The Evaluation of Suspected Pediatric Sexual Abuse

Children who are suspected to have been sexually abused frequently present to an emergency department. When evaluating patients with concerns for sexual abuse, the emergency practitioner must be aware of the following: (1) the appropriate examination techniques and methods for documentation of findings; (2) indications for forensic evidence collection; (3) indications for referring the child to undergo a forensic interview; (4) indications for testing for sexually transmitted diseases; (5) indications for postexposure prophylaxis for sexually transmitted diseases and pregnancy; (6) identification of genital and anal findings that have resulted from trauma, from medical conditions, and from sexual assault; and (7) when child protective services and/or law enforcement reporting is required. Many conditions are misdiagnosed as sexual abuse. A thorough discussion of these conditions is included. Finally, this article focuses on technologies that allow better evidence documentation and expert-opinion utilization.