Physical Examination of Sexually Abused Children and Adolescents

Abstract

Sexual abuse of children has come to the forefront of our national consciousness through continued exposure in newspapers, in magazines, and on television. Despite this media attention, many pediatricians have not been trained to evaluate cases of suspected sexual abuse. Because estimates of the prevalence of sexual abuse in the general population range into the millions,1 it is likely that the office-based pediatrician will encounter more and more cases. Although guidelines for evaluation of child abuse exist,2 professional journals are now beginning to address sexual abuse. A recent article by Krugman3 reviewed the role of the office-based pediatrician in sexual abuse cases. Some points that he discussed included maintaining a high index of suspicion for both direct and masked presentations of sexual abuse; interviewing skills needed for both the child and family; legal ramifications; and the need for a coordinated effort among the many groups of professionals involved in each case, in an effort to minimize separate, repetitive, and traumatic evaluations. This article is intended to supplement Krugman's by providing a detailed description of the vaginal examination of the prepubertal child and adolescent. PHYSICAL EXAMINATION The prerequisite of a thorough, sensitive examination is time. This is the one element most lacking in a busy office or emergency room. Preparing the child for the examination will take more time the examination itself; this preparation is the most important part of the examination process. PHYSICAL EXAMINATION The prerequisite of a thorough, sensitive examination is time. This is the one element most lacking in a busy office or emergency room. Preparing the child for the examination will take more time than the examination itself; this preparation is the most important part of the examination process.