Medical Findings in 2975 Examinations for Child Sexual Abuse: A Retrospective Review

To describe anogenital examination findings in a large cohort seen for child sexual abuse concerns, with findings classified following current international guidelines.

Retrospective review of records of the Starship Children's Hospital child protection team for all children and adolescents (0-17 years) seen over 20 years.

A total of 4443 children and adolescents were seen, of whom 3942 (89%) were female. The age distribution was bimodal, with a small peak in childhood and a larger peak in adolescence. Anogenital examination occurred in 2975 (67%), more often in those < 8 years (1197/1394, 86%) compared to those 8 years and older (1778/3049, 58%), p < 0.0001. The proportion examined declined steadily, from 93% in 1999 to 54% in 2018. 2263 examinations (76%) were normal, 425 (14%) had findings unrelated to sexual abuse and 287 (10%) had abnormal findings possibly related to sexual abuse. Of 1426 examined at Tanner Stage 1, 41 (3%) had abnormal findings, compared to 246/1549 (16%) at Tanner Stages 2-5. Of 16 pregnant adolescents examined, 2 (13%) had anogenital findings of previous trauma. In adolescents examined acutely where semen was observed on Gram stain, 8/17 (47%) had anogenital findings of acute trauma.

The cohort seen for sexual abuse concerns has changed over 20 years, becoming increasingly adolescent. This has resulted in a decrease in the proportion examined and an increase in the rate of abnormal findings. Anogenital examinations are often normal in pregnancy or with semen present, reinforcing the international consensus that normal does not mean nothing happened.