Child Sexual Abuse

Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.


More than 88,000 children were confirmed victims of sexual abuse in the United States in 2002. Of the 3 million cases of child abuse investigated each year, about 20% are reported as sexual abuse.

In the majority of children with legal confirmation of sexual abuse, the genital examination of the abused child rarely reveals findings different from that of the non-abused child. In one study, only 4% of all children referred for medical evaluation of sexual abuse had abnormal examinations at the time of evaluation. This study showed that even among children who reported vaginal or anal penetration, the rate of abnormal examination findings was only about 5%. Physical findings are often absent even when the perpetrator admits to penetration of the child’s genitalia. Thus, it is not appropriate to interpret a normal genital examination as evidence that sexually abusive contact did not take place.

When physical signs are present, they are often nonspecific and range from erythema and ecchymosis to ulcerations. All girls suspected of possible sexual abuse should undergo evaluation of the labia majora, labia minora, introitus, and hymen for erythema, ecchymoses, lesions, abrasions, or tears. There may also be urethral injury as well.

Look For

  • Erythema of vulval vestibule or perianal tissues
  • Increased vascularity of vulvar vestibule, labial adhesions, friability of posterior fourchette or commissure, thickened hymen or hymenal notch, and/or vaginal discharge or bleeding
  • Vesicular lesions, verrucous lesions, ulceration, ecchymosis, or scarring
  • Anal dilatation and/or anal fissures
  • Oral sexual trauma in children can result in a torn labial or lingual frenulum.

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