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Child sexual abuse - Anogenital in
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Child sexual abuse - Anogenital in

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Contributors: Mary Spencer MD, Ann Lenane MD, Sireesha Reddy MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
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Synopsis

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.

Codes

ICD10CM:
T76.22XA – Child sexual abuse, suspected, initial encounter

SNOMEDCT:
95922009 – Child sexual abuse

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

A variety of dermatologic conditions cause ulcers, erythema, friability, and even bleeding of the perineum and should be considered when sexual abuse is suspected. The differential diagnosis is extensive and includes lichen sclerosus, nonspecific vulvovaginitis, seborrheic dermatitis, atopic dermatitis, contact dermatitis, scabies, perianal streptococcal infection, pinworm infection, lichen simplex chronicus, lichen planus, psoriasis, hemangiomas, bullous pemphigoid, Behçet disease, and urethral prolapse.

Findings (Boys and Girls)
Perineal Area

Findings (Girls Only)

Best Tests

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Therapy

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Last Updated: 12/14/2018
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Child sexual abuse - Anogenital in
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Child sexual abuse : Abrasion, Anxiety, Erythema, Female genital, Fine skin fissures, Genital edema, Male genital, Personality changes, Ecchymosis
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