Children referred for possible sexual abuse: medical findings in 2384 children.
OBJECTIVE
The goal of this study was to compare rates of positive medical findings in a 5-year prospective study of 2384 children, referred for evaluation of possible sexual abuse, with two decades of research. The prospective study summarizes demographic information, clinical history, relationship of perpetrators, nature of abuse, and clinical findings. The study reports on the results by patterns of referral and the medical examination.


RESULTS
There were 2384 children evaluated in a tertiary referral center between 1985 and 1990 for possible sexual abuse. Children were referred after they disclosed sexual abuse, because of behavioral changes or exposure to an abusive environment, and because of possible medical conditions. A total of 96.3% of all children referred for evaluation had a normal medical examination; 95.6% of children reporting abuse were normal, 99.8% who were referred for behavioral changes or exposure to abuse were also normal. Of the 182 children referred for evaluation of medical conditions, 92% were found to be normal at the time of examination by the Child Advocacy Center. The remaining 15/182 (8%) that were found to be abnormal were diagnosed with sexually transmitted diseases, acute or healed genital injuries, and were 17% (15/88) of the total cases found to have medical findings diagnostic of abuse. Interviews of the children indicated that 68% of the girls and 70% of the boys reported severe abuse, defined as penetration of vagina or anus. Penetration was associated with a higher percentage of abnormal findings in girls (6%) compared to 1% of the boys. The relationship of the abuser impacted on the severity of the abuse.


CONCLUSIONS
Research indicates that medical, social, and legal professionals have relied too heavily on the medical examination in diagnosing child sexual abuse. History from the child remains the single most important diagnostic feature in coming to the conclusion that a child has been sexually abused. Only 4% of all children referred for medical evaluation of sexual abuse have abnormal examinations at the time of evaluation. Even with a history of severe abuse such as vaginal or anal penetration, the rate of abnormal medical findings is only 5.5%. Biological parents are less likely to engage in severe abuse than parental substitutes, extended family members, or strangers.
Heger
Astrid
A
Department of Pediatrics, Keck School of Medicine, University of Southern California, Center for the Vulnerable Child, LAC + USC Medical Center, 1240 North Mission Road Tr. 11, Los Angeles, CA 90033, USA.
Ticson
Lynne
L
Velasquez
Oralia
O
Bernier
Raphael
R
D000046:Academic Medical Centers; D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000208:ethnology / Q000706:statistics & numerical data*; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D005836:Genitalia, Female / Q000293:injuries; D005837:Genitalia, Male / Q000293:injuries; D006801:Humans; D007223:Infant; D015141:Los Angeles; D008297:Male; D010808:Physical Examination; D011446:Prospective Studies; D012017:Referral and Consultation; D012742:Sex Offenses