The Role of Photo Documentation of Genital Findings in Medical Evaluations of Suspected Child Sexual Abuse

Abstract

Results of a national survey of 104 nurse practitioners (NPs), registered nurses (RNs), and Physician Assistants (PAs) who conducted physical assessments in cases of suspected child physical abuse, neglect, and sexual abuse revealed that evaluation for suspected CSA was the type of evaluation conducted most often (92.5%), followed by physical abuse (70%), and neglect (54%). Most participants (76.9%) conducting CSA evaluations used a colposcope and interpreted colposcopic findings (70.2%). The mean number of years of speciality practice in CM reported by participants was 6, with a range of one to 20 years. While the majority (68%) of respondents were members of interdisciplinary child protection teams, only 10.7% were members of child fatality review teams.

Although the vast majority (78.4%) of participants had testified in court on CM cases, most reported experiencing barriers to testifying in cases of CM. The barrier to testifying cited most often was a lack of credibility with the judicial system (60%), with 32% of respondents citing not being a physician (31%) as a major barrier in being accepted as an expert in CM.

Implications for practice, policy, and future research are discussed.

Get full access to this article

View all access options for this article.

References

Adams, J. A. , Harper, K. , & Knudson, S. (1992). A proposed system for the classification of anogenital findings in children with suspected sexual abuse. Adolescent & Pediatric Gynecology, 5, 73-75.

Adams, J. A. , Harper, K. , & Wells, R. (1993). How do pediatricians interpret genital findings in children? Results of a survey. Adolescent & Pediatric Gynecology, 6, 203-208.

Adams, J. A. , Phillips, P. , & Ahmad, M. (1990). The usefulness of colposcopic photographs in the evaluation of suspected child sexual abuse. Adolescent & Pediatric Gynecology, 3, 75-82.

Adams, J. A. , & Wells, R. (1993). Normal versus abnormal genital findings in children: How well do examiners agree? Child Abuse & Neglect, 17, 663-675.

American Academy of Pediatrics, Committee on Child Abuse and Neglect . (1991). Guidelines for the evaluation of sexual abuse of children. Pediatrics, 87, 254-260.

American Academy of Pediatrics, Committee on Child Abuse and Neglect . (1994). A guide to references and resources in child abuse and neglect. Elk Grove Village, IL: Author.

American Professional Society on the Abuse of Children (APSAC) . (1995). Practice guidelines: Descriptive terminology in child sexual abuse medical evaluations. Chicago: Author.

Bays, J. , & Chadwick, D. (1993). Medical diagnosis of the sexually abused child. Child Abuse & Neglect, 17, 91-110.

Berenson, A. B. (1995). A longitudinal study of hymenal morphology in the first 3 years of life. Pediatrics, 95, 490-496.

10.

Berenson, A. B. , Heger, A. , & Andrews, S. (1991). Appearance of the hymen in newborns. Pediatrics, 87, 458-465.

11.

Berenson, A. B. , Heger, A. H. , Hayes, J. M. , Bailey, R. K. , & Emans, S. J. (1992). Appearance of the hymen in prepubertal girls. Pediatrics, 89, 387-394.

12.

Brayden, R. M. , Altmier, W. A. , Yeager, T. , & Muram, D. (1991). Interpretations of colposcopic photographs: Evidence for competence in assessing sexual abuse? Child Abuse & Neglect, 15, 69-76.

13.

Finkel, M. A. (1989). Anogenital trauma in sexually abused children. Pediatrics, 84, 317-322.

14.

Gardner, J. J. (1992). Descriptive study of genital variation in healthy, nonabused, premenarchal girls. Journal of Pediatrics, 120, 251-257.

15.

Heger, A. , & Emans, S.J. (1992). Evaluation of the sexually abused child. A medical textbook and photographic atlas. New York: Oxford University Press.

16.

Kellogg, N. D. , & Parra, J. M. (1991). Linea vestibularis: A previously undescribed normal genital structure in female neonates. Pediatrics, 87, 926-929.

17.

McCann, J. (1990). Use of the colposcope in childhood sexual abuse examinations. Pediatric Clinics of North America, 37, 863-880.

18.

McCann, J. J. (1993). The colposcopic genital examination of the sexually abused prepubertal female. Adolescent & Pediatric Gynecology, 6, 123-128.

19.

McCann, J. , & Voris, J. (1993). Perianal injuries resulting from sexual abuse: A longitudinal study. Pediatrics, 91, 390-397.

20.

McCann, J. , Voris, J. , & Simon, M. (1992). Genital injuries resulting from sexual abuse: A longitudinal study. Pediatrics, 89, 307-317.

21.

McCann, J. , Voris, J. , Simon, M. , & Wells, R. (1989). Perianal findings in prepubertal children selected for nonabuse: A descriptive study. Child Abuse & Neglect, 13, 179-193.

22.

McCann, J. , Wells, R. , Simon, M. , & Voris, J. (1990). Genital findings in prepubertal girls selected for nonabuse: A descriptive study. Pediatrics, 86, 428-439.

23.

Muram, D. (1989). Child sexual abuse: Genital tract findings in prepubertal girls. I. The unaided medical examination. American Journal of Obstetrics and Gynecology, 160, 328-333.

24.

Muram, D. , & Elias, S. (1989). Child sexual abuse: Genital tract findings in prepubertal girls. II. Comparison of colposcopic and unaided examinations. American Journal of Obstetrics and Gynecology, 160, 333-335.

25.

Paradise, J. E. , Finkel, M. , Beiser, A. , Berenson, A. , Greenberg, D. , & Winter, M. (1996). Physicians conformity to standards in assessing girl's genital findings [Abstract]. Archives of Pediatrics and Adolescent Medicine, 150, 80.

26.

Reece, R. M. (1994). Child abuse: Medical diagnosis and management. Philadelphia: Lea & Febiger.

27.

Ricci, L. R. (1988). Medical forensic photography of the sexually abused child. Child Abuse & Neglect, 12, 305-310.

28.

Stephens, F. D. , & Smith, E. D. (Eds.). (1971). Ano-rectal malformations in children (pp. 114-116). Chicago: Year Book Medical.

29.

Teixeira, W. R. (1981). Hymenal colposcopic examination in sexual offenses. American Journal of Forensic Medicine and Pathology, 2, 209-214.

30.

Woodling, B. A. , & Heger, A. (1986). The use of the colposcope in the diagnosis of sexual abuse in the pediatric age group. Child Abuse & Neglect, 10, 111-114.