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Abnormal Findings Diagnostic of Anogenital Trauma in Prepubertal Children

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Handbook of Interpersonal Violence and Abuse Across the Lifespan

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Abstract

Genital injuries are uncommon among prepubertal children when sexual abuse is alleged. When genital injuries occur, they must be distinguished from abnormal findings due to dermatologic conditions, congenital anomalies, urologic conditions, and accidental trauma. Correct identification and assessment of anogenital injuries is essential for relating history to injury; a mismatch between history and injury aids in detection of false histories. Some sexually transmitted infections are diagnostic of sexual abuse, but proper testing methods are required in order to ensure appropriate interpretation of findings. When injuries occur, only rarely is surgical management needed; instead, injuries heal rapidly and usually without scarring. Follow-up is recommended within several weeks after presentation for care, to permit clarification of examination findings, and for further testing for sexually transmitted infections, as needed.

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References

  • Adams, J. A., Harper, K., Knudson, S., & Revilla, J. (1994). Examination findings in legally confirmed child sexual abuse: It’s normal to be normal. Pediatrics, 94, 310–317.

    Google Scholar 

  • Adams, J. A., Farst, K. J., & Kellogg, N. D. (2018). Interpretation of medical findings in suspected child sexual abuse: An update for 2018. Journal of Pediatric and Adolescent Gynecology, 31, 225–231. https://doi.org/10.1016/j.jpag.2017.12.011.

    Article  Google Scholar 

  • American Academy of Pediatrics. (2018a). Sexually transmitted infections in adolescents and children. In D.W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), AAP red book: 2018 report of the committee on infectious diseases (31st ed., pp. 165–176). American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018b). Chlamydia trachomatis. In D. W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), AAP red book: 2018 report of the committee on infectious diseases (31st ed., pp. 276–283). Itasca: American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018c). Gonococcal infections. In D.W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), AAP red book: 2018 report of the committee on infectious diseases (31st ed., pp. 355–365). American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018d). Syphilis. In D.W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), AAP Red Book: 2018 report of the committee on infectious diseases (31st ed., pp. 773–788). American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018e). Human immunodeficiency virus infection. In D.W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), AAP red book: 2018 report of the committee on infectious diseases (31st ed., pp. 459–476). American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018f). Trichomonas vaginalis Infections. AAP Red Book: 2018 report of the committee on infectious diseases (31st ed., pp. 820–823). American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018g). Herpes simplex. In D.W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), aap red book: 2018 report of the committee on infectious diseases (31st ed., pp. 437–449). American Academy of Pediatrics.

    Google Scholar 

  • American Academy of Pediatrics. (2018h). Human papillomaviruses. In D.W. Kimberlin, M. T. Brady, M. A. Jackson, & S. S. Long (Eds.), AAP red book: 2018 report of the committee on infectious diseases (31st ed., pp. 582–590). American Academy of Pediatrics.

    Google Scholar 

  • Anderst, K., Kellogg, N., & Jung, I. (2009). Reports of repetitive penile-genital penetration often have no definitive evidence of penetration. Pediatrics, 124(3), e403–e409. https://doi.org/10.1542/peds.2008-3053.

    Article  Google Scholar 

  • Casey, J. T., Bjurlin, M. A., & Cheng, E. Y. (2013). Pediatric genital injury: An analysis of the National Electronic Injury Surveillance System. Urology, 82(5), 1125–1130. https://doi.org/10.1016/j.urology.2013.05.042.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2016). Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV – United States, 2016. US Department of Health and Human Services.

    Google Scholar 

  • De Jong, A. R., & Rose, M. (1989). Frequency and significance of physical evidence in legally proven cases of child sexual abuse. Pediatrics, 84(6), 1022–1026.

    Google Scholar 

  • Eroglu, E., Yip, M., Oktar, T., Kayiran, S. M., & Mocan, H. (2011). How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: Estrogen only, betamethasone only, and combination estrogen and betamethasone. Journal of Pediatric and Adolescent Gynecology, 24(6), 389–391.

    Article  Google Scholar 

  • Funaro, D., Lovett, A., Leroux, N., & Powell, J. (2014). A double-blind, randomized prospective study evaluating topical clobetasol propionate 0.05% versus topical tacrolimus 0.1% in patients with vulvar lichen sclerosus. Journal of the American Academy of Dermatology, 7(1), 84–91.

    Article  Google Scholar 

  • Gabriel, N. M., Clayton, M., & Starling, S. P. (2009). Vaginal laceration as a result of blunt vehicular trauma. Journal of Pediatric and Adolescent Gynecology, 22, e166–e168.

    Article  Google Scholar 

  • Gavril, A. R., Kellogg, N. D., & Nair, P. (2012). Value of follow-up examinations of children and adolescents evaluated for sexual abuse and assault. Pediatrics, 129(2), 282–289. https://doi.org/10.1542/peds.2011-0804.

    Article  Google Scholar 

  • Goldman, R. D. (2013). Estrogen cream for labial adhesion in girls. Canadian Family Physician, 59(1), 37–38.

    Google Scholar 

  • Heger, A., Ticson, L., Velasquez, O., & Bernier, R. (2002). Children referred for possible sexual abuse: Medical findings in 2384 children. Child Abuse & Neglect, 26, 645–659.

    Article  Google Scholar 

  • Heppenstall-Heger, A., Mcconnell, G., Ticson, L., Guerra, L., Lister, J., & Zaragoza, T. (2003). Healing patterns in anogenital injuries: A longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics, 112(4), 829–837. https://doi.org/10.1542/peds.112.4.829.

    Article  Google Scholar 

  • Holbrook, C., & Misra, D. (2012). Surgical management of urethral prolapse in girls: 13 years’ experience. BJU International, 110(1), 132–134.

    Google Scholar 

  • Iqbal, C. W., Jrebi, N. Y., Zielinski, M. D., Benavente-Chenhalls, L. A., Cullinane, D. C., Zietlow, S. P., Moir, C. R., & Ishitani, M. B. (2010). Patterns of accidental genital trauma in young girls and indications for operative management. Journal of Pediatric Surgery, 45(5), 930–933.

    Article  Google Scholar 

  • Jenny, C., Crawford-Jakubiak, J. E., & Committee on Child Abuse and Neglect. (2013). The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics, 132, e558–e567.

    Google Scholar 

  • Kellogg, N., & the Committee on Child Abuse and Neglect. (2005). The evaluation of sexual abuse in children. Pediatrics, 116(2), 506–512.

    Article  Google Scholar 

  • Kellogg, N. D., Menard, S. W., & Santos, A. (2004). Genital anatomy in pregnant adolescents: “Normal” does not mean “nothing happened”. Pediatrics, 113(1), e67–e69.

    Article  Google Scholar 

  • Kellogg, N., Melville, J., Lukefahr, J., Nienow, S., & Russell, E. (2018). Genital and extragenital gonorrhea and chlamydia in children and adolescents evaluated for sexual abuse. Pediatric Emergency Care, 34(11), 761–766.

    Article  Google Scholar 

  • Marfatia, Y., Surani, A., & Baxi, R. (2019). Genital lichen sclerosus et atrophicus in females: An update. Indian Journal of Sexually Transmitted Diseases and AIDS, 40(1), 6–12.

    Article  Google Scholar 

  • McCann, J., Miyamoto, S., Boyle, C., & Rogers, K. (2007). The healing of hymenal injuries in prepubertal and adolescent females: A descriptive study. Pediatrics, 119(5), e1094–e1106. https://doi.org/10.1542/peds.2006-0964.

    Article  Google Scholar 

  • Miller, J. M., Binnicker, M. J., Campbell, S., Carroll, K. C., Chapin, K. C., Gilligan, P. H., Gonzalez, M. D., Jerris, R. C., Kehl, S. C., Patel, R., Pritt, B. S., Richter, S. S., Robinson-Dunn, B., Schwartzman, J. D., Snyder, J. W., Telford, S., III, Theel, E. S., Thomson, R. B., Jr., Weinstein, M. P., & Yao, J. D. (2018). A guide to the utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology. Clinical Infectious Diseases, 67(6), e1–e94.

    Article  Google Scholar 

  • Powell, J., & Wojnarowska, F. (2001). Childhood vulvar lichen sclerosus: An increasingly common problem. Journal of the American Academy of Dermatology, 44(5), 803–806.

    Article  Google Scholar 

  • Scheidler, M. G., Schultz, B. L., Schall, L., & Ford, H. R. (2000). Mechanisms of blunt perineal injury in female pediatric patients. Journal of Pediatric Surgery, 35(9), 1317–1319.

    Article  Google Scholar 

  • Sena, A. C., Hsu, K. K., Kellogg, N., Girardet, R., Christian, C. W., Linden, J., Griffith, W., Marchant, A., Jenny, C., & Hammerschlag, M. R. (2015). Sexual assault and sexually transmitted infections in adults, adolescents, and children. Clinical Infectious Diseases, 61(S8), S856–S864.

    Article  Google Scholar 

  • Smith, T. D., Raman, S. R., Madigan, S., Waldman, J., & Shouldice, M. (2018). Anogenital findings in 3569 pediatric examinations for sexual abuse/assault. Journal of Pediatric and Adolescent Gynecology, 31(2), 79–83. https://doi.org/10.1016/j.jpag.2017.10.006.

    Article  Google Scholar 

  • Spitzer, R. F., Kives, S., Caccia, N., Ornstein, M., Goia, C., & Allen, L. M. (2008). Retrospective review of unintentional female genital trauma at a pediatric referral center. Pediatric Emergency Care, 24(12), 831–835.

    Article  Google Scholar 

  • Uprety, P., & Cardenas, A. M. (2019). Extragenital screening is essential for comprehensive detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the pediatric population. Journal of Clinical Microbiology, 57(6), e00335–e00319. https://doi.org/10.1128/JCM.00335-19.

    Article  Google Scholar 

  • Widni, E. E., Hollwarth, M. E., & Saxena, A. K. (2011). Analysis of nonsexual injuries of the male genitals in children and adolescents. Acta Paediatrica, 100(4), 590–593.

    Article  Google Scholar 

  • Workowski, K. A., Bolan, G. A., & Center for Disease Control. (2015). Sexually transmitted diseases treatment guidelines. Morbidity and Mortality Weekly Reports Recommendations and Reports, 64(3), 1–137.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Eastern Virginia Medical School/Children’s Hospital of The King’s Daughters, Norfolk, VA, USA

    Michelle Clayton & Amber L. Shipman

Authors
  1. Michelle Clayton
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  2. Amber L. Shipman
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Corresponding author

Correspondence to Michelle Clayton .

Editor information

Editors and Affiliations

  1. Institute on Violence, Abuse and Trauma, Alliant International University, San Diego, CA, USA

    Robert Geffner

  2. School of Health and Human Sciences, University of North Carolina at Greensbo, Greensboro, NC, USA

    Jacquelyn W. White

  3. Dept of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    L. Kevin Hamberger

  4. Department of Psychology, Northern Illinois University, DeKalb, IL, USA

    Alan Rosenbaum

  5. Ethelyn R. Strong School of Social Work, Norfolk State University, Norfolk, VA, USA

    Viola Vaughan-Eden

  6. Education and Research, Zero Abuse Project, St. Paul, MN, USA

    Victor I. Vieth

Section Editor information

  1. Associate Professor of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA

    Ernestine Briggs

  2. School of Social Work, University of Alabama, Tuscaloosa, AL, USA

    Javonda Williams

  3. Associate Professor of Pediatrics, Eastern Virginia Medical School/Children's Hospital of The King's Daughters, Norfolk, VA, USA

    Michelle Clayton MD, MPH, FAAP

  4. The UP Institute, CEO, New Orleans, LA, USA

    Stacie LeBlanc JD, MEd

  5. Ethelyn R. Strong School of Social Work, Norfolk State University, Norfolk, VA, USA

    Viola Vaughan-Eden Ph.D

  6. Owner/Principal Consultant & Trainer, Russell Consulting Specialists, LLC, Vancouver, Washington, USA

    Amy Russell

  7. Executive Director, Arthur D. Curtis Children's Justice Center http://www.clark.wa.gov/cjc

    Amy Russell

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Clayton, M., Shipman, A.L. (2020). Abnormal Findings Diagnostic of Anogenital Trauma in Prepubertal Children. In: Geffner, R., White, J.W., Hamberger, L.K., Rosenbaum, A., Vaughan-Eden, V., Vieth, V.I. (eds) Handbook of Interpersonal Violence and Abuse Across the Lifespan. Springer, Cham. https://doi.org/10.1007/978-3-319-62122-7_245-1

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  • DOI: https://doi.org/10.1007/978-3-319-62122-7_245-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62122-7

  • Online ISBN: 978-3-319-62122-7

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