Pediatric emergency medicine trisk 4230 4230
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or genital pain or other complaint, bleeding, or discharge. If that is not the
case, it may be preferable to refer the child/adolescent for an outpatient
medical evaluation with a specialist in child sexual assault.
As stated previously, the vast majority of children have normal anogenital
examinations, in part due to the rapid healing of the mucosa as well as the
nonviolent nature of most child sexual abuse. A normal physical
examination does not rule out sexual assault. Many studies have documented
the examination findings that are indicative of sexual abuse, including
lacerations of posterior aspect of the hymen and posterior fourchette,
ecchymosis of the hymen, or perianal lacerations. Other acute genital
injuries are concerning, though not diagnostic of sexual abuse, and include
bruising or lacerations of the vulva, penis, scrotum, or perineum. These
injuries can be caused by accidental mechanisms, but the history provides
the context for interpretation of these types of injuries.
Management/Diagnostic Testing
Acute Medical Management
Medical or surgical treatment of associated injuries follows standard
procedure with immediate consultation by specialty services as indicated
(Chapter 7 A General Approach to the Ill or Injured Child ). During initial
medical evaluation and stabilization, make all reasonable attempts to
preserve potential evidence, if possible. Avoiding cutting through holes
found in clothing; collect all clothing and place in paper bags and keep it
with the patient until chain of custody can be confirmed. Avoid washing
away potential DNA evidence. The management of serious coexisting
injuries or other acute medical conditions takes precedence over preservation
of forensic evidence. If needed, a forensic examination can be completed in
the operating room, prior to prepping the injured area for surgery, and in
concert with the surgeon managing the serious injury. Weighing the
risk/benefit of forensic evidence collection to providing medical/surgical
treatment is a collaborative decision of the treatment team.
Forensic Evidence Collection
Studies in prepubertal children have shown that the yield of forensic
evidence collection diminishes rapidly with time and is low for children
presenting more than 24 hours after assault. However, a few recent studies
