In spite of an abundance of data on medical findings in CSA victims and their differentiation from normal, normal variants and other differential diagnoses, the medical proof of abuse remains the exception when evaluating suspected sexual abuse cases. This would be the case in massive acute anogenital trauma in the absence of a convincing history of accidental trauma, proof of gonorrhea or syphilis (after excluding a congenital infection), pregnancy, proof of semen, sperm cells, acid phosphatase or sperm-specific glycoprotein p30 in or on the body of a child.
The overall assessment of the likelihood of sexual abuse and the final conclusions have to be done conscientiously and need to include all physical findings, possible laboratory results and especially the history obtained from the child. The medical expert contributes a thoughtful and qualified piece of evidence to the multidisciplinary puzzle of evaluating children for possible CSA.
Strictly medical interventions in CSA include treatment of injuries, infections, or STDs, and emergency contraception. Reassurance of physical intactness should be an integral part of the medical examination. The ongoing management and interventions in therapeutic, social and legal fields is no longer the duty of the medical expert. She/he participates in referral to therapy, emotional guidance of the family, and assisting the legal system in cases with confirmatory findings.
It is crucial to develop extensive interdisciplinary and multiprofessional cooperation and consultation in all cases.
Although we are constantly learning more about the role and significance of medical aspects in suspected sexual abuse cases, the diagnosis ‘child sexual abuse’ primarily rests on the professionally and qualified obtained descriptive statements made by an abused child.
Revision date: July 7, 2011
Last revised: by Andrew G. Epstein, M.D.