Medical Evidence

1. Medical Evidence • Is Medical evidence helpful in determining whether child sexual abuse occurred?

2. In most cases, medical evidence is NOT helpful in determining whether a child was sexually abused

3. Reference articles: Adams, J. (2005) Medical & Laboratory Findings in cases of Child Sexual Abuse: 2005 Revision. APSAC Advisor, Spring, 9-12 Bays, J. & Chadwick, D. (1993). Medical diagnosis of the sexually abused child. Child Abuse and Neglect 17, 91-110.

4. A normal physical exam is common among sexually abused children • Across studies, 50% of sexually abused children had “normal” examinations. • Most of the “abnormal” findings in the remaining 50% are non-specific findings, which are notdiagnosticof abuse.

5. Medical Findings Diagnosticof Child Sexual Abuse • “Diagnostic” medical findings include such things as: • Certain types of acute or healed genital or anal trauma • Certain STDs, e.g., gonorrhea, syphilis • Sperm taken from child’s body • Pregnancy

6. Acute or healed genital or anal trauma is rarely found among children who provide clear histories of being sexually abused • Recent studies have shown that 85% to 95% of children who have given clear histories of being sexually abused have NO findings of acute or healed trauma on examination • Therefore, only 5 -15% do have such findings

7. Reasons for the absence of evidence of acute or healed genital/anal trauma among sexually abused children • Many forms of sexual activity do not result in physical trauma, i.e., fondling, oral sex, “simulated intercourse.” • The elasticity & structure of the hymen & anal sphincter permit penetration without trauma (especially when lubricants and/or physical manipulation are used) • Even when there is trauma, healing occurs quickly in children, often between 24 hours and one week, and delays in seeking medical exams are common

8. Even penile penetration of the anus or hymen may not result in findings of injury because of: • Partial penetration • The ability of the tissues to stretch (elasticity) • Or because it may cause minor injuries that heal completely before the examination

9. Reasons for the Absence of Other Diagnostic Medical Evidence Among Sexually Abused Children • Pregnancy may not occur because the perpetrator did not ejaculate during penile-vaginal intercourse; contraceptives were used; or the child is prepubescent • Semen is unlikely to be found more than 72 hours after intercourse • STDs may not be present because of lack of exposure or because the child has received treatment for the STD

10. Are Children’s Reports about Being Penetrated Accurate? • Not necessarily. Many children have a limited understanding of penetration. Children who were not penetrated sometimes report that something was put “in” them because it “felt” that way, e.g., they felt pressure against the vaginal introitus or the anus or some pain • Also, children and adults use the word “in” to refer to painful experiences-even those that do not involve penetration. “He punched me in the stomach.” • This sometimes explains why there is no medical evidence of penetration when a child appears to be alleging that penetration occurred.

11. Buyer Beware:Not all Medical Exams are Created Equally! • A 1987 survey of 129 physicians, primarily pediatricians and family practitioners. • When asked to label the anatomic parts on a picture of the genitalia of a 6-year-old girl, only 59% correctly identified the hymen! • Hopefully, the medical field has advanced in recent years. But be discerning about the credentials of the examining physician.