Emotional response to the ano-genital examination of suspected sexual abuse

Abstract

A brief assessment of child demographics should be solicited prior to exam. Children sharing demographic characteristics listed above may benefit from interventions to decrease anxiety regardless of provider ability to detect anxiety.

The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

“…Perhaps the focus should be on more specific aspects of the history and injury (frequency of abuse, severity of sexual abuse, injury associated with more invasive forms of sexual abuse) that researchers have found to be associated with child distress during examination (e.g. Gully et al, 2000;Hornor et al, 2009). However, we found significant associations between caregiver response to child disclosure of abuse and child and caregiver report of distress prior to the examination.…”

“…Per recommendations of the American Academy of Pediatrics Committee on Child Abuse and Neglect (2005), CSAME should entail the examination of the child's genital and anal regions with the use of a colposcope (McCann, 1990;Steward, Schmitz, Steward, Joye, & Reinhart, 1995). However, there are concerns regarding the emotional impact of this potentially invasive examination on child victims (Britton, 1998;Hornor, Scribano, Curran, Stevens, & Roda, 2009). Specifically, it has been argued that the CSAME can cause undue stress and pain to a potentially traumatized child (Steward et al, 1995).…”

“…However, while the relationship between these variables and child psychological functioning has garnered the attention of researchers over the past several years, there is a general dearth of research examining the relationship of these variables and their potential impact on psychological functioning prior to the medical exam procedures. For example, some existing data suggest that a history of sexual abuse or resulting physical injuries due to abuse are significantly associated with increased emotional distress and anxiety among children during the ano-genital examination (Gully, Hansen, Britton, Langley, & McBride, 2000;Hornor et al, 2009).…”

“…Taken as a whole, results from the aforementioned studies suggest there is a significant relationship between knowledge of the examination procedures and child and caregiver distress during the forensic medical examination. However, several notable limitations exist in the research, including the use of primarily Caucasian participants (e.g., Hornor et al, 2009) and utilization of single raters of child anxiety (Hornor et al, 2009;Lazebnik et al, 1994), with only a handful of studies including both child and caregiver (e.g., Steward et al, 1995) or child and medical provider ratings of child anxiety (e.g., Gully et al, 2000;Marks et al, 2009). As such, the current study attempted to address the limitations in the existing literature by including a sample of Caucasian and African-American children attending CSAME and utilizing multiple informants (i.e., child, caregiver, and provider).…”

Physical Examination in Child Sexual Abuse

“…The child's emotional reaction to the history and physical examination will be determined partly by the quality of these procedures themselves and by the empathy shown by the examiner, and largely by pre-existing factors such as general anxiety, previous experiences with doctors, age, developmental stage, and the type of abuse that was suffered. In general, children tolerate the examination well as long as it is gently conducted, rather than forcibly imposed (13). Historytaking and the verbal preparation of the child for physical examination take much more time than the physical examination itself, which usually requires no more than a few minutes.…”