HD FS 258 Lecture Notes - Lecture 11: Perineum, Scrotum, Foley Catheter
17 Jan 2017
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Medical evaluation of sexual abuse guest lecture (dr. frasier) 68% of girls and 70% of boys reported severe abuse defined as. Lecture 11 penetration of the vagina or anus. Penetration was associated with a higher percentage of girls (6%) vs. boys (1%) having abnormal findings. Medical, legal and social professionals rely too heavily on the medical exam. History from the child remains the single most important diagnostic feature. 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. A technique to define the hymenal edge should be utilized: q-tip, foley catheter, prone knee-chest. Acute lacerations or extensive bruising of labia, penis, scrotum, peri-anal tissues, or perineum: may be from un-witnessed accidental trauma, or from physical or sexual abuse. Only a few vulvar or hymenal findings are reliable indicators of sexual abuse among pre-pubertal girls.
