David Adelson MD
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Sanah Ali MD
Carl Allen DDS, MSD
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Bart J. Currie MBBS, FRACP, DTM&H
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Sunir J. Garg MD, FACS
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Lowell Goldsmith MD, MPH
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Vidal Haddad MSC, PhD, MD
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John Harvey
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Peter W. Heald MD
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Sarah Hocker DO
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Sue Lewis-Jones FRCP, FRCPCH
Taisheng Li MD
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Anis Miladi MD
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Zaw Min MD
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Edward O'Keefe ND
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David Peng MD, MPH
Robert Penne MD
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Bertrand Richert MD, PhD
J. Martin Rodriguez, MD, FACP
Theodore Rosen MD
Misha Rosenbach MD
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Glynis A. Scott MD
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Deniz Seçkin MD
Daniel Sexton MD
Paul K. Shitabata MD
Tor Shwayder MD, FAAP, FAAD
Daniel Siegel, MD
Elaine Siegfried MD
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Christye Sisson
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William Van Stoecker MD
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Hensin Tsao MD, PhD
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Jenny Valverde MD
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Susan Voci MD
Lisa Wallin ANP, FCCWS
Douglas Walsh MD
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Erin X. Wei MD
Zachary Werle DO
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Sally-Ann Whelan MS, NP, CWOCN
Danielle Wilbur MD
Jan Willems MD, PhD
Victoria L. Williams MD
James Henry Willig MD, MPH
Kelly Wilmas MD
Karen Wiss MD
Vivian Wong MD, PhD
Sook-Bin Woo MS, DMD, MMSc
Jamie Woodcock MD
Stephen J. Xenias MD
Nathaniel Yohannes
Lisa Zaba MD
Vijay Zawar MD
Bonnnie Zhang MD
Carolyn Ziemer MD
Barret Zimmerman MD
Jeffrey P. Zwerner MD, PhD
Organizations
American Academy of Dermatology
Am. Journal of Trop. Med & Hygiene
Armed Forces Pest Management Board
Blackwell Publishing
Broward Health Medical Center
Bugwood Network
Centers For Disease Control and Prevention
Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
Dermatology Associates of Concord
Dermatology Online Journal
East Carolina University (ECU), Division of Dermatology
International Atomic Energy Agency
Massachusetts Medical Society
NYU Department of Dermatology
Oregon Health & Science University (OHSU)
Oxford University Press
Radiological Society of North America
Washington Hospital Center
Wikipedia
World Health Organization
Genital abrasions may occur following accidental, self-inflicted, or sexually assaultive trauma. Dermatologic conditions causing pruritus can also lead to abrasions and excoriations. Acute abrasions with associated lacerations or extensive bruising of the penis, scrotum, or perineum are considered of moderate specificity of abuse. Injury to the genital area in children always gives cause for concern. Parents are often worried about permanent damage and are often concerned about sexual abuse.
Accidental injuries to the genitalia usually have a clear history with findings on examination consistent with that history. Straddle injuries are a type of accidental trauma that lead to compression of the soft tissues of the penis between the object and the pubic ramus, causing bruising, abrasions, and/or lacerations. In a typical straddle injury, one foot slips and the child falls forward, compressing the genital area (eg, on the monkey bars). This causes anteriorly placed abrasions and asymmetrical bruising of the genitalia. Scraping of the medial side of one thigh may also occur, especially if the object straddled has a rough surface (eg, the side of a swimming pool). Associated lacerations, if present, are most often superficial.
Stretch injuries, "the splits," can result in superficial lacerations in the skin of the perineum.
Severe self-inflicted injury is unlikely because of the pain caused by self-trauma. Minor abrasions may occur if children scratch because of pinworm infection. Adolescents may cause minor injuries with masturbation.
Children with genital abrasions typically complain of genital pain, soreness, and, sometimes, dysuria when the urine passes over the abraded area.
The external genitalia of boys must also be evaluated for abrasions and lacerations possibly due to a bite. Often, there is associated erythema and/or ecchymosis. The urethral meatus may also have evidence of lacerations, erythema, and discharge.
Perineal irritation, abrasion, and erythema are common causes, most likely due secondarily to pruritus from contact dermatitis (often caused by diapers), seborrheic dermatitis, poor hygiene, and candidal lesions.
Since positive physical findings of sexual abuse occur infrequently, one cannot overemphasize that the history from the child still remains the single most important diagnostic feature in assessing whether a child has been sexually abused.
Codes
ICD10CM: S30.817A – Abrasion of anus, initial encounter