Fast Five Quiz: Addressing Sexual Assault

Richard H. Sinert, DO


May 08, 2019

Most cases of suspected or substantiated sexual abuse of prepubertal girls have normal examination findings. This may be due to elasticity of the hymenal tissue and genital mucosa and rapid healing of any injuries. Findings of sexual abuse in boys may include injuries to the glans, shaft of the penis, or scrotum. Anal findings are unusual but may include scars (most apparent if located off the midline), distorted or irregular folds, flattening of the anal folds, and poor anal tone. Anal soiling, lacerations, and dilatation may also be present in children with history of anal penetration and sexual abuse.

The forensic interview differs from a good medical history. This interview is essential to prosecution of a case and is often a critical aspect of the evaluation. The forensic interview is mostly concerned with detailed answers to who, what, where, and when the abuse occurred. The forensic interview should not replace the medical history obtained by the healthcare provider.

Photography can be used, but only if the patient consents. Consent for photographs in children who have experienced sexual assault may not be necessary if the case is under investigation by Child Protective Services, but it is recommended. A body diagram is typically used as part of the medical record to document any physical injuries, including abrasions, lacerations, bite marks, scratches, and ecchymoses.

In many jurisdictions, sexual assault centers provide trained examiners (generally SANE teams) to perform evidence collection and to provide initial contact with the aftercare resources of the center. In such cases, the physician may confidently defer the gynecologic examination to the SANE; studies have repeatedly demonstrated the accuracy of sexual assault examinations performed by SANE teams. Clinicians must nonetheless be diligent and exacting in their general examination and in their documentation. Discrepancies between the ED record and the SANE report can sow doubt about the facts of the case in the minds of juries. Defense lawyers will not fail to exploit such discrepancies.

Read more on the physical examination of patients who have experienced sexual assault.