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Child sexual abuse - Anogenital in
Female Child
Male Child
Child sexual abuse - Anogenital in
Female Child
Male Child
Contributors: Mary Spencer MD, Ann Lenane MD, Sireesha Reddy MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
Synopsis
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
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Diagnostic Pearls
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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
Inflammation or erythema: candidiasis , pinworm infection , cellulitis , contact dermatitis , atopic dermatitis , psoriasis , Kawasaki syndrome (perianal erythema commonly precedes the development of the diagnostic criteria for the disease)
Ulcer or vesicular rash: syphilis , herpes simplex virus (HSV) , varicella , Behçet disease , bullous pemphigoid
Bruising: lichen sclerosus , congenital dermal melanocytosis (formerly Mongolian spot), trauma, hemolytic uremic syndrome , disseminated intravascular coagulation (DIC) , immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
Erythema: encopresis, poor hygiene, pinworm infection , group A streptococcal or staphylococcal cellulitis , irritants, trauma
Anal fissures: constipation , Crohn disease , irritation
Scarring: Crohn disease , medical procedures, result of fissures; midline findings less suspicious for abuse
Anogenital warts: condyloma acuminata (HPV) , molluscum contagiosum , verruca vulgaris , acrochordon (skin tag)
Rectal bleeding: hemorrhoids , Crohn disease , polyps, rectal prolapse , rectal tumors, anal fissure from penetration
Flattened anal folds: relaxation of anal sphincter, perianal edema from infection or trauma
Findings (Boys Only)
Penile trauma: hair tourniquet, zipper entrapment injury, straddle injury
Penile or scrotal erythema: irritants, infection, trauma
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References
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Last Updated:11/06/2022
Child sexual abuse - Anogenital in
Female Child
Male Child
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