Diagnostic findings in alleged sexual abuse: symptoms have no predictive value

To describe demographic characteristics and trends, indications for referral and medical findings in children and young people seen for suspected sexual abuse.

Retrospective review of consecutive medical records over a 7-year period.

A total of 2310 new patients were seen for concerns about sexual abuse and/or genital symptoms, resulting in 2162 genital examinations, of which 2134 were statistically analysed. The age ranged from 1 month to 17 years, with peaks at 3 and 14 years. Eighty-six percent were female. Most were referred by statutory authorities, with a marked reduction in referral numbers from 1997. Where a perpetrator was described, 97% were male and 92% were family members or friends. Medical findings diagnostic of sexual abuse were found in 130 cases (6%). Diagnostic findings were more likely to be found in adolescent girls. For the most part, physical symptoms were of no value in differentiating between those who had been sexually abused and those who had not.

The demographics are concordant with the literature. The reduction in referrals may reflect changes in practice by statutory authorities. In pre-pubertal children, referrals were often made on the basis of physical symptoms, which have no predictive value in the diagnosis of sexual abuse.