Genital and Anal Conditions Confused With Child Sexual Abuse Trauma

The Evaluation of Sexual Abuse in Children

“…Because many normal anatomic variations, congenital malformations and infections, or other medical conditions may be confused with abuse, familiarity with these other causes is important. 41,42 Physicians should be aware that child sexual abuse often occurs in the context of other family problems, including physical abuse, emotional maltreatment, substance abuse, and family violence. If these problems are suspected, referral for a more comprehensive evaluation is imperative and may involve other professionals with expertise needed for evaluation and treatment.…”

Children With Anogenital Symptoms and Signs Referred for Sexual Abuse Evaluations

“…20 Patterns of injury associated with accidental genital trauma also differ from those of injury in sexual assault; accidental injuries tend to involve external (vulvar) more than internal (hymen, vestibule) structures, are more often anterior (toward the mons pubis) than posterior, and more often unilateral than symmetrical in pattern. 21 Children presenting with "vaginal discharge" had either no discharge (26%) a culture-negative discharge (44%), or a culture-positive discharge (29%). Many of the younger children were referred for "stains on the panties," the significance of which is unknown and does not necessarily reflect the presence of infection or discharge.…”

δ-Storage pool disease: a pitfall in the forensic investigation of sudden anal blood loss in children: a case report

“…Taking sexual abuse into the diagnostic process is an important step in correlating a pattern of behavioural and medical indicators with the possibility of sexual abuse [2]. Behavioural indicators include a history of a newly manifested clinging behaviour and irritability, thumb sucking and loss of bowel control, sleepwalking or bed-wetting, anorexia, loss of concentration and sexualised behaviour inappropriate for developmental age [3,4].…”