Emotional response to the ano-genital examination of suspected sexual abuse

Guidelines for pediatric anogenital examination: Insights from our vulvar dermatology clinic

To our knowledge, there are no guidelines in the dermatology literature for performing anogenital examinations in prepubescent children. Based on experience in our joint pediatric dermatology-gynecology vulvar clinic, we aim to provide a framework for conducting genital examinations in children, focusing on the vulvar examination. Our goal is to enhance confidence in the pediatric dermatologist's ability to perform thorough examinations by providing general principles as well as concrete "do's" and "don'ts" that will create a maximally comfortable and productive experience. These steps will help create a positive experience for the patient and family, encouraging further follow-up and enhancing the overall well-being of the child.

Emotional and Psychosocial Problems Encountered by Children Who Have Been Sexually Abused

The current descriptive analysis sought to identify the emotional and psychosocial problems experienced by children who have been sexually abused. Of 518 children with a history of sexual abuse who applied to the Child Protection Center, 443 were included in the study. Approximately 71.6% of children were subject to sexual abuse entailing penetration, whereas 69% were subject to sexual abuse not entailing penetration. After-effects reported included despair (46.5%), fear of reoccurrence of the incident (52.8%), distrust of others (36.8%), difficulty sleeping (32.7%), negative expectations about the future (32.1%), and self-blame (31.1%). Nurses have crucial roles and functions in the protection, improvement, treatment, and rehabilitation of the health of children who have been sexually abused. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 37-43.].

Clinical practice: recognizing child sexual abuse-what makes it so difficult?

Recognizing child sexual abuse (CSA) in children is difficult, as there can be many hurdles in the assessment of alleged CSA. With this paper, we try to improve the recognition of CSA by discussing: (1) the difficulties regarding this matter and (2) the diagnostic evaluation of alleged CSA, combining both practical clinical recommendations based on recent research. Children are restrained to disclose CSA due to various reasons, such as fears, shame, and linguistic or verbal limitations. Associations between CSA and urogenital or gastrointestinal symptoms, internalizing and externalizing behavioral problems, post-traumatic stress symptoms, and atypical sexual behavior in children have been reported. However, these symptoms are non-specific for CSA. The majority of sexually abused children do not display signs of penetrative trauma at anogenital examination. Diagnosing a STI in a child can indicate CSA. However, other transmission routes (e.g., vertical transmission, auto-inoculation) need to be considered as well.Conclusion: The assessment consists of medical interview and child interview (parents and child separate and together) with special attention to the child's development and behavior (problems), psychosocial situation and physical complaints, the child's mental health, and the child's trauma history; anogenital examination should be done in all cases of alleged CSA. The examination should be documented by photo or video graphically. Recent research suggests that videography may be the preferred method, and testing on STIs. The assessment should be done multidisciplinary by experienced professionals. Health-care professionals who care for children need to know how child protective agencies and law enforcement are organized. In case there are concerns about a child's safety, the appropriate authorities should be alarmed. What is Known: • Sexual abuse in children often remains unrecognized in the majority of cases. What is New: • Research suggests that videographic documentation is preferred above photographic documentation for anogenital examination; observations of children's behavioral reactions during examinations might be valuable in the evaluation of suspected sexual abuse; nucleic acid amplification testing can be used on vaginal swabs or urine samples for chlamydia and gonorrhea; the CRIES-13 and the CAPS-CA can be used to assess trauma-symptoms in children after sexual abuse.

Disorders of Sex Development: Pediatric Psychology and the Genital Exam

Objective

To provide suggestions for clinical care of youth with disorders of sex development (DSD) and their families, by drawing on preexisting pediatric psychology literature with a particular focus on child sexual abuse (CSA) genital exams.

Method

Relevant peer-reviewed papers published since 1990 in the CSA literature were systematically reviewed, as well as an illustrative sample of general pediatric psychology papers.

Results

Empirical research from the CSA literature provided information on prevalence of distress and the impact of provider behavior, the importance of preparation, and proposed interventions. Expert recommendations from CSA literature and general findings gleaned from pediatric psychology also address these issues.

Conclusions

Psychological findings in the CSA pediatric population suggest that fears and anxieties are not universal and can be linked to a number of variables. Based on this review, we make a number of recommendations for potential interventions for youth with DSD and their families, emphasizing the need for further clinical research.

The relationship between knowledge and child and caregiver distress during the medical examination for child sexual abuse

When child sexual abuse is suspected, a child sexual abuse-related medical examination is recommended to ensure the child's well-being. While the extant research has sought to identify factors influencing child distress during this examination, only recently have studies began examining variables that may be directly associated with the child or with the medical setting. Knowledge of the child sexual abuse-related medical examination is one medical-related variable that has been implicated in child and caregiver distress during the examination. The current study contributes to the existing literature by investigating associations among examination knowledge in relation to caregiver and child anxiety at the time of a child sexual abuse-related medical examination, taking into account ethnicity, past child abuse, injury to child as result of abuse, and caregiver response to disclosure. Sixty-eight children and their nonoffending caregiver were assessed. Results indicated that understanding of the examination and caregiver response to disclosure were significantly associated with caregiver and child anxiety.

The role of the medical provider in the evaluation of sexually abused children and adolescents

It was only 30 years ago that the medical community began to develop an increased awareness of child sexual abuse, and the role of the medical provider in the evaluation of sexually abused children has evolved significantly. As clinicians worldwide develop a greater understanding of the impact of the sexual abuse evaluation on the child, the roles of the physician and nurse have changed. In the United States, current practice often uses a multidisciplinary assessment involving skilled forensic interviewing of the child and a medical examination done by a medical provider with specialized training in sexual abuse. In order to minimize child interviews, these assessments are frequently held in settings such as child advocacy centers, where forensic interviewers and medical clinicians, child protective service workers, and police and district attorneys can work jointly to address the legal and protective issues in a coordinated fashion.