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Child Sexual Abuse Treatment & Management

  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Jun 09, 2016
 

Medical Care

Medical treatment is guided by any conditions uncovered. The incidence of STDs in child sexual abuse (CSA) is low. In prepubertal children, asymptomatic vaginal infections are thought to be increasingly uncommon. Therefore, the Centers for Disease Control and Prevention (CDC) does not recommend prophylaxis for STDs in asymptomatic prepubertal children who are evaluated for possible CSA. In contrast, the CDC recommends that teenaged patients and adults who are sexually abused or assaulted should receive antibiotic prophylaxis for STDs. For more information, see MMWR Recommendation and Report Sexually Transmitted Diseases Treatment Guidelines.

  • Treat STDs with appropriate medications based on the infection and the child's age and weight.
  • In postmenarcheal children, consider the possibility of pregnancy.
  • Recognize the overriding need for emotional support and attention to the psychosocial crisis in which the child and family now find themselves.
  • Health care providers are mandated reporters in all 50 states; once sexual abuse seriously is suspected or diagnosed, a report to the appropriate child protective services (CPS) agency is necessary. Attention to the safety of the child is essential. The AAP recommends reporting in the following situations:
    • When a child makes a clear disclosure of abusive sexual contact, with or without specific findings
    • When individuals present with STDs (see Workup section)
    • When physical examination findings are believed to be the result of abusive sexual contact
  • When sexual abuse is being considered, the AAP suggests the possibility of reporting, depending on the perceived risk to the child. In such cases, discussion with members of an interdisciplinary team may be helpful.
  • Cases of sexual abuse may result in law enforcement action against the alleged perpetrator and possible criminal court proceedings. Well-documented medical records are essential, since legal proceedings may occur over long periods of time. The health care provider cannot rely solely on recollection of the case.
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Consultations

Mental health consultation is warranted to evaluate and treat acute stress reaction and, later, posttraumatic stress disorder (PTSD).

Expert mental health management of stress disorders is warranted because of the burgeoning evidence that psychic trauma in young children has a significant effect.

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Contributor Information and Disclosures
Author

Angelo P Giardino, MD, MPH, PhD Professor and Section Head, Academic General Pediatrics, Baylor College of Medicine; Senior Vice President and Chief Quality Officer, Texas Children’s Hospital

Angelo P Giardino, MD, MPH, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Received grant/research funds from Health Resources and Services Administration (HRSA) Integrated Community Systems for CSHCN Grant for other; Received advisory board from Baxter Healthcare Corporation for board membership.

Coauthor(s)

Eileen R Giardino, RN, MSN, PhD FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Family Nursing, University of Texas Health Sciences Center Houston, School of Nursing

Eileen R Giardino, RN, MSN, PhD is a member of the following medical societies: American College Health Association, American Professional Society on the Abuse of Children, American Association of Nurse Practitioners, American Nurses Association, International Society for the Prevention of Child Abuse and Neglect

Disclosure: Nothing to disclose.

Reena Isaac, MD Assistant Professor of Pediatrics, Baylor College of Medicine; Forensic Pediatrician, Child Protection Section of Emergency Department, Texas Children’s Hospital, Houston; Staff Physician, Children's Assessment Center, Houston

Reena Isaac, MD is a member of the following medical societies: American Academy of Pediatrics, Texas Pediatric Society, Ray E Helfer Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Chet Johnson, MD Professor of Pediatrics, Associate Director and Developmental-Behavioral Pediatrician, KU Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies; Assistant Dean, Faculty Affairs and Development, University of Kansas School of Medicine

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors acknowledge the consistent support and mentorship by Carol D Berkowitz who, despite multiple clinical, teaching, and administrative responsibilities, has found the time to share her considerable expertise and even took the time out of her busy schedule to provide the photographs used to illustrate the physical findings possible when evaluating cases of suspected child sexual abuse. Dr. Berkowitz exemplifies the characteristics of a committed medical educator who is not limited by organizational or geographic boundaries.

References
  1. Adams JA. Evolution of a classification scale: medical evaluation of suspected child sexual abuse. Child Maltreat. 2001 Feb. 6(1):31-6. [Medline].

  2. Adams JA, Kaplan RA, Starling SP, Mehta NH, Finkel MA, Botash AS. Guidelines for medical care of children who may have been sexually abused. J Pediatr Adolesc Gynecol. 2007 Jun. 20(3):163-72. [Medline].

  3. Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, et al. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol. 2016 Apr. 29 (2):81-7. [Medline].

  4. Black CM, Driebe EM, Howard LA, Fajman NN, Sawyer MK, Girardet RG, et al. Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse. Pediatr Infect Dis J. 2009 Jul. 28 (7):608-13. [Medline].

  5. Workowski, KA, Berman S., et al. Sexually transmitted diseases treatment guidelines, 2010. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/pdf/rr/rr5912.pdf. December 10, 2010; Accessed: May 25, 3016.

  6. Gallion HR, Dupree LJ, Scott TA, Arnold DH. Diagnosis of Trichomonas vaginalis in female children and adolescents evaluated for possible sexual abuse: a comparison of the InPouch TV culture method and wet mount microscopy. J Pediatr Adolesc Gynecol. 2009 Oct. 22 (5):300-5. [Medline].

  7. Menoch M, Zimmerman S, Garcia-Filion P, Bulloch B. Child abuse education: an objective evaluation of resident and attending physician knowledge. Pediatr Emerg Care. 2011 Oct. 27(10):937-40. [Medline].

  8. Finkelhor D, Hotaling GT. Sexual abuse in the National Incidence Study of Child Abuse and Neglect: an appraisal. Child Abuse Negl. 1984. 8(1):23-32. [Medline].

  9. Sgroi SM, Blick LC, Porter FS. A conceptual framework for child sexual abuse. Sgroi SM, ed. Handbook of Clinical Intervention in Child Sexual Abuse. Lexington, MA: Lexington Books; 1982. 9-37.

  10. Finkelhor D, Browne A. The traumatic impact of child sexual abuse: a conceptualization. Am J Orthopsychiatry. 1985 Oct. 55(4):530-41. [Medline].

  11. Floyed RL, Hirsh DA, Greenbaum VJ, Simon HK. Development of a screening tool for pediatric sexual assault may reduce emergency-department visits. Pediatrics. 2011 Aug. 128(2):221-6. [Medline].

  12. Adams JA. Guidelines for medical care of children evaluated for suspected sexual abuse: an update for 2008. Curr Opin Obstet Gynecol. 2008 Oct. 20(5):435-41. [Medline].

  13. Child Maltreatment 2014. U.S. Department of Health & Human Services Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau U.S. Department of Health & Human Services Administration for Children and Families Administration on... Available at http://www.acf.hhs.gov/sites/default/files/cb/cm2014.pdf.

  14. Fourth National Incidence Study of Child Abuse and Neglect (NIS-4). US Department of Health and Human Services. Administration for Children and Families. Available at https://www.nis4.org/DOCS/ProjectSummary.pdf.

  15. Sedlak AJ, Broadhurst DD. Third National Incidence Study of Child Abuse and Neglect. Final Report NIS-3. US Department of Health and Human Services. 1996.

  16. Finkelhor D, Jones LM, Shattuck A. Updated Trends in Child Maltreatment, 2009. Crimes Against Children Research Center. Crimes Against Children Research Center. Available at http://www.unh.edu/ccrc/pdf/Updated_Trends_in_Child_Maltreatment_2009.pdf. Accessed: December 20, 2011.

  17. Jones, L and Finkelhor, D. The Decline in Sexual Abuse Cases. U.S. Department of Justice Office of Justice Programs. Available at https://www.ncjrs.gov/pdffiles1/ojjdp/184741.pdf . 2001; Accessed: May 25, 2016.

  18. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May. 14(4):245-58. [Medline].

  19. Heger A, Ticson L, Velasquez O, Bernier R. Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Negl. 2002 Jun. 26(6-7):645-59. [Medline].

  20. Jenny C, Crawford-Jakubiak JE, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013 Aug. 132 (2):e558-67. [Medline]. [Full Text].

  21. Christian CW, Lavelle JM, De Jong AR, et al. Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics. 2000 Jul. 106(1 Pt 1):100-4. [Medline].

  22. Girardet R, Bolton K, Lahoti S, et al. Collection of forensic evidence from pediatric victims of sexual assault. Pediatrics. 2011 Aug. 128(2):233-8. [Medline].

  23. Thackeray JD, Hornor G, Benzinger EA, Scribano PV. Forensic evidence collection and DNA identification in acute child sexual assault. Pediatrics. 2011 Aug. 128(2):227-32. [Medline].

  24. Paolucci EO, Genuis ML, Violato C. A meta-analysis of the published research on the effects of child sexual abuse. J Psychol. 2001 Jan. 135(1):17-36. [Medline].

  25. Janeczko L. A Single Question to Sexually Abused Children Predicts Their Trauma Symptoms. Medscape Medical news. Available at http://www.medscape.com/viewarticle/823104. Accessed: April 14, 2014.

  26. Melville JD, Kellogg ND, Perez N, Lukefahr JL. Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse. Child Abuse Negl. 2014 Mar 10. [Medline].

  27. Laidman J. New guidelines for evaluating suspected child sexual abuse. July 31, 2013; Accessed August 4, 2013. Available at: . Medscape Medical News. Available at http://www.medscape.com/viewarticle/808730. Accessed: August 7, 2013.

  28. Jenny C, Crawford-Jakubiak JE. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013 Aug. 132(2):e558-67. [Medline].

  29. Paradise JE, Rostain AL, Nathanson M. Substantiation of sexual abuse charges when parents dispute custody or visitation. Pediatrics. 1988 Jun. 81(6):835-9. [Medline].

  30. Adams JA. Medical evaluation of suspected child sexual abuse. J Pediatr Adolesc Gynecol. 2004 Jun. 17(3):191-7. [Medline].

  31. Adams JA, Harper K, Knudson S. A proposed system for the classification of anogenital findings in children with suspected sexual abuse. J Pediatr Adolesc Gynecol. 1992. 5:73-5.

  32. Adams JA, Harper K, Knudson S, Revilla J. Examination findings in legally confirmed child sexual abuse: it's normal to be normal. Pediatrics. 1994 Sep. 94(3):310-7. [Medline].

  33. Atabaki S, Paradise JE. The medical evaluation of the sexually abused child: lessons from a decade of research. Pediatrics. 1999 Jul. 104(1 Pt 2):178-86. [Medline].

  34. Bays J. Conditions mistaken for child abuse. Reece RM, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2001. 287-306.

  35. Bays J, Chadwick D. Medical diagnosis of the sexually abused child. Child Abuse Negl. 1993 Jan-Feb. 17(1):91-110. [Medline].

  36. Bays J, Jenny C. Genital and anal conditions confused with child sexual abuse trauma. Am J Dis Child. 1990 Dec. 144(12):1319-22. [Medline].

  37. Berenson AB. Normal anogenital anatomy. Child Abuse Negl. 1998 Jun. 22(6):589-96; discussion 597-603. [Medline].

  38. Berkowitz CD. Medical consequences of child sexual abuse. Child Abuse Negl. 1998 Jun. 22(6):541-50; discussion 551-4. [Medline].

  39. Briere JN, Elliott DM. Immediate and long-term impacts of child sexual abuse. Future Child. 1994 Summer-Fall. 4(2):54-69. [Medline].

  40. Burgess AW, Groth AN, Holmstrom LL, Sgroi SM. Sexual Assault of Children and Adolescents. New York, NY: Lexington Books; 1978.

  41. CDC. Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm.

  42. Cooper A. Thoracoabdominal trauma. Ludwig S, Kornberg AE, eds. Child Abuse: A Medical Reference. 2nd ed. Churchill Livingstone; 1991. 131-50.

  43. De Jong AR, Rose M. Frequency and significance of physical evidence in legally proven cases of child sexual abuse. Pediatrics. 1989 Dec. 84(6):1022-6. [Medline].

  44. De Jong AR, Rose M. Legal proof of child sexual abuse in the absence of physical evidence. Pediatrics. 1991 Sep. 88(3):506-11. [Medline].

  45. DeLago C, Deblinger E, Schroeder C, Finkel MA. Girls who disclose sexual abuse: urogenital symptoms and signs after genital contact. Pediatrics. 2008 Aug. 122(2):e281-6. [Medline].

  46. Douglas Em, finkelhor D. Child Sexual Abuse Fact Sheet. Crimes against Children Research Laboratory, University of New Hampshire. Available at http://www.unh.edu/ccrc/factsheet/pdf/CSA-FS20.pdf. Accessed: September 2007.

  47. Emans SJ, Goldstein DP. Pediatric and Adolescent Gynecology. 3rd ed. Boston, MA: Little Brown & Co Inc; 1990.

  48. Feldman W, Feldman E, Goodman JT, et al. Is childhood sexual abuse really increasing in prevalence? An analysis of the evidence. Pediatrics. 1991 Jul. 88(1):29-33. [Medline].

  49. Finkel M. Physical examination. Finkel M, Giardino A, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. Thousand Oaks, CA: SAGE Publications; 2001. 39-98.

  50. Finkel M. The evaluation. Finkel M, Giardino A, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. Thousand Oaks, CA: SAGE Publications; 2001. 23-37.

  51. Finkel MA. "I can tell you because you're a doctor". Pediatrics. 2008 Aug. 122(2):442. [Medline].

  52. Finkel MA. Sexual abuse: The medical evaluation. Giardino AG, Alexander R, eds. Child Maltreatment: A Clinical Guide and Reference. St Louis, MO: GW Medical Publishing Inc; 2005. 253-88.

  53. Finkel MA. Technical conduct of the child sexual abuse medical examination. Child Abuse Negl. 1998 Jun. 22(6):555-66. [Medline].

  54. Finkel MA, DeJong AJ. Medical findings in child sexual abuse. Reece RM, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nd ed. Boston, MA: Lippincott Williams & Wilkins; 2001. 207-86.

  55. Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child. 1994 Summer-Fall. 4(2):31-53. [Medline].

  56. Finkelhor D. Epidemiological factors in the clinical identification of child sexual abuse. Child Abuse Negl. 1993 Jan-Feb. 17(1):67-70. [Medline].

  57. Finkelhor D, et al. A Sourcebook on Child Sexual Abuse. London UK: Sage Publications; 1988.

  58. Finkelhor D, Moore D, Hamby SL, Straus MA. Sexually abused children in a national survey of parents: methodological issues. Child Abuse Negl. 1997 Jan. 21(1):1-9. [Medline].

  59. Finkelhor DH. Child sexual abuse: New Theory and research. New York, NY: Free Press; 1984.

  60. Friedrich WN. Behavioral manifestations of child sexual abuse. Child Abuse Negl. 1998 Jun. 22(6):523-31; discussion 533-9. [Medline].

  61. Gorey KM, Leslie DR. The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases. Child Abuse Negl. 1997 Apr. 21(4):391-8. [Medline].

  62. Gushurst CA. Child abuse: behavioral aspects and other associated problems. Pediatr Clin North Am. 2003 Aug. 50(4):919-38. [Medline].

  63. Dubowitz H, DePanfilis D, eds. Handbook for Child Protection Practice. Thousand Oaks, CA: SAGE Publications; 2000.

  64. Jones LM, Finkelhor D, Halter S. Child maltreatment trends in the 1990s: why does neglect differ from sexual and physical abuse?. Child Maltreat. 2006 May. 11(2):107-20. [Medline].

  65. Kellogg ND, Parra JM, Menard S. Children with anogenital symptoms and signs referred for sexual abuse evaluations. Arch Pediatr Adolesc Med. 1998 Jul. 152(7):634-41. [Medline].

  66. Kempe CH. Sexual abuse, another hidden pediatric problem: the 1977 C. Anderson Aldrich lecture. Pediatrics. 1978 Sep. 62(3):382-9. [Medline].

  67. Kerns DL, Terman DL, Larson CS. The role of physicians in reporting and evaluating child sexual abuse cases. Future Child. 1994 Summer-Fall. 4(2):119-34. [Medline].

  68. Ladson S, Johnson CF, Doty RE. Do physicians recognize sexual abuse?. Am J Dis Child. 1987 Apr. 141(4):411-5. [Medline].

  69. Larson C, Terman DL, Gomby DS, et al. Sexual abuse of children: recommendations and analysis. Future Child. 1994 Summer-Fall. 4(2):4-30. [Medline].

  70. Lentsch KA, Johnson CF. Do physicians have adequate knowledge of child sexual abuse? The results of two surveys of practicing physicians, 1986 and 1996. Child Maltreat. 2000 Feb. 5(1):72-8. [Medline].

  71. Leventhal JM. Epidemiology of sexual abuse of children: old problems, new directions. Child Abuse Negl. 1998 Jun. 22(6):481-91. [Medline].

  72. Levitt C. Further technical considerations regarding conducting and documenting the child sexual abuse medical examination. Child Abuse Negl. 1998 Jun. 22(6):567-8; discussion 569-71. [Medline].

  73. Ludwig S. Child abuse. Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

  74. Marshall WN, Locke C. Statewide survey of physician attitudes to controversies about child abuse. Child Abuse Negl. 1997 Feb. 21(2):171-9. [Medline].

  75. McCann J, Voris J, Simon M. Genital injuries resulting from sexual abuse: a longitudinal study. Pediatrics. 1992 Feb. 89(2):307-17. [Medline].

  76. Muram D. Child sexual abuse: relationship between sexual acts and genital findings. Child Abuse Negl. 1989. 13(2):211-6. [Medline].

  77. Myers JE. Adjudication of child sexual abuse cases. Future Child. 1994 Summer-Fall. 4(2):84-101. [Medline].

  78. Myers JE. Legal Issues in Child Abuse and Neglect Practice (Interpersonal Violence). 2nd ed. SAGE Publications; 1998.

  79. Myers JE. Expert testimony. Briere J, Berliner L, Buckley JA, et al, eds. The APSAC Handbook on Child Maltreatment. Sage Publications; 1996. 319-40.

  80. Nadal FM, Giardino AP. Differential diagnosis: conditions that mimic child maltreatment. Giardino ER, Giardino AP. Nursing Approach to the Evaluation of Child Maltreatment. St. Louis, MO: GW Medical Publishing; 2003. 215-50.

  81. Nicholson EB, Bulkley J. Sexual Abuse Allegations in Custody and Visitation Cases: A Resource Book for Judges and Court Personnel. Washington, DC: American Bar Association; 1988.

  82. Pence DM, Wilson CA. Reporting and investigating child sexual abuse. Future Child. 1994 Summer-Fall. 4(2):70-83. [Medline].

  83. Royal College of Paediatrics and Child Health. The Physical Signs of Child Sexual Abuse. An Evidence-Based Review and Guidance for Best Practice. 2008.

  84. Russell DE. The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children. Child Abuse Negl. 1983. 7(2):133-46. [Medline].

  85. Sgroi SM. Sexual molestation of children. The last frontier in child abuse. Child Today. 1975 May-Jun. 4(3):18-21, 44. [Medline].

  86. Swanston HY, Tebbutt JS, O'Toole BI, Oates RK. Sexually abused children 5 years after presentation: a case-control study. Pediatrics. 1997 Oct. 100(4):600-8. [Medline].

  87. US Dept of Health and Human Services. Child Maltreatment 2002: Summary of Key Findings. 2004.

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Possible factors influencing the decline in substantiated cases of child sexual abuse. Courtesy of David Finkelhor, PhD.
Adverse Childhood Experience (ACE) Pyramid.
Infant girl in frog-leg supine position. Genital examination reveals translucent hymenal membrane with significant redundant tissue making hymenal orifice difficult to appreciate in this photo. With further traction applied to both labia majora, the hymenal orifice could be observed. Courtesy of Carol D. Berkowitz, MD.
Infant girl in frog-leg supine position. Hymenal orifice is crescentic (little time is present at 12-o'clock posterior). Hymen is thin and translucent with vessels visible. Hymenal edge is regular and without interruption. Courtesy of Carol D. Berkowitz, MD.
Girl in knee-chest position. Hymenal orifice is crescentic, thin, translucent, and without interruption or scarring. Courtesy of Carol D. Berkowitz, MD.
Infant girl in frog-leg supine position. Hymenal orifice is annular, with tissue present around entire opening. Some redundancy is present. Courtesy of Carol D. Berkowitz, MD.
Infant girl in frog-leg supine position. Hymenal orifice is annular with a "bump" at 1-o'clock position and a small "notch" at 10-o'clock position. Hymenal membrane is thin and translucent, with no interruption or scarring. Courtesy of Carol D. Berkowitz, MD.
Girl in frog-leg supine position, exhibiting annular hymenal orifice. Tissue is thin and translucent without disruption or scarring. Courtesy of Carol D. Berkowitz, MD.
Girl in frog-leg supine position exhibiting hymenal orifice, which is crescentic and has symmetric attenuation at lateral margins. No scarring is present. Courtesy of Carol D. Berkowitz, MD.
Girl in frog-leg supine position exhibiting hymen. Hymen is septate; a band of tissue crosses the hymenal orifice. Tissue is thin with no scarring present. Courtesy of Carol D. Berkowitz, MD.
Adolescent girl in supine position demonstrating estrogenized tissue. Hymen is thicker, pink, and fairly opaque with no vessels visible. Tissue is redundant. Courtesy of Carol D. Berkowitz, MD.
Genital examination of adolescent girl revealing estrogenized hymenal tissue that is pink, thick, and opaque. Orifice appears irregular, secondary to significant redundancy of tissue. Courtesy of Carol D. Berkowitz, MD.
Genital examination of adolescent girl demonstrating estrogenized hymenal tissue that is pink, thick, and opaque. Orifice is irregular due to areas of redundancy, especially at the 9-o'clock position. Courtesy of Carol D. Berkowitz, MD.
Prepubertal girl with foul-smelling bloody discharge. On examination, a foreign body in the vagina was found just past the hymenal orifice. The foreign body is lodged in vagina and appears to be toilet tissue that is colonized with bacteria, causing a vulvovaginitis. The foreign body was dislodged with gentle water flushing during examination. Courtesy of Carol D. Berkowitz, MD.
Genital examination of prepubertal girl with foul-smelling bloody discharge. On examination, a foreign body in the vagina was found lodged just past the hymenal orifice and appears to be toilet tissue that is colonized with bacteria, causing a vulvovaginitis. The foreign body was dislodged with gentle water flushing during examination. Courtesy of Carol D. Berkowitz, MD.
Infant girl with imperforate hymen and absence of a hymenal orifice. Courtesy of Carol D. Berkowitz, MD.
Genital examination of girl revealing bruising on medial aspects of labia minora, hymenal trauma with disruption of hymenal tissue, and fresh blood. Courtesy of Carol D. Berkowitz, MD.
Infant girl with significant bruising that involved labia minora and labia majora, hymenal trauma with disruption of hymen, and fresh blood. Courtesy of Carol D. Berkowitz, MD.
Genital examination 10 days after infant girl presented with significant bruising that involved labia minora and labia majora, hymenal trauma with disruption of hymen, and fresh blood. Bruising on vulvar structure is nearly resolved. Hymen is healing and no blood is observed. Courtesy of Carol D. Berkowitz, MD.
Genital examination of girl in frog-leg supine position after genital trauma. Examination reveals suture in place at 6-o'clock position to stop bleeding from injury. Hymenal edge is irregular and asymmetric. Courtesy of Carol D. Berkowitz, MD.
US Maltreatment Trends, 1990-2013. Courtesy of David Finkelhor, PhD.
 
 
 
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