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¿Ha sido abusada sexualmente esta niña prepuberal?
Molly Curtin Berkoff1, Adam J Zolotor, Kathi L Makoroff
1Division of General Pediatrics, University of North Carolina, 231 MacNider, CB #7225, Chapel Hill, NC 27599, USA. molly_berkoff@med.unc.edu
JAMA
|December 18, 2008
Resumen
El examen genital en niñas prepuberales puede levantar sospechas de abuso sexual, pero no puede confirmarlo o excluirlo. Los hallazgos como el flujo vaginal o las anomalías del himen requieren una investigación adicional para un diagnóstico preciso.
Área de la Ciencia:
- La pediatría es la medicina de los niños.
- La medicina forense es la medicina forense.
- Ginecología Ginecología.
Sus antecedentes:
- La interpretación de los hallazgos genitales en niños tiene importantes implicaciones legales y sociales.
- Si bien la ausencia de trauma no descarta el abuso, los exámenes físicos pueden revelar hallazgos compatibles.
- La utilidad diagnóstica de los exámenes genitales para identificar el abuso sexual no agudo en niñas en la prepubertad es crítica.
Objetivo del estudio:
- Determinar el valor diagnóstico del examen genital en niñas prepuberales para la detección de abuso sexual no agudo.
- Para evaluar la sensibilidad y especificidad de los hallazgos físicos en el diagnóstico de abuso sexual.
Principales métodos:
- Revisión sistemática de los artículos indexados por MEDLINE desde 1966 hasta octubre de 2008.
- Los términos de búsqueda incluyeron abuso infantil, abuso sexual, examen físico, genitales y métricas de precisión de diagnóstico.
- Revisión independiente y extracción de datos por múltiples autores para calcular los ratios de probabilidad de trauma genital.
Principales resultados:
- Las secreciones vaginales aumentaron la probabilidad de abuso sexual (proporción de probabilidad positiva, 2.7).
- Las transecciones posteriores del himenoma, las muescas profundas y las perforaciones plantean preocupación, pero tienen una sensibilidad desconocida.
- La especificidad de la transección del himen es alta (casi el 100%) en ausencia de antecedentes de trauma.
Conclusiones:
- Los hallazgos genitales como secreciones o anomalías himenales sugieren un posible abuso sexual, pero no lo confirman.
- Los hallazgos del examen físico tienen una sensibilidad baja o desconocida, lo que limita su capacidad para confirmar o excluir de forma independiente el abuso sexual no agudo.
- Es necesaria una investigación adicional cuando los hallazgos físicos plantean sospechas de abuso sexual en niñas en la prepubertad.
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