[Sexual abuse of prepubertal children].
BACKGROUND
During the last 15 years, a considerable change has taken place regarding the understanding of anatomical and microbiological anogenital findings in children. At the end of the 1980s, abnormal findings were described in more than 50 % of allegedly abused children. Today such findings are described in 5 %. An important consequence of this change is that absence of abnormal findings should never be used to exclude abuse, not even abuse with anogenital penetration. The main reason for this change is increased knowledge about normal variation and healing after injury, as well as an improvement in standardisation of terminology.


METHODS
This paper is based on relevant literature published on this topic.


CONCLUSIONS
During this period, several findings have been reclassified from abnormal to normal or non-specific. Examples of such findings are anal dilatation, large and gaping hymenal opening and narrow hymenal brim. Some of the previously reported cases of anogenital scarring are probably mis-classified normal structures. Research-based international classification scales are now established in order to aid the physician in diagnosing sexual abuse, and these are revised on a regular basis. It is currently common to classify medical findings into three main categories; normal/unspecific findings, indeterminate findings and diagnostic findings.
Myhre
Arne Kristian
AK
Barne- og ungdomsklinikken, St. Olavs Hospital, 7006 Trondheim, Institutt for laboratoriemedisin barne- og kvinnesykdommer, Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, Norway. arne.k.myhre@ntnu.no
Borgen
Geir
G
Ormstad
Kari
K
D001003:Anal Canal / Q000033:anatomy & histology / Q000473:pathology; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D003127:Colposcopy; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D006924:Hymen / Q000033:anatomy & histology / Q000473:pathology; D008297:Male; D014621:Vagina / Q000033:anatomy & histology / Q000473:pathology