Adolescents' responses to sexual abuse evaluation including the use of video colposcopy

To examine adolescents' responses to a medical examination, which included the use of video colposcopy, conducted during an investigation of possible child sexual abuse.

Girls aged 11 to 18 years, referred for evaluation and treatment of sexual abuse at an academic medical center were eligible to participate. Demographic data and information regarding the alleged sexual abuse event(s) were obtained by medical record review. Prior to the medi- cal examination subjects were assessed regarding: anticipations of the medical examination; level of state anxiety using the State-Trait Anxiety Inventory (STAI); response to stressful situations along the dimensions of information-seeking or information-avoiding using the Miller Behavioral Style Scale (MBSS); and knowledge of reproduction and genital anatomy. Subsequently, a medical examination, which included the use of video colposcopy with a monitor for subject viewing, was completed. The examining physician provided a standardized educational intervention regarding genital anatomy and a discussion about abuse issues and sexually transmitted infections. An exit interview assessed perceptions of the medical examination and video colposcopy and reassessed anxiety using the state portion of the STAI. Follow-up interviews occurred 3 months later during which knowledge of reproduction and genital anatomy was reassessed. Measures were evaluated using paired Student's t-tests, McNemar tests for correlated proportions, correlations and independent Student's t-tests, as appropriate.

Seventy-seven eligible girls participated; 51 returned for follow-up. The mean age of the subjects was 13.5 years (SD 1.4 years). Fifty-one percent of the sample was Caucasian, 29% African-American, 18% Hispanic, and 2% other. Seventy-nine percent of the girls chose to watch the examination on the video monitor. The girls' post-examination perceptions were significantly more positive than their pre-examination anticipations (p <.001), even though some aspects continued to be embarrassing, painful, or "scary". Anxiety, as measured by the STAI, significantly decreased from pre- to post-examination (p <.001). Pre-examination and post-examination anxiety were negatively associated with pre-examination anticipation and post-examination perceptions, respectively. Information-avoiding coping styles on the MBSS were associated with positive anticipations of the examination, but exhibited a trend toward negative associations with perceptions of video colposcopy. Scores assessing knowledge of the reproductive functions of their bodies at 3 months revealed no significant differences during the period from pre-examination assessment to three month follow-up. CONCLUSIONS; Teens generally reported that the medical examination, which included the use of video colposcopy, was beneficial. There was a significant reduction in anxiety from pre-examination to post-examination and the girls' feelings about the medical examination were significantly more positive afterwards.