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Clinical Summary

Most physical examinations in cases of sexual abuse or assault will be normal. Findings specific for acute trauma, although not necessarily diagnostic of sexual abuse or assault, include bruising, lacerations, and abrasions. Most of these injuries will heal quickly, usually within a few days, and will heal completely without scarring. Nonacute examination findings caused by trauma can be difficult to diagnose and should be interpreted by a qualified child abuse expert.

Sexually transmitted infections diagnosed in a prepubertal child usually indicate sexual abuse. Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas, and syphilis are almost always transmitted by intimate sexual contact (intimate contact with infected secretions or lesions) unless acquired perinatally. HIV (unless acquired perinatally) and hepatitis are transmitted by intimate sexual contact or contact with infected blood. Condylomata acuminata (human papillomavirus or genital warts) and herpes simplex virus may be transmitted to the prepubertal child through sexual or nonsexual contact.

Management and Disposition

Victims of an acute sexual assault may have genital and/or anal bleeding. Patients who have active genital and/or anal bleeding need immediate attention and evaluation.

Also see “Child Sexual Abuse Exam and Genital Findings.”

FIGURE 15.94

Hymenal Bruise. The hymen has bruising from 3- to 5-o’clock position after an acute sexual assault. (Photo contributor: Cincinnati Children’s Hospital Medical Center.)

FIGURE 15.95

Posterior Fourchette Laceration. A laceration is present in the posterior fourchette, after sexual assault. This is a common location for injury after sexual assault/abuse. (Photo contributor: Cincinnati Children’s Hospital Medical Center.)

FIGURE 15.96

Acute Genital Injury. This prepubertal girl has bruising to her left labia minora, and an acute, bleeding transection of her inferior hymen. (Photo contributor: Daniel M. Lindberg, MD.)

FIGURE 15.97

Scrotal Bruise. Bruising to the scrotum is present as well as an abrasion to the tip of the penis. Physical abuse as well as sexual abuse should be considered when genital injury is noted. (Photo contributor: Kathi L. Makoroff, MD.)

FIGURE 15.98

Penile Abrasion. Abrasion to the underside of the penis illustrates that it is important to examine all parts of the genitalia. (Photo contributor: Daniel M. Lindberg, MD.)

FIGURE 15.99

Acute Deep Perianal Lacerations and Bruising. An acute rectal laceration is visible at 8-o’clock position with bruising on the right side of the perianal area. (Photo contributor: Cincinnati Children’s Hospital Medical Center.)

FIGURE 15.100

Vaginal Discharge—Neisseria gonorrhoeae. Vaginal ...

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