Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

View all Images (7)

Child sexual abuse - Anogenital in
Print
Other Resources UpToDate PubMed

Child sexual abuse - Anogenital in

Print Images (7)
Contributors: Mary Spencer MD, Ann Lenane MD, Sireesha Reddy MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
Other Resources UpToDate PubMed

Alerts and Notices

Synopsis

Child sexual abuse : Abrasion, Anxiety, Erythema, Fine skin fissures, Genital edema, Personality changes, Ecchymosis
More than 88,000 children were confirmed victims of sexual abuse in the United States in 2002. Of the 3 million cases of child abuse investigated each year, about 20% are reported as sexual abuse.

In the majority of children with legal confirmation of sexual abuse, the genital examination of the abused child rarely reveals findings different from that of the non-abused child. In one study, only 4% of all children referred for medical evaluation of sexual abuse had abnormal examinations at the time of evaluation. This study showed that even among children who reported vaginal or anal penetration, the rate of abnormal examination findings was only about 5%. Physical findings are often absent even when the perpetrator admits to penetration of the child's genitalia. Thus, it is not appropriate to interpret a normal genital examination as evidence that sexually abusive contact did not take place.

When physical signs are present, they are often nonspecific and range from erythema and ecchymosis to ulcerations. Though less common than in girls, sexual abuse in boys is still a major but under-recognized problem. In boys, the external genitalia must be evaluated for erythema, ecchymosis, abrasions, lacerations, and bite patterns. The urethral meatus may also have lacerations, erythema, and discharge.

Circumferential injuries to the shaft or glans penis in boys is suggestive of abuse. Penile and anal secretions should be cultured for sexually transmitted diseases, and anal secretions should be examined for semen if penetration is suspected.

Codes

ICD10CM:
T76.22XA – Child sexual abuse, suspected, initial encounter

SNOMEDCT:
95922009 – Child sexual abuse

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

A variety of dermatologic conditions cause ulcers, erythema, friability, and even bleeding of the perineum and should be considered when sexual abuse is suspected. The differential diagnosis is extensive and includes lichen sclerosus, seborrheic dermatitis, atopic dermatitis, contact dermatitis, scabies, perianal streptococcal infection, pinworm infection, lichen simplex chronicus, lichen planus, psoriasis, hemangiomas, bullous pemphigoid, Behçet disease, and urethral prolapse.

Findings (Boys and Girls)
Perineal Area
Findings (Boys Only)
  • Penile trauma: hair tourniquet, zipper entrapment injury, straddle injury
  • Penile or scrotal erythema: irritants, infection, trauma

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated:11/06/2022
Copyright © 2023 VisualDx®. All rights reserved.
Child sexual abuse - Anogenital in
Print   View all Images (7)
(with subscription)
A medical illustration showing key findings of Child sexual abuse : Abrasion, Anxiety, Erythema, Fine skin fissures, Genital edema, Personality changes, Ecchymosis

+6 More images of Child sexual abuse with subscription

Copyright © 2023 VisualDx®. All rights reserved.