Anogenital Findings in 3569 Pediatric Examinations for Sexual Abuse/Assault

Tanya D Smith; Sudha R Raman; Sheri Madigan; Judy Waldman; Michelle Shouldice

doi:10.1016/j.jpag.2017.10.006

Anogenital Findings in 3569 Pediatric Examinations for Sexual Abuse/Assault

J Pediatr Adolesc Gynecol. 2018 Apr;31(2):79-83. doi: 10.1016/j.jpag.2017.10.006. Epub 2017 Oct 28.

Authors

Tanya D Smith¹, Sudha R Raman², Sheri Madigan³, Judy Waldman⁴, Michelle Shouldice⁵

Affiliations

¹ The Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; The Suspected Child Abuse and Neglect Program, The Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: tanya.smith@sickkids.ca.
² The Department of Population Health Sciences, Duke University, Durham, North Carolina.
³ The Suspected Child Abuse and Neglect Program, The Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; The Department of Psychology, University of Calgary, and Alberta Children's Hospital, Calgary, Alberta, Canada.
⁴ The Suspected Child Abuse and Neglect Program, The Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ The Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; The Suspected Child Abuse and Neglect Program, The Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.

PMID: 29111300
DOI: 10.1016/j.jpag.2017.10.006

Abstract

Study objective: Accurate interpretation of anogenital examination findings in the context of suspected child and adolescent sexual abuse/assault is essential, because misinterpretation has significant child protection and criminal justice implications. A consensus approach to the interpretation of anogenital examination findings is widely used to support accurate diagnosis; however, a large-scale study using this standardized approach is lacking. The objectives of this study were to: (1) determine the proportion of anogenital examinations for sexual abuse concerns with findings diagnostic of trauma and/or sexual contact; (2) determine whether frequency of diagnostic findings varies according to age, gender, and timing of examination; and (3) characterize diagnostic findings. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Retrospective records of children aged 0-18 years evaluated for sexual abuse/assault were reviewed. Case details of 3569 patients were extracted and anogenital examination findings were reinterpreted using a published consensus approach.

Results: Anogenital examination findings diagnostic of trauma and/or sexual contact were present in 173 of 3569 patients (4.8%). The prevalence of diagnostic findings was significantly higher in adolescents than in children younger than 12 years of age (13.9%, 114/823 vs 2.2%, 59/2657), in female vs male patients (5.7%, 164/2866 vs 1.5%, 9/614), and in examinations within 72 hours for children younger than 12 years (14.2%, 91/643 vs 4.5%, 45/997). Acute injuries were the most common type of diagnostic finding.

Conclusion: Diagnostic findings are present in a small proportion of children and adolescents examined for suspected sexual abuse/assault. It is essential that practitioners who interpret examination findings be adequately trained and familiar with the current consensus approach and are aware of case characteristics associated with higher likelihood of findings.

Keywords: Child sexual abuse; Examination findings; Sexual abuse diagnostic findings.

MeSH terms

Adolescent
Child
Child Abuse, Sexual / diagnosis
Child Abuse, Sexual / statistics & numerical data*
Child, Preschool
Female
Humans
Infant
Male
Physical Examination
Prevalence
Retrospective Studies