Medical diagnosis of the sexually abused child

This article reviews what has been learned in the last two decades about the medical diagnosis of child sexual abuse. Studies indicate that a normal physical exam is common in sexual abuse victims, that healing of injuries due to abuse is rapid and sometimes complete, that a minority of victims seen for abuse are boys, that nonsexual transmission of sexually transmitted diseases is rare, and that congenital and acquired conditions may mimic physical findings caused by sexual abuse. The article summarizes clinical research on physical findings in nonabused children, abused children, and abused children with independent confirmation of abuse. A classification of physical findings is proposed along a continuum of certainty that sexual abuse has occurred. The child's history is essential in the accurate diagnosis of most cases of sexual abuse.