Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused

Abstract

The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.

Medico legal procedures related to sexual assault: a 10-year retrospective experience of a Daphne protocol application

“…Among genital trauma, we distinguished vulvo-vaginal lesions (68.5%) and anal lesions (31.5%) (Fig. 6) We have classified the minor victims using Adam's classification, which is based on anogenital findings in children with suspected sexual abuse (Adams et al 2016). Physical examination of minors in "knee chest or frog position" was systematically performed.…”

The emergency management of a rape case in a nutshell: adolescent and adult cases

“…This is normal and should not be misdiagnosed as pathological findings. 19 In the presence of cupping and funnelling, the anal canal is everted and shortened, which is also a non-significant finding. The tyre sign, a muscular ring circumferential to the anal orifice, is the result of contraction of the superficial part of the external sphincter in the presence of relaxation of the internal sphincter and is also a form of partial dilatation, and thus not significant.…”

“…19 The area behind the 3 to 9 o'clock line should, in addition, preferably be examined with the aid of toluidine blue 1%, a tissue stain with affinity for cell nuclei. Toluidine blue is applied to the area where injury is suspected and, after approximately 60 seconds, removed with a KY gel® swab.…”

Factors associated with child sexual abuse confirmation at forensic examinations

“…Child sexual abuse differs substantially from sexual violence involving adults and adolescents, since many cases do not involve penetration 10 and tend to be reported later, making it unlikely that evidence will be found in the victim's body 5 . The window of opportunity for finding traces of the perpetrator in a child is smaller than in the case of adult victims 11 . In addition, the need to collect material for tests designed to detect sexually transmitted infections should be decided case by case; the collection of sperm from the vagina is seldom indicated 12 .…”