title: A normal ano-genital exam: sexual abuse or not?
abstract: Sexual abuse is a problem of epidemic proportions in the United States. Pediatric nurse practitioners (PNPs) are at the forefront of providing care to children and families. The PNP is in a unique position to educate patients and families regarding sexual abuse and dispel common myths associated with sexual abuse. One such myth is that a normal ano-genital examination is synonymous with the absence of sexual abuse. This article will provide primary care providers, including PNPs, with a framework for understanding why a normal ano-genital examination does not negate the possibility of sexual abuse/assault. Normal ano-genital anatomy, changes that occur with puberty, and physical properties related to the genitalia and anus will be discussed. Photos will provide visualization of both normal variants of the pre-pubertal hymen and genitalia as well as changes that occur with puberty. Implications for practice for PNPs will be discussed.
authors.affiliation: Nationwide Children's Hospital, Center for Child and Family Advocacy, 655 E Livingston Ave, Columbus, OH 43205, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Hornor
mesh_terms: D001003:Anal Canal / Q000033:anatomy & histology* / Q000293:injuries; D001004:Anus Diseases / Q000175:diagnosis / Q000451:nursing; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000451:nursing; D005836:Genitalia, Female / Q000033:anatomy & histology* / Q000293:injuries; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D010371:Pediatric Nursing; D010808:Physical Examination; D011627:Puberty / Q000502:physiology