Scarring of the genitalia or anus may be due to a number of dermatologic conditions. However, sexual abuse must always be considered during evaluation.

Most traumatic injuries to the genital and anal tissue are superficial and heal relatively quickly. Therefore, the majority of children who disclose abuse do not have physical evidence of genital trauma. Lacerating injuries may heal with residual scarring, which can be observed after the assault. When scars form, they may distort the appearance of the genital tissue, making appreciation of the extent of injury difficult. In addition, prepubertal genital scars are modified during puberty. Furthermore, well-delineated acute lacerations may be much smaller than their original size when healed, particularly in the anus.

Perianal scars occur with increased frequency in a sexually abused child, although they are not diagnostic of abuse. Scars outside the midline associated with marked irregularity of the anus are suggestive of chronic trauma. Scarring with associated abscesses in the anal region may be due to furuncles or by fistula in ano, which do not suggest sexual abuse but rather inflammatory bowel disease. Failure of midline fusion is a congenital finding that should not be confused with a midline scar.

Biopsy of the genital area for histologic confirmation of scar tissue is not recommended. It is most important to obtain a history concerning the nature of the injury and the associated symptoms to exclude other possibilities leading to avascular areas of the genitalia.

Childhood sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign anogenital skin conditions.