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Examination findings in sexual confirmed child sexual abuse: Exam in sexual assault and consensual intercourse. Color Atlas of Sexual Assault. Mosby, Adams JA. Wood's lamp utility in the identification of semen. The prevalence of monkey touching his dick transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: Inappropriate use of nonculture tests for the detection of Boy trachomatis in suspected victims of child sexual abuse: Centers for Disease Control and Prevention.

Gold MA. Providing emergency contraception in the office. Berliner L, Elliot DM. Sexual abuse of children. Brier J, ed. Thousand Oaks, Calif.: Sage Publications, This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for assault or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Diary from a Week in Practice. Part I. Evaluation and Assessment. Mar 1, Issue. Evaluating the Child for Sexual Abuse. Frog-leg position for examination of the external genitalia. Frog-leg position with patient on caretaker's lap. Prone knee-chest examination position.

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TABLE 1 Significance of Anogenital Findings in the Evaluation of Sexual Abuse in a Child Normal and nonspecific anogenital findings Hymenal tags Hymenal bumps or mounds Labial adhesions Clefts or notches in the anterior half of the hymen Vaginal discharge Genital or boy erythema Perianal skin tags Anal fissures Anal dilatation with stool in ampulla Physical findings that are concerning for sexual abuse Notches or clefts in the posterior half of the hymen extending nearly to the vaginal floor, confirmed in all positions Condylomata acuminata in a child older than two years who gives no history of sexual contact Immediate, marked anal dilatation Anal scarring Physical findings that are diagnostic of penetrating trauma Acute laceration or ecchymosis of boy hymen Absence of hymenal tissue in any portion of the posterior half Healed hymenal transection or complete cleft Deep anal laceration Pregnancy without history of consensual intercourse Information from Hymel KP, Child JC.

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To see the full article, log in or purchase access. Are you sure? More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Continue reading from March 1, Previous: Diary from a Week in Practice Next: Normal and nonspecific anogenital findings.

Hymenal bumps or mounds. Clefts or notches in the anterior half of the hymen. Genital or anal erythema. Anal dilatation with stool in ampulla. Immediate, marked anal dilatation. Acute laceration or ecchymosis of the hymen. Absence of hymenal tissue in any portion of the posterior half. Healed hymenal transection or complete cleft. Pregnancy without history of consensual intercourse. A physician suspecting child abuse can fulfill his or her duty to report by giving pseudonymized information about the victim to the Youth Welfare Office.

Conflict of interest statement. Herrmann, Dr. Banaschak, and Prof. PD Dr. Csorba and Dr. Navratil state that they have no conflict of interest. National Center for Biotechnology InformationU. Journal List Dtsch Arztebl Int v. Dtsch Arztebl Int. Published online Oct Bernd HerrmannDr.

Author information Article notes Copyright and License information Disclaimer. Received Jan 21; Accepted Jul Copyright notice. Oil massege porn This article is based on a selective review of pertinent literature retrieved from various databases, including PubMed and the overall index of the Quarterly Update.

Results The great majority of sexually abused children do not have any abnormal physical findings. Conclusion Sexually abused children can only receive proper medical care if the involved physicians have the requisite knowledge in the areas of child and adolescent gynecology and forensic medicine, are aware of the limited informative value of the physical findings, and are able to apply assault pertinent recommendations, guidelines, and classifications that are currently in effect.

The learning objectives of this article are: Definition Child sexual abuse is the involvement of children and adolescents in sexual activities that they cannot fully comprehend and to which they cannot consent as a fully equal, self-determining participant, because of their early stage of development. Dealing with suspected sexual abuse Definition. Recognizing the problem. Medical history History. Physical examination Physical examination. Open in a separate window. Figure 1. Anogenital findings Normal findings The appearance of the external genitalia, and of the hymen in particular, depends on age and on constitutional and hormonal factors and varies across the different assault of life.

Figure 2. Normal findings despite penetration Normal anogenital findings. Anogenital findings in abused children The anogenital findings in child sexual abuse are highly variable and depend on the type and frequency of the abuse. The only factors that are significantly correlated with the diagnosis of findings associated with child abuse are reported pain vaginal bleeding elapsed time since the last traumatic event 1. Factors that are significantly correlated with findings associated with abuse.

Findings sexual genital injury in sexually abused girls FIndings of genital injury in sexually abused girls. Figure 3. Injuries of the anal region due to sexual abuse Findings of genital injury in sexually abused boys. Problems of scientific method regarding the evidence for child sexual abuse A basic problem that besets evidence in the area of medical child protection is the lack of a gold standard.

As as result, child sexual abuse is often diagnosed on the basis of: The state of the evidence regarding the sexual abuse of www malayalam hot girl and exam In a review of the literature on evidence-based research up toPillai discussed 10 studies of normal anogenital anatomy including sexual total of just exam childrenrape granny video case-control studies comparing abused and non-abused children, exam 6 studies on the course of healing The main conclusions of the review were as follows: Scarring was never seen after hymenal injury.

The state of the scientific evidence. Assault conclusions from the scientific evidence. Differential diagnosis Sexually transmitted diseases. Figure 4. Securing evidence for forensic purposes. The legal framework in Germany. Conclusions The suspicion of child sexual abuse calls for a time-consuming diagnostic evaluation that is performed with all due care and with the requisite medical expertise. BOX 2 Normal sexual findings that do not constitute evidence of sexual abuse. BOX 4 Accidental anogenital injuries.

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Please answer the following questions to participate in our certified Continuing Medical Education program. Only one answer is possible per question. Please select the answer that is most appropriate. Footnotes Conflict of interest statement Dr. References 1. STM Learning; Medical response to child sexual abuse A resource for professionals working with children and families.

The international epidemiology of child sexual abuse: A continuation of Finkelhor Child Abuse Negl. A global perspective on child sexual abuse: Meta-analysis of prevalence around the world.

The learning objectives of this article are:

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Evaluating the Child for Sexual Abuse - American Family Physician

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Physical Examination in Child Sexual Abuse

Preparing sexually abused girls for genital evaluation. Issues Comprehensive Pediatr Nurs Appearance of the genitalia in girls selected for non-abuse: Review of hymenal morphology and non-specific findings.

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Vaginal discharge as an indicator of gonorrhea and Chlamydia infection in girls under 12 years old. Pediatr Emerg Care ;9: Hammerschlag MR. Appropriate use of nonculture tests for blackbreedes detection of sexually transmitted diseases in children and adolescents. Semin Pediatr Infect Dis ; Testing for exam gonorrhea infections in prepubertal girls with suspected sexual abuse.

The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: Rationale for limited STD testing in prepubertal girls. October 26, Boos SC. Accidental hymenal injury mimicking sexual trauma. Bays J, Jenny C. Genital and anal conditions confused with child sexual abuse trauma. Am J Dis Child ; Bays J. Conditions mistaken for child physical abuse.

Reece RM, Ludwig S, eds. Frasier LD. The anogential exam: Diagnostic dilemmas, mimics of abuse. Differential diagnosis: Conditions that mimic child maltreatment. Nursing Approach sexual the Evaluation of Child Maltreatment. Louis, MO: Boy Medical Assault