The medical evaluation of the sexually abused child: lessons from a decade of research.

The problem of child sexual abuse (CSA) has engendered lively interest among physicians and other health care providers for more than 20 years. The number of cases of sexual abuse known to child protection service agencies in the United States rose sharply from 1977 to 1988, then leveled off and declined between 1988 and 1996 (Fig 1).1 Since the mid-1970s, accumulating clinical experience and research have considerably expanded and refined our understanding of this common problem. Several investigators have provided comprehensive reviews of CSA and of the role of the physician in diagnosis and management.2–4 A partial list of epidemiologic, psychological, and legal topics in the area of CSA that have been investigated and reviewed during the past decade includes the effectiveness and accuracy of various techniques for obtaining histories of sexual abuse (repeated interviews, standardized questionnaires, drawings, anatomically correct dolls)5–7; the sexual abuse of boys8,9; the impact of sexual abuse on children’s subsequent psychosocial wellbeing10,11; the relationship of CSA to sexual aggression in children and appropriate treatment for offending children12,13; the criminal prosecution of CSA cases14; and the effectiveness of CSA prevention programs.2 In this article, we will highlight research published during the past decade that deals particularly with topics in the medical evaluation of sexually abused children and that has advanced our understanding of those topics. We have divided our discussion into three sections: the conduct of the physical examination, the interpretation of physical examination findings, and selected sexually transmitted infections in children. CONDUCTING THE PHYSICAL EXAMINATION