A new measure for distress during child sexual abuse examinations: the genital examination distress scale

The primary aim was to develop a simple scale to quantify indices of emotional distress during the rectal-genital (anogenital) phase of a child sexual abuse examination.

A scale successfully developed to measure reactions of children to painful procedures, in particular bone marrow aspirations, was used as a model (Elliot, Jay, & Woody, 1987). This new scale was developed to have a simplified rating format, more relevant operational definitions and possibly a different set of behavioral categories. This new scale was developed using 300 children being examined for possible child sexual abuse. Intraclass correlation coefficients identified reliable items to use. Factor analysis and Cronbach alpha were employed to understand the internal structure of the scale. Paired t-tests, Pearson correlations and hierarchical regression were used to explore validity.

A simple 7-item scale was developed along with two subscales representing agitated and verbally mediated distress. Ratings of distress were significantly greater during the anogenital phase than the general physical part of the examination. Increased distress was associated with positive physical findings. Ratings by the children that they disliked the physician looking at their bodies provided discriminant validity by correlating with increased scores for emotional distress during the anogenital segment of the examination.

The Genital Examination Distress Scale (GEDS) has been developed for measuring the emotional distress of children during the anogenital component of child sexual abuse examinations. The GEDS has been provided for prudent use. Descriptive data offer a comparative standard for other programs and research.