Child sexual abuse-Genital tract findings in prepubertal girls

A parent or carer’s observation of blood in a child’s nappy or underwear can be quite alarming for both parent and child and may indicate vaginal bleeding. At first glance, it may be difficult to ascertain whether the bleeding is from the skin, genital tract, urinary tract or anus. Confirmed vaginal bleeding in a pre-pubertal girl is rare but always abnormal and requires comprehensive assessment to determine the cause. Recognition of normal female pre-pubertal anatomy is essential to detect any abnormalities. Appropriate action should be taken according to findings on initial inspection of the ano-genital area. The possibility of child sexual abuse and the need for specialist paediatric sexual offences medicine examination by an FME (Forensic Medical Examiner) or specialist paediatrician should always be considered. This article offers a systematic approach to assessment in pre-pubertal girls with apparent vaginal bleeding which will benefit general paediatricians, emergency department practitioners and GPs.

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The value of paediatric assessment in historic child sexual abuse

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311989 ◽

2017 ◽

Vol 102 (6) ◽

pp. 550-555 ◽

Cited By ~ 7

Author(s):

Sarah Al-Jilaihawi ◽

Kevin Borg ◽

Sabine Maguire ◽

Deborah Hodes

Keyword(s):

Sexual Abuse ◽

Child Sexual Abuse ◽

Forensic Evidence ◽

Retrospective Case ◽

Professional Help ◽

Children And Young People ◽

Unmet Health Needs ◽

Broad Variety ◽

Prepubertal Girls ◽

Case Note Review

IntroductionA perception exists that there are few benefits of a paediatric assessment in historic child sexual abuse (CSA), as the likelihood of finding forensic evidence is low.AimTo determine the value of a comprehensive paediatric assessment in a dedicated clinic for children and young people who present following suspicion or allegation of historic CSA.MethodAll children with suspected or alleged historic CSA, defined as >7 days after the last episode of sexual assault in pubertal girls, or >3 days for prepubertal girls and all boys, were assessed in a specialised paediatric clinic. Clinic data were collected prospectively between October 2009 and November 2014 and through retrospective case note review.ResultsAmong the 249 children who presented with possible historic CSA, ages ranged from 0 to 17 years (median 7, SD 4.3). Of these children, 141 (57%) had a medical concern(s) related to the referral reason, 78 (31%) had an unrelated medical concern(s) and 55 (22%) had emotional or behavioural concerns requiring onward referral, while 18 (7%) children had physical signs supportive of CSA. Findings referable to social care were identified in 26 cases (10%), the police in 6 cases and 15 (6%) parents required professional help for anxiety symptoms.ConclusionsThis study highlights the value of a comprehensive paediatric assessment in a dedicated clinic for cases of suspected or alleged historic CSA, by identifying a broad variety of unmet health needs in this group. The findings have important implications for the child, their families and the multiagency team.

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Malpractice & Negligence: State Supreme Courts Limit Therapists’ Duties to Third Parties

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012985 ◽

1999 ◽

Vol 27 (2) ◽

pp. 204-205

Author(s):

Megan Cleary

Keyword(s):

Sexual Abuse ◽

Child Sexual Abuse ◽

Supreme Court ◽

New Hampshire ◽

Third Parties ◽

State Supreme Courts ◽

Recovered Memories ◽

Supreme Courts ◽

Repressed Memory ◽

University Of Colorado

In recent years, the law in the area of recovered memories in child sexual abuse cases has developed rapidly. See J.K. Murray, “Repression, Memory & Suggestibility: A Call for Limitations on the Admissibility of Repressed Memory Testimony in Abuse Trials,” University of Colorado Law Review, 66 (1995): 477-522, at 479. Three cases have defined the scope of liability to third parties. The cases, decided within six months of each other, all involved lawsuits by third parties against therapists, based on treatment in which the patients recovered memories of sexual abuse. The New Hampshire Supreme Court, in Hungerford v. Jones, 722 A.2d 478 (N.H. 1998), allowed such a claim to survive, while the supreme courts in Iowa, in J.A.H. v. Wadle & Associates, 589 N.W.2d 256 (Iowa 1999), and California, in Eear v. Sills, 82 Cal. Rptr. 281 (1991), rejected lawsuits brought by nonpatients for professional liability.

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