A Comparison of Accidental and Abusive Ano‐Genital Injury in Children

Abstract

Three two‐year datasets of ano‐genital signs were collected for comparisons of the injuries seen with accidental trauma and child sexual abuse in children less than 16 years of age: (1) Those attending a regional children's emergency department (South East Scotland) (n = 146) for injuries to the ano‐genital area; (2) all admissions to hospital in Scotland for straddle injury (n = 56); and (3) all children attending a regional child abuse and neglect service for assessment of suspected child sexual abuse (n = 98). Accidental injury types were combined for comparison with abusive injuries. In South East Scotland, 1:1785 children under 16 years will attend an emergency department and 1:9305 will be admitted annually for an ano‐genital injury. In boys, penile and scrotal injuries were only seen following accidents; anal injury was more frequent following suspected abuse (36%) than after accidents (5%). In girls, injuries to the perineum and labia were more frequent after accidental trauma (32% and 74%, respectively, compared to 2% and 11% following suspected abuse), while hymenal injuries were more frequent after sexual abuse (19% compared to 1% in the accident group). Acute injuries to the posterior fourchette were common from both causes, (17% accidents and 10% abuse) and vaginal injuries were uncommon in both groups (5% accidents and 2% abuse). The sites of injury may assist in the differential diagnosis of the cause in ano‐genital injuries. Copyright © 2017 John Wiley & Sons, Ltd Key Practitioner Messages Hymenal or vaginal injury is very unlikely in accidental ano‐genital injury unless there are indications of significant impalement. Perineal and labial injuries are very common in accidental ano‐genital injury. Injuries to the posterior fourchette poorly differentiate abusive and accidental ano‐genital injuries. In boys, penile and scrotal injuries are more common following accidental injury, whereas anal/perianal injuries are more likely abusive.

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“…The results of this study make very interesting reading, with the authors reporting that ‘exclusion of abuse was variable’ with the child's explanation usually accepted if they were over six years of age and under this age ‘accidental injury was accepted if a reliable witness gave a consistent story’ (McIntosh and Mok, , p. 234). The authors also report that ‘relatively few sets of notes stated that CSA was considered and even fewer that this diagnosis was explored…’ (p. 234).…”

“…Our final paper of this issue is an extremely interesting report by Neil McIntosh and Jacqueline Mok () from Edinburgh who have collated and compared three datasets of accidental and abusive ano‐genital injury in children under 16 years across Scotland. ‘Ano‐genital (AG) injuries in children may be accidental or secondary to sexual abuse’ (p. 230).…”

“…It is worth reading the whole study and reviewing their findings which cover injuries to the female genitalia, injuries to the male genitalia and perineal, perianal and anal injuries. McIntosh and Mok () found that in boys ‘penile and scrotal injuries were only seen following accidents; anal injury was more frequent following suspected abuse (36%) than after accidents (5%)’ (p. 230). The authors found that in girls,

‘injuries to the perineum and labia were more frequent after accidental trauma (32% and 74%, respectively, compared to 2% and 11% following suspected abuse), while hymenal injuries were more frequent after sexual abuse (19% compared to 1% in the accident group)’ (McIntosh and Mok, , p. 230)

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“…‘injuries to the perineum and labia were more frequent after accidental trauma (32% and 74%, respectively, compared to 2% and 11% following suspected abuse), while hymenal injuries were more frequent after sexual abuse (19% compared to 1% in the accident group)’ (McIntosh and Mok, , p. 230)…”