CMAS 258 Lecture Notes - Lecture 12: Perineum, Scrotum, Foley Catheter
Document Summary
Children referred for possible sexual abuse: medical findings in 2384 children: 96. 3% overall had normal medical exams, 95. 6% of children reporting sexual abuse were normal, 99. 8% who were referred for behavioral changes or exposure to abuse were normal. Results: 68% of girls and 70% of boys reported severe abuse, penetration was associated with a higher percentage of defined as penetration of the vagina or anus girls (6%) vs. boys (1%) having abnormal findings. Conclusion: medical, legal and social professionals rely too heavily on the medical exam, history from the child remains the single most important diagnostic feature. Examination techniques: frog-leg position, labial traction vs. spreading, prone knee chest position, saline technique, no speculum in pre-pubertal children. Hyemenal morphology: redundant, common in children less than 2 and in adolescents, annular, hymenal tissue is present 360 degrees around vaginal opening, crescentic, variable insertions anteriorly, hymen present only in posterior aspects, most common type in pre-pubertal girls.
