Genital Findings in Sexually Abused, Symptomatic and Asymptomatic, Girls

Abstract

Although evaluation of the vulva of sexually abused girls using magnification with a colposcope or pediatric otoscope has become increasingly popular, the incidence of various genital findings in sexually abused and asymptomatic children has not been reported. A prospective study was carried out in which 20 genital findings from three groups of girls (mean age 4.8 ± 2.6 years) were analyzed. The three groups were (1) sexually abused girls (n = 119), (2) normal girls with no genital complaints (n = 127), and (3) girls with other genital complaints (n = 59). Group 1 was more likely than group 2 to have scars on the hymen or posterior forchette (9% v 1%, P = .002), increased friability of the posterior forchette (10% v 1%, P = .001), attenuated hymen (18% v 4%, P = .0003), and synechiae from the hymenal ring to the vagina (8% v 0%, P = .0009). Groups 1 and 3 were remarkably similar with the exception of erythema which was more common in group 3 (34% v 68%, P = .0001). Hymenal diameter was slightly greater in group 1 than 2 but not 3. Although genital findings distinguish some sexually abused girls from asymptomatic girls, many findings also occur in girls with other genital complaints, which suggests that many of these girls have also been molested or that vulvar inflammation may lead to some of these findings.

Les défis diagnostiques posés par l'évaluation clinique des allégations de sévices sexuels concernant des enfants.

“…Contrairement à ce qui est parfois véhiculé, il n'y a aucun indice comportemental ni symptomatologique qui puisse cue associé de façon significative avec le fait pour un enfant d'être victime de sévices sexuels (Benedek & Schetzky, 1985; Campbell, Casoni & Gattuso, 1993; Cooke & Cooke, 1991; Hall, 1989; Levy, 1989; Underwager, Wakefield, Legrand, Bartz & Erickson, 1986; Wakefield & Underwager, 1991), Les vietimes de sévices sexucls proviennent de toutes lea classes sociales et peuvent réagir de multiples façons devant l'agneasion sexuelle comme devant d'auirea types de stress on de traumatismes, d'ailleurs. Bien que de nombreux auteurs (Emans, 1987; Hughes & Barad, 1983; Jaffe Wolf, Wilson & Zak, 1986) aient cherché à verifier des hypothèses associant un symptôme psychologique ou comportemental et le fait d'être victime de sévices sexuels, les résultats de ces necherches permettent de conclure qu'un tel lien ne peut être retrouvé de facon fiable.…”

Forensic psychological examination of the child witness in cases of alleged sexual abuse.

“…Hence, medical assumptions about specific characteristics of sexually abused children were made in the absence of crit ical normative base-rate information. Stud ies by McCann, Voris, and Simon ( 1988);Mccann, Voris, Simon, and Wells ( 1989); Emans, Woods, Flagg, and Freeman ( 1987); and Coleman ( 1989) indicate clearly that there is a wide range of variability within normal populations. Many of these norma tive variations have led medical examiners erroneously to conclude that their findings were consistent with signs and symptoms of sexual abuse.…”

Where researchers fear to tread: Interpretative differences among testifying experts in child sexual abuse cases.

“…No consistent pattern of physical signs can be identified in a majority of sexually abused children because approximately half of sexually abused children appear normal on examination (Bays & Chadwick, 1993). Erythema is the most common physical sign, but it is irrelevant because it appears in the same proportion of nonabused children as abused children (Emans, Woods, Flagg, & Freeman, 1987). Gonorrhea is a rare sign, appearing in fewer than 5% of abused children, but it is highly suggestive of abuse because it is virtually nonexistent in nonabused children (Bays & Chadwick, 1993).…”