Medical evaluation for suspected sexual violence against girls

Introduction: Sexual violence against children is a hidden problem. Medical examination and evaluation is needed to search for possible injuries, exclude infections, procure legal evidence and ensure the child's welfare. We assessed medical evaluations done at Landspitali University Hospital and in the Reykjavik Children's House, a specialized clinic for childhood abuse cases. Material and methods: Retrospective descriptive analysis was performed on the standardized medical examinations. Age, sex, waiting time from reported violence until examination and recorded aberrant external genitalia findings were noted, and classified by the medically oriented Adams system. Offence severity stages were assigned. Results: Medical examination cases numbered 224 for 220 girls aged 1-17 years. Records were available on 218 standarized examinations among girls; 201 were adequate (92%). Most were conducted within a month (medium waiting-time 28 days; range 1-166). Hymenal changes were in 24 cases possibly associated with sexual violence, including 21 in a girl not sexually active. Two girls had human papillomavirus warts (1%) and one chlamydial infection (0.5%). Medical examination was normal in 85% (165/193) of girls who were not sexually active; 24 had possibly experienced sexual violence and four results were uncertain/controversial. For 71 offence severity was serious. Conclusion: Most examinations were conducted on prepubertal girls, were not a matter of urgency and showed normal results. Possible relation to sexual violence was described for one in eight. Infections were rare. When child sexual abuse is suspected, care with methodology and procedures is needed, both for elective and acute medical examinations.