[Sexual abuse. Experience in a child sexual abuse unit].
OBJECTIVE
To describe the clinical findings in children treated in a child sexual abuse unit.


METHODS
We carried out a retrospective study of the clinical histories of children under suspicion of sexual abuse who visited the hospital from January 1992 to April 2000. Data on age, sex, need of urgent medical care, means of arrival, mechanism of discovery of abuse, parental separation, anamnesis, physical findings and complementary investigations were collected. The patients were then classified in four groups: normal, compatible, highly probable or certain sexual contact. In cases with a high probability of abuse, data of the aggressor's identity, place, duration and type of abuse were also collected.


RESULTS
We studied 704 patients. Seventy-five percent were girls. The child's account of events was the most frequent means of discovering abuse (51%). Anamnesis was positive in 45% of the patients, genital examination was normal in 74% and anal examination was normal in 79%. According to our classification, 40% of the patients were normal, 11% were compatible, 41% were highly probable and 4% were of certain sexual contact. Ninety-two percent of aggressors were male. Molestation was the most frequent form of abuse and in 25% of cases abuse took place for more than 1 year.


CONCLUSIONS
Diagnosis of sexual abuse is difficult and is almost always based on the child's account of events. The diagnostic yield of physical examination and complementary investigations is very low. We propose a diagnostic classification of four levels: normal, compatible, highly probable abuse and certain sexual contact.
Servicio de Pediatría.Unidad Integrada Sant Joan de Déu-Hospital Clínic. Universidad de Barcelona. jpou@hsjdbcn.org
J
J
Pou Fernández
A
A
Ruiz España
L
L
Comas Masmitjá
M D
MD
Petitbó Rafat
M
M
Ibáñez Fanes
J
J
Bassets Marill
D002648:Child; D002650:Child Abuse, Sexual / Q000145:classification / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies