Sexual abuse of children and adolescents. Handling of suspected cases

Background. Sexual abuse in childhood and adolescence represents a great challenge in the pediatric daily routine. Medical expertise on examination techniques, anogenital structures, abuse-related findings, physiological normal variants, differential diagnoses and legal conditions are of far-reaching diagnostic importance. Objective. The present article is intended to impart aplomb to pediatricians in private practice and in hospitals when dealing with suspected cases of child sexual abuse, increase diagnostic confidence and illustrate the importance of interdisciplinary cooperation. Material and methods. In addition to the procedure of a physical examination and anogenital inspection, typical physical findings, infections and anogenital abnormalities for a forensic interpretation of findings are illustrated. Furthermore, legal framework conditions and intervention steps are explained. Results. Diagnostic or indicative findings that provide evidence of child sexual abuse can rarely be ascertained in the context of a physical or anogenital examination. Nevertheless, correct examination, documentation and securing of evidence have significant consequences for the protection of affected children and adolescents. Conclusion. In order to avoid possible false diagnoses in the context of suspected cases of sexual abuse and to handle the affected children professionally, expertise in clinical forensic examinations and in findings taking current guidelines and classifications into account, inclusion of medicolegal experts and a close interdisciplinary cooperation are necessary. These conditions can protect affectedminors from repeated sexual assault and adjust abuse-related disorders of body self-perception.