The stress of child sexual abuse examinations

The objective of this paper was to determine if the medical evaluation of sexual abuse victims is stressful by heart rate variability monitoring. The design of the study was a case series of children referred for sexual abuse examination to determine child stress response monitored by heart rate variability during baseline, disclosure, and anogenital examination with photographs. The setting was a referral center for the investigation of child sexual abuse in two sites (Reno and Las Vegas, Nevada, USA). Patients included a consecutive sample of 30 children; 15 in Reno ranging in age from 3-10 years with a mean age of 7.1 (1 male and 14 females); 15 in Las Vegas ranging in age from 6-10 years with a mean age of 7.8 (3 males and 12 females). Measurements and results were: each subject's heart rate was obtained during the first 3 minutes of the baseline, disclosure, and the anogenital examination with photographs, using a telemetric Vantage Performance Heart Watch consisting of a 5.5 x 1.25 inch transmitter attached to a chest strap and a microcomputer wristwatch attached to the subject's non-dominant wrist. Heart rates were taken every 5 or 15 seconds throughout the entire examination. A follow-up home visit was made 6 weeks after the examination to determine the replicability of clinic baseline measures and child behavioral sequelae. Physiologic measurements did not show statistically significant stress responses when children were prepared according to the clinic protocol in Reno and Las Vegas. There was a trend toward more responsivity among some of the older subjects during the anogenital examination with photographs, and when clinic procedures inadvertently overlapped several procedures at the same time (anogenital examination, photographs and disclosure). The conclusion of the study was that child sexual abuse investigations may be accomplished without undue psychophysiological stress when recommended precautions are taken.