title: [The prevalence of physical evidence in the anogenital area in sexual assault cases of children in Israel].
abstract: BACKGROUND
  Sexual abuse includes obscenity, rape and sodomy. Forensic medical examinations routinely include the genital area, anus and the body of the victims for signs of recent or old injury.
  
  
  OBJECTIVE
  To evaluate the incidence of physical evidence in forensic sexual abuse cases and to compare the Israeli findings to data from other countries, including the USA.
  
  
  METHODS
  The study was conducted during one calendar year in Israel and included 95 children from infancy to 16 years of age, of whom 83% were females. Examination results were defined by the presence of physical injury or its absence. These findings were classified by their location in the anogenital area or other body areas and findings in the anogenital area were further classified by their likelihood to have been caused by a sexual assault. The results of the examination were related to parameters such as age and sex of the participants, length of time since the last assault, and the degree of proximity between the suspected assailant and the victim.
  
  
  RESULTS
  Evidence of physical abuse was found in 41 patients, in 37 (39%) of these cases physical abuse was detected in the anogenital area. In all these cases of anogenital abuse, 11 (12%) showed clear evidence of sexual assault and five of them had recent signs of injury; 80% of the recent injuries in the anogenital area were identified in patients within the first 24 hours after the assault.
  
  
  CONCLUSIONS
  The prevalence of clear evidence of sexual assault in the U.S. ranges from 3-23%, in Italy 9.5%, in Thailand 32% and in Denmark 40%. In Israel, as elsewhere in the world, few cases of sexual assault in children will have clear evidence of a sexual nature. A lack of physical evidence does not rule out sexual assault, therefore, finding physical evidence during an examination is the exception rather than rule. Questioning the victim and investigating the circumstances of the case are crucial elements in all instances of presumed sexual assault on children.
authors.affiliation: The National Center of Forensic Medicine, Assaf Harofeh Medical Center. forensic.health.gov.il@andrei.kotik
authors.forename: Andrei
authors.initials: A
authors.lastname: Kotik
authors.forename: Konstantin
authors.initials: K
authors.lastname: Zaitsev
authors.forename: Aino
authors.initials: A
authors.lastname: Shperber
authors.forename: Jehuda
authors.initials: J
authors.lastname: Hiss
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000293:injuries; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D005554:Forensic Medicine / Q000379:methods*; D005835:Genitalia / Q000293:injuries; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D010808:Physical Examination; D015995:Prevalence; D013997:Time Factors