[Diagnosis] : Sexual Abuse
Clinical findings in sexual abuse are rare. A "negative" or normal examination does not exclude the possibility of sexual abuse. The most important aspect of the child sexual abuse evaluation is the child’s history. Children who have non-specific findings may actually have findings that are consistent with the history, such as perineal erythema after fondling. Having no physical findings after sexual abuse is an expected finding. Therefore, the fact that there are no findings or signs of injury may be consistent with a history of sexual abuse, even though it does not provide further evidence to support the history.
There are several reasons for lack of physical findings and forensic evidence in sexually abused children and adolescents. They include the following:
- Many types of sexual abuse do not include acts that would be expected to cause trauma to skin or body tissues.
- Delays in seeking medical care decrease the likelihood of positive findings.
- Evidence of ejaculate is unlikely to be found if many hours have elapsed since the assault (particularly if more than 96 hours).
- Semen and evidence of ejaculate are unlikely to be found in sexually abused children if the child has washed, urinated, or defecated.
- Rape can occur without ejaculation or damage to tissues.
- Hymenal tissue is elastic and penetration by a finger or penis may cause invisible trauma or simply stretch the hymenal opening.
- The anal sphincter is highly elastic and may not be damaged by penetration.
- Injuries, when they do occur, heal rapidly and often completely.
- A child may interpret a painful sexual act as intercourse, when it may have been vulvar coitus.
- With onset of puberty, evidence of injury can be obscured by changes in hymen tissue due to estrogen effect.
For recommendations related to how to document the diagnosis, see DOCUMENTATION: Documenting the Diagnosis.
