Pediatric Gynecology: Assessment Strategies and Common Problems

Jane H. Kass-Wolff, RN, MS; Ellen E. Wilson, MD

Disclosures

Semin Reprod Med. 2003;21(4) 

In This Article

Sexual Abuse

Practitioners are frequently asked to help determine whether a child has been sexually abused. In these cases, it is important to be familiar with the locally mandated reporting laws.

Evaluation is certainly warranted when organisms are found on cultures that are associated with sexual transmission. Genital infection with Neisseria gonorrhoeae is associated with a purulent thick yellow discharge along with vulvar erythema and edema. Chlamydia trachomatis may present with vulvovaginitis, pruritis, and discharge. Infants born to mothers with chlamydia may carry the organism for up to 18 months.[19] After this age, however, findings of chlamydia warrant a search for sexual abuse. Trichomonas observed on saline wet mount is uncommon in an unestrogenized vagina and therefore is rarely a cause of vaginitis in the prepubertal child.[15] Young children who have been sexually abused do not always present with physical signs of injury. The abuse may have occurred some time ago, or there may not have been actual attempt to penetrate the vagina. Behavioral symptoms vary for each individual. Sleep disturbances with nightmares may be seen. Children who perform sexual acts on others are often found to have a history of abuse. Physical symptoms may include enuresis, encopresis, dysuria, vaginal bleeding, and pelvic or abdominal pain.

Collection of forensic evidence should be handled by an experienced practitioner with recognition of the emotional needs of the child as well as the legal requirements for successful prosecution of the perpetrator. Excellent reviews of the subject are available.[12,20]

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