Rare (uro-)genital pathologies in young girls mimicking sexual abuse

Abstract

Examinations of young children for suspicions of sexual abuse are challenging for the involved medical specialists because the consequences of the interpretation of the findings can be severe and dramatic. A broad knowledge of differential diagnoses including rare pathologies like urethral prolapse and failure of the midline fusion of the perineum, known as perineal groove, is essential in order to avoid unnecessary diagnostics and treatment, prejudgment, and to reduce patient family’s anxiety. We report two independent cases of girls aged 7 months and 5 years suffering from these rare pathologies, one presenting with painless lower genital tract bleeding, the other showing a lesion of the perineum as random finding during a neuropediatrician’s consultation. In both cases, the pathologies were initially misdiagnosed as injuries due to sexual assault, and judicial investigation procedures were initiated. In this paper, the characteristic symptoms and morphology of urethral prolapse and perineal groove are presented to enhance the awareness of these pathologies among forensic experts and help to establish the correct diagnosis.

Sexual abuse of children – some recommendations from a forensic gynaecologist's expert experience

“…described vaginal foreign bodies as causes of genitourinary infections and bleeding, and possible malpractice in suspected CSA. 8 Also, Schaul and Schwark 9 presented the cases of a seven-month-old and a five-year-old girl with a rare urogenital pathology (urethral prolapse), which could suggest a primary misdiagnosis of CSA, and suggest the extreme importance of an objective gynaecological examination to prevent the unwanted course of a criminal investigation. The redness of the genitals and anal opening in girls and boys caused by the irritation of urine, stool or poor hygiene, as well as foreign bodies, can mimic the image of CSA and vice versa.…”