Medical Findings in Child Sexual Abuse

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Medical Findings in Child Sexual Abuse

• Robert A. Shapiro, M.D.
• Associate Professor of Clinical Pediatrics
• Cincinnati Childrens Hospital Medical Center

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Female Pre-pubertal Anatomy
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Male Pre-pubertal Anatomy
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Female Tanner Stages
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Male Tanner Stages
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Normal hymen
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Normal hymen variants
Heger and Emans, Evaluation of the sexually
abused child
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Normal hymen variants
Heger and Emans, Evaluation of the sexually
abused child
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Different exam techniques
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Positioning effects exam findings
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Hymenal Variants
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Septate Hymen
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Significance of exam findings
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Size of the hymenal opening
Cantwell (1983) 74 girls with gt 4mm were abused
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Frequency of Abnormal Exams
Review of 21 studies
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Hymen is absent
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Healed tears
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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Bite on penis
Graphic removed for public display. To request
the original presentation, contact Robert Allan
Shapiro, M.D., 513-636-7966.
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STDs

• GC, chlamydia and syphilis are almost always
  indicative of abuse
• HPV and herpes infections are frequently due to
  abuse
• Gardnerella can be seen in sexually inactive
  children
• HIV is often sexually transmitted

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Transmission of HPV and HSV

• Perinatal
• HPV incubation period up to 2 years
• Autoinoculation
• Fomites (towels, underwear, etc)
• Abuse (digital or genital)

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HPV Sexual Abuse
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Herpes Simplex Sexual Abuse