Medical Evidence

1
Medical Evidence

• Is Medical evidence helpful in determining
  whether child sexual abuse occurred?

2
In most cases, medical evidence is NOT helpful in
determining whether a child was sexually abused
3
Reference articles

• Adams, J. (2005) Medical Laboratory Findings in
  cases of Child Sexual Abuse 2005 Revision. APSAC
  Advisor, Spring, 9-12
• Bays, J. Chadwick, D. (1993). Medical diagnosis
  of the sexually abused child. Child Abuse and
  Neglect 17, 91-110.

4
A normal physical exam is common among sexually
abused children

• Across studies, 50 of sexually abused children
  had normal examinations.
• Most of the abnormal findings in the remaining
  50 are non-specific findings, which are not
  diagnostic of abuse.

5
Medical Findings Diagnostic of Child Sexual Abuse

• Diagnostic medical findings include such things
  as
• Certain types of acute or healed genital or anal
  trauma
• Certain STDs, e.g., gonorrhea, syphilis
• Sperm taken from childs body
• Pregnancy

6
Acute or healed genital or anal trauma is rarely
found among children who provide clear histories
of being sexually abused

• Recent studies have shown that 85 to 95 of
  children who have given clear histories of being
  sexually abused have NO findings of acute or
  healed trauma on examination
• Therefore, only 5 -15 do have such findings

7
Reasons for the absence of evidence of acute or
healed genital/anal trauma among sexually abused
children

1. Many forms of sexual activity do not result in
   physical trauma, i.e., fondling, oral sex,
   simulated intercourse.
2. The elasticity structure of the hymen anal
   sphincter permit penetration without trauma
   (especially when lubricants and/or physical
   manipulation are used)
3. Even when there is trauma, healing occurs quickly
   in children, often between 24 hours and one
   week, and delays in seeking medical exams are
   common

8
Even penile penetration of the anus or hymen may
not result in findings of injury because of

1. Partial penetration
2. The ability of the tissues to stretch
   (elasticity)
3. Or because it may cause minor injuries that heal
   completely before the examination

9
Reasons for the Absence of Other Diagnostic
Medical Evidence Among Sexually Abused Children

• Pregnancy may not occur because the perpetrator
  did not ejaculate during penile-vaginal
  intercourse contraceptives were used or the
  child is prepubescent
• Semen is unlikely to be found more than 72 hours
  after intercourse
• STDs may not be present because of lack of
  exposure or because the child has received
  treatment for the STD

10
Are Childrens Reports about Being Penetrated
Accurate?

• Not necessarily. Many children have a limited
  understanding of penetration. Children who were
  not penetrated sometimes report that something
  was put in them because it felt that way,
  e.g., they felt pressure against the vaginal
  introitus or the anus or some pain
• Also, children and adults use the word in to
  refer to painful experiences-even those that do
  not involve penetration. He punched me in the
  stomach.
• This sometimes explains why there is no medical
  evidence of penetration when a child appears to
  be alleging that penetration occurred.

11
Buyer BewareNot all Medical Exams are Created
Equally!

• A 1987 survey of 129 physicians, primarily
  pediatricians and family practitioners.
• When asked to label the anatomic parts on a
  picture of the genitalia of a 6-year-old girl,
  only 59 correctly identified the hymen!
• Hopefully, the medical field has advanced in
  recent years. But be discerning about the
  credentials of the examining physician.