medicine in the United Kingdom so different from that in America. The United States government avoids dealing with medical care as much as possible, recognising that whatever policies are instituted some major constituency will be offended. .. in the last presidential election neither George Bush nor Michael Dukakis offered a specific statement on health care.... The great gap is not between Americanisation and socialised medicine. It is between a system run by business versus one run by politics, by the standards of the market versus those of public discourse."6 As someone who has spent about a quarter of a century in each country, I would find it hard to disagree. GORDON BEST King's Fund College, London W2 4HS

Physical evidence of rape against children and adolescents in Brazil: Analysis of 13,870 reports of sexual assault in 2017

“…1 Unfortunately, even today, the incomplete knowledge of this event persists, making it impossible for many diagnoses to be reached. As Robinson stated, “many sexually abused children show no physical signs, and even when signs believed to be indicative of sexual abuse are present the diagnosis should very rarely be made on investigation.” 2 The most important single feature is a statement by the child. As the author pointed out, “this may be supported by medical and forensic evidence, an admission by the abuser,” and so on.…”

“…As the author pointed out, “this may be supported by medical and forensic evidence, an admission by the abuser,” and so on. All are fallible guides to diagnosis, which should be approached with caution and humility, “knowing the serious consequences of diagnostic error in either direction.” 2…”

“…The report concentrates, however, on signs present the genital area in girls and the anal region in both sexes. 2…”

“…All are fallible guides to diagnosis, which should be approached with caution and humility, "knowing the serious consequences of diagnostic error in either direction." 2 Several forms of violence are applied to children and adolescents; however, sexual violence, including rape and other forms of sexual abuse (obscenity, sodomy, etc. ), undoubtedly entails serious immediate and late consequences, being itself considered a public health problem.…”

The role of the gynaecologist in the diagnosis and management of child sexual abuse

“…It is clearly essential that those examining the genitalia of a child should not only be able to do so without distressing the child unnecessarily but also be competent to recognise both normality and the significance of any apparent deviation from normal in the age of child examined (McCann et al 1990). It is recommended by the Department of Health and all experts in this field (Robinson 1991) that specific training should be acquired in recognising the range of age related normality and significance of abnormality by all those who may be required to diagnose child sexual abuse. Raising anxiety on the basis of failure to recognise normal variation in anatomy or of over‐reliance on a single physical sign or test may have led to some of the distressing situations described in Cleveland.…”