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A case-control study of anatomic changes resulting from sexual abuse.

A B Berenson1, M R Chacko, C M Wiemann

  • 1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston 77555-0587, USA.

American Journal of Obstetrics and Gynecology
|April 14, 2000
PubMed
Summary

Genital examination findings in young children rarely indicate sexual abuse. Hymenal transection or perforation was only seen in abused children, but overall, physical signs are not reliable indicators of abuse.

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Area of Science:

  • Pediatric Forensics
  • Child Abuse Detection
  • Gynecology

Background:

  • Identifying physical signs of sexual abuse in prepubertal children is crucial for legal and medical evaluations.
  • Vulvar and hymenal characteristics are often examined to assess for potential abuse.

Purpose of the Study:

  • To determine specific vulvar and hymenal features associated with sexual abuse in female children aged 3–8 years.
  • To differentiate physical findings between abused and non-abused children.

Main Methods:

  • A case-control study compared 192 prepubertal children with a history of penetration to 200 controls who denied abuse.
  • External genitalia were examined and photographed.
  • Bivariate analyses assessed differences in vulvar and hymenal features.

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Main Results:

  • Vaginal discharge was more frequent in abused children (P = .01).
  • No significant differences were found in labial agglutination, increased vascularity, linea vestibularis, friability, perineal depression, or various hymenal features (bump, tag, ridge, band, superficial notch).
  • Hymenal transection, perforation, or deep notch occurred in 4 abused children.

Conclusions:

  • Genital examination findings in abused children often do not differ from non-abused children.
  • The child's history should be considered primary evidence in cases of suspected sexual abuse.
  • Physical evidence alone is often insufficient for diagnosing sexual abuse in young children.