Physical Examination in Child Sexual Abuse Approaches and Current Evidence

Background: The worldwide prevalence of child sexual abuse is 12-13% (18% of girls, and just under 8% of boys). Many doctors are nevertheless unsure of the proper procedures to follow and the scientific basis of the physical findings that are associated with sexual abuse. This article is focused on the physical findings of abuse, rather than its emotional and psychiatric consequences. Method: This article is based on a selective review of pertinent literature retrieved from various databases, including PubMed and the overall index of the Quarterly Update. Results: The great majority of sexually abused children do not have any abnormal physical findings. The proper determination and documentation of physical findings and their interpretation based on current scientific knowledge are essential for the protection of abused children. Conclusion: Sexually abused children can only receive proper medical care if the involved physicians have the requisite knowledge in the areas of child and adolescent gynecology and forensic medicine, are aware of the limited informative value of the physical findings, and are able to apply the pertinent recommendations, guidelines, and classifications that are currently in effect. Although physical examination is important, the diagnosis of child sexual abuse is generally based on the affected child's statements, which should be obtained according to the proper procedure. All physicians should know that the physical findings are normal in more than 90% of cases and understand why this is so. Physical examination can have the benefit of restoring the child's bodily self-image from a pathological to a normal state by confirming physical normality and integrity.