title: Genital Findings in Cases of Child Sexual Abuse: Genital vs Vaginal Penetration.
abstract: OBJECTIVE
  To (1) examine the prevalence of abnormal genital findings in a large cohort of female children presenting with concerns of sexual abuse; and (2) explore how children use language when describing genital contact and genital anatomy.
  
  
  METHODS
  In this prospective study we documented medical histories and genital findings in all children who met inclusion criteria. Findings were categorized as normal, indeterminate, and diagnostic of trauma. Logistic regression analysis was used to determine the effects of key covariates on predicting diagnostic findings. Children older than 4 years of age were asked questions related to genital anatomy to assess their use of language.
  
  
  METHODS
  A regional, university-affiliated sexual abuse clinic.
  
  
  METHODS
  Female children (N = 1500) aged from birth to 17 years (inclusive) who received an anogenital examination with digital images.
  
  
  METHODS
  Physical exam findings, medical history, and the child's use of language were recorded.
  
  
  RESULTS
  Physical findings were determined in 99% (n = 1491) of patients. Diagnostic findings were present in 7% (99 of 1491). After adjusting for age, acuity, and type of sexual contact reported by the adult, the estimated odds of diagnostic findings were 12.5 times higher for children reporting genital penetration compared with those who reported only contact (95% confidence interval, 3.46-45.34). Finally, children used the word "inside" to describe contact other than penetration of the vaginal canal (ie, labial penetration).
  
  
  CONCLUSIONS
  A history of penetration by the child was the primary predictor of diagnostic findings. Interpretation of children's use of "inside" might explain the low prevalence of diagnostic findings and warrants further study.
authors.affiliation: The Our Kids Center, Nashville, Tennessee; Nashville General Hospital at Meharry, Nashville, Tennessee; Vanderbilt Children's Hospital, Nashville, Tennessee. Electronic address: hollye.r.gallion@vanderbilt.edu.
authors.forename: H R
authors.initials: HR
authors.lastname: Gallion
authors.affiliation: The Our Kids Center, Nashville, Tennessee; Nashville General Hospital at Meharry, Nashville, Tennessee.
authors.forename: L J
authors.initials: LJ
authors.lastname: Milam
authors.affiliation: The Our Kids Center, Nashville, Tennessee; Nashville General Hospital at Meharry, Nashville, Tennessee; Vanderbilt Children's Hospital, Nashville, Tennessee.
authors.forename: L L
authors.initials: LL
authors.lastname: Littrell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D010808:Physical Examination; D011446:Prospective Studies; D014621:Vagina / Q000473:pathology*; D014844:Vulva / Q000473:pathology*
keywords: Adolescent sexual assault; Child sexual abuse; Genital injury; Penetration