Child sexual abuse: what the urologist needs to know

We define what the urologist needs to know regarding child sexual abuse.

Based on our experience in treating numerous child victims of sexual assault and a review of the contemporary literature, the data concerning child sexual abuse incidence, risk factors, clinical presentation, child interview, physical examination and management were analyzed.

It is estimated that at least 1 in 4 girls and 1 in 10 boys will suffer victimization by age 18 years. There are no predicting socioeconomic factors. In legally proved cases of child sexual abuse the majority of victims have no diagnostic physical findings. Examination findings change depending on the position of the child, degree of relaxation, amount of labial traction and time to perform the evaluation. Findings that are consistent but not independently diagnostic of abuse include chafing, abrasions or bruising of inner thighs or genitalia, scarring, tears or distortion of the hymen, a decreased amount of or absent hymenal tissue, scarring of the fossa navicularis, injury to or scarring of the posterior fourchette/posterior commissure and scarring or tears of the labia minora. In all 50 states physicians are mandated by law to report to child protection services whenever they suspect that a child has been sexually abused.

The urologist must routinely examine the anogenital area of children during routine urethral evaluation and include child sexual abuse as part of the routine urological history.