Guidelines for medical care of children evaluated for suspected sexual abuse: An update for 2008

Current Opinion in Obstetrics and Gynecology

Volumn 20, Issue 5, 2008, Pages 435-441

  Adams, Joyce A ^a,b  

^a UNIVERSITY OF CALIFORNIA SAN DIEGO   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Child sexual abuse; Genital injuries; Interpretation of medical findings

Indexed keywords

ABRASION; ANUS INJURY; CHILD HEALTH CARE; CHILD SEXUAL ABUSE; CLINICAL EXAMINATION; CONTUSION; FORENSIC MEDICINE; GENITAL INJURY; GONORRHEA; HEALTH CARE PERSONNEL; HERPES; HERPES SIMPLEX VIRUS 1; HERPES SIMPLEX VIRUS 2; HUMAN; HYMEN; LACERATION; MEDICAL ASSESSMENT; MEDICAL EXAMINATION; MEDICAL EXPERT; MEDICAL INFORMATION; PENIS; PRACTICE GUIDELINE; PREPUBERTY; PRIORITY JOURNAL; PROFESSIONAL COMPETENCE; PUBERTY; REVIEW; SALIVA; SEXUAL CRIME; SEXUAL INTERCOURSE; SEXUALLY TRANSMITTED DISEASE; SPERM; TIME; VULVA DISEASE; WOUND HEALING;

ADOLESCENT; ADULT; CHILD; CHILD ABUSE, SEXUAL; CHILD WELFARE; FEMALE; GENITALIA; HUMANS; MALE; MEDICAL HISTORY TAKING; PEDIATRICS; PHYSICAL EXAMINATION; RAPE; SEX OFFENSES; SEXUALLY TRANSMITTED DISEASES;

EID: 55349120160     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/GCO.0b013e32830866f4     Document Type: Review

References (42)

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22. McCann J, Miyamoto S, Boyle C, Rogers K. Healing of nonhymenal genital injuries in prepubertal and adolescent girls: a descriptive study. J Pediatr 2007; 120:1000-1011. This is the second article from the retrospective study reviewing photographs of injuries. The main findings were that petechiae resolved within 24 h, 'blood blisters' persisted up to 24 days, and deep perineal lacerations took up to 20 days to heal, following the initial injury.
23. Boyle C, McCann J, Miyamoto S, Rogers K. Comparison of examination methods used in the evaluation of prepubertal and pubertal female genitalia: a descriptive study. Child Abuse Negl 2008; 32:229-243. The authors reviewed a subset of cases in which photographs were taken using labial separation, labial traction, and the prone knee-chest position. The latter position was found to be the most effective in showing hymen lacerations.
24. Drocton P, Sachs C, Chu L, Wheeler M. Validation set correlates of anogenital injury after sexual assault. Acad Emerg Med 2008; 15:1-8. The authors of this article used an electronic database to summarize demographic data and medical findings in 2879 cases of acute sexual assault. Half of the cases were of girls/women between age 12 and 20 years, and this group had the highest rates of injury. Although limited in not being able to separate out the youngest victims, this study is important because of the ability to correlate findings with specific factors related to the assault.
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34. Muram D, Simmons KJ. Pattern recognition in pediatric and adolescent gynecology: a case for formal education. J Pediatr Adolesc Gynecol 2008; 21:103-108. This is a report of a small but sobering study in which physicians reviewed color photographs of common pediatric gynecologic conditions. The overall percentage of correct interpretations ranged from 42% for residents to 58% for faculty. The authors propose that there is a need for an easily accessible library of images to assist physicians with accurate diagnosis of normal and abnormal gynecologic conditions in children.
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38. Tunback P, Bergstrom T, Claesson BA, et al. Early acquisition of herpes simplex virus type 1 antibodies in children: a longitudinal serological study. J Clin Virol 2007; 40:26-30. In this article from Sweden, the authors show that antibodies to HSV-1 and HSV-2 are common in mothers and decrease in the children up to the age of 1 year. None of the infants had antibodies to HSV-2 after maternal antibodies disappeared, but 30% acquired antibodies to HSV-1, most between 12 and 30 months of age. This study implies that HSV-2 infections in children may be more concerning for sexual transmission and HSV-1 infections less concerning.
39. Gupta R, Warren T, Wald A. Genital herpes. Lancet 2007; 370:2127-2137. The authors present a comprehensive and scholarly review of the epidemiology, diagnosis, and treatment of genital herpes in adults.
40. Reading R, Rannan-Eilya Y. Evidence for sexual transmission of genital herpes in children. Arch Dis Child 2007; 92:608-618. An attempt was made by the authors to systematically review published research concerning the transmission of HSV in children. None of the studies had sufficient details regarding the cases of genital herpes and the possible modes of transmission, so the authors concluded that the evidence concerning the likelihood of sexual transmission of HSV in children is weak.
41. Huppert JS, Gerber MA, Deitch HR, et al. Vulvar ulcers in young females: a manifestation of apthosis. J Pediatr Adolesc Gynecol 2006; 19:195-204.
42. Goodyear-Smith F. What is the evidence for nonsexual transmission of gonorrhea in children after the neonatal period? A systematic review. J Forensic Legal Med 2007; 14:489-502. The author asks a legitimate question and this review with 116 references makes very interesting reading. Although a vast majority of cases of genital gonorrhea in children are due to sexual abuse, a careful reading of this article may convince medical providers that transmission by mucosal contact with infected and infective secretions can also spread gonorrhea.