History-taking should avoid further trauma to the child and still gain a maximum of information. Depending on a possible previous historical evaluation it is not always necessary to repeat questioning on all details of the abuse, which is often difficult and embarrassing for the child. In some cases however, information on the specifics of what has happened will contribute to interpreting physical signs in the light of history. It is advisable to take a separate history from the child and the caretaker if possible. A gentle and open attitude of the examiner and a quiet and accepting atmosphere are essential. The use of anatomically correct dolls is controversial and should be reserved only to very experienced examiners in this field [Leventhal et al., 1989].
History-taking should also be interjected with certain therapeutic messages like ‘it was good to tell’, that many children experience abuse, and that children are never responsible for the abuse. Questions directed to the child should be simple, non-leading and not suggestive of the answer. Scrupulous and verbatim documentation is crucial for further court proceedings and the credibility of the child [Levitt, 2000; Finkel and De Jong, 2001; Horowitz, 1987]. In selected cases, children may disclose sexual abuse during the medical examination, for instance if they are asked if someone has ever touched them ‘in this area’ while the anogenital examination is performed [Palusci et al., 1999].
Revision date: July 7, 2011
Last revised: by Janet A. Staessen, MD, PhD