Sexual abuse is an important diagnosis to confirm for both the child and family so that appropriate treatment can begin. Remember though that some physical findings that may be suggestive of abuse, may not be definitive
Yolanda Lewis-Ragland MD
What to Do – Interpret the Data
There is a wide range of nonabusive causes of physical and behavioral symptoms that serve as presenting complaints of sexual abuse victims; likewise, the physical findings are often vague and nonspecific, with many having other likely causes. For example, although erythema of the vaginal vestibule could be a tell-tale sign of sexual abuse, it is seen commonly in asymptomatic, nonabused, prepubescent girls, and in girls with irritant vulvovaginitis.
Normal Variants
After years of anatomical analysis of female genitalia, it is accepted that there is wide variation in normal hymenal configuration and of vaginal orifice shape. It is important, therefore, to keep in mind some of the following presentations as normal variants:
Septal remnants, seen as tags near the midline on either the anterior or posterior portion of the hymenal membrane
Anterolateral hymenal flaps
Periurethral bands
Intravaginal ridges
Thin labial adhesions.
Nonabusive Causes of Irritation
Vulvovaginitis (due to chemical irritation, poor perineal hygiene or aeration, nonabusive frictional trauma, and contact dermatitis or itching and scratching due to pinworms or fomites)
Urethral prolapse
Lichen sclerosus et atrophicus
Straddle injuries
Foreign bodies
Anal fissures/anal tags (often associated with constipation).
When to Suspect Abuse
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