The risk of misinterpreting genital signs of sexual abuse in cadavers: a case report

Ambrosetti, F.; Palazzo, Elisa; Gibelli, Daniele; Andreola, Salvatore; Giancamillo, A. Di; Domeneghini, C.; Spagnoli, Laura; Cattaneo, Cristina

doi:10.1007/s00414-013-0891-y

Cited by 7 publications

(11 citation statements)

References 16 publications

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“…Additions to the guidelines table since the prior version are noted in bold, including a section on conditions that often are erroneously attributed to sexual abuse trauma 29 .…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused

Adams

Kellogg

Farst

et al. 2016

Journal of Pediatric and Adolescent Gynecology

156

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The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.

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“…Additions to the guidelines table since the prior version are noted in bold, including a section on conditions that often are erroneously attributed to sexual abuse trauma 29 .…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused

Adams

Kellogg

Farst

et al. 2016

Journal of Pediatric and Adolescent Gynecology

156

View full text Add to dashboard Cite

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“…The genital photographs of female descendants in this study in whom putrefaction did not start showed either paleness or normal color of the hymen, fossa navicularis, and vagina. Therefore, before putrefaction sets in, any discoloration of the hymen and the area around it should not be attributed to hypostasis, and further study of such an area should be pursued to establish the etiology of the discoloration, and this could include biopsy and histologic evaluation of the area of concern (3,5,6).…”

Section: Discussionmentioning

confidence: 99%

Postmortem Changes of Female External Genitalia and Their Importance in Suspected Sexual Abuse

Alsaif

Al-Farayedhi

Al-Shamsi

et al. 2020

Journal of Forensic Sciences

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Examination of the female external genitalia to assess for sexual abuse is performed in living individuals, and the interpretation of the findings is based on evidence‐based studies. However, in the deceased, no such studies are available, and postmortem changes could present as suspicious findings that can be mistaken for trauma. Patches of discoloration in the hymen were reported previously in one case as hypostasis (i.e., livor and lividity), and based on this finding, it was listed as a finding that is not associated with trauma. This was a retrospective study that was conducted in the Center of Forensic and Legal Medicine in Dammam, Saudi Arabia over a 4‐year period. The study included 30 deceased women in whom photographic documentation of their external genitalia was assessed for postmortem changes. The postmortem interval ranged from less than 24 h to more than 100 days, and the ages of these deceased women were in the 20–40 year‐old age group. In cases where the hymen, vagina, and/or fossa navicularis were clearly visible, none of these areas showed any hypostatic discoloration. A comparison between antemortem and postmortem appearance of the hymen in one case clearly showed the absence of hypostatic changes in the hymen. In conclusion, any discoloration of the external genitalia that is detected in a female decedent requires serious consideration.

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“…Although there are many papers and textbooks discussing the anogenital findings in abused and non-abused living children (81–90), the medical literature shows a surprising dearth of evidence regarding the postmortem anogenital findings in cases of acute or chronic sexual abuse. Very few papers deal with the specific issues involved in the investigation of possible sexual abuse in postmortem cases (73, 75, 80, 91), therefore the pathologist will need to rely on the first principles of anatomy, histopathology, and pathophysiology to guide their examination.…”

Section: Discussionmentioning

confidence: 99%

“…There was a positive association between the age of the subjects and the anteroposterior dimension of the anal orifice, and there was an increased likelihood of anal dilation in cases where the child had suffered significant injury to the central nervous system prior to death (75). Postmortem dilation of the anus and vagina (Image 7) is a phenomenon that is now well-recognized by forensic pathologists (73,(76)(77)(78)(79)(80), and misinterpretation of this finding is rare in cases where the autopsy was performed by an appropriately trained pathologist.…”

Section: Anogenital Injuries In Pediatric Sexual Abusementioning

confidence: 99%

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Are There Hallmarks of Child Abuse? II. Non-Osseous Injuries

Kepron

Walker

Milroy

2016

Academic Forensic Pathology

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Certain conditions have been considered hallmarks of child abuse. Such pathognomonic conditions have led to an inevitable diagnosis of inflicted injury. Forensic pathologists are faced with complex analyses and decisions related to what is and what is not child abuse. In this review, we examine the literature on the specificity of five conditions that have been linked to inflicted injury to varying degrees of certainty. The conditions examined include tears of the labial frena (frenula), cigarette burns, pulmonary hemorrhage and intraalveolar hemosiderin-laden macrophages as markers of upper airway obstruction, intraabdominal injuries, and anogenital injuries and postmortem changes. Analysis of the literature indicates that frena tears are not uniquely an inflicted injury. Cigarette burns are highly indicative of child abuse, though isolated cigarette burns may be accidental. Pulmonary hemorrhage is seen more commonly in cases with a history suggestive of upper airway obstruction, but is not diagnostic in an individual case. Hemosiderin-laden macrophages may be seen in cases with inflicted injuries and in natural deaths. Abdominal injuries may be seen in accidents and from resuscitation, though panreatico-duodenal complex injuries in children under five years of age are not reported to be seen in falls or resuscitation. The understanding of anogenital injuries is increasing, but misunderstanding of postmortem changes has led to miscarriages of justice.

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The risk of misinterpreting genital signs of sexual abuse in cadavers: a case report

Cited by 7 publications

References 16 publications

Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused

Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused

Postmortem Changes of Female External Genitalia and Their Importance in Suspected Sexual Abuse

Are There Hallmarks of Child Abuse? II. Non-Osseous Injuries

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