A Gynecologic Aspects of Child Sexual Abuse / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate victims of child sexual abuse and assess the similarities and differences between them. METHODS: The authors studied retrospectively 55 patients among 230 sexual abuse victims between the ages 2 and 13 who visited and were treated at the Department of Obstetrics and Gynecology, National Police Hospital between the dates Oct, 13, 2001 and Mar, 25, 2003 were followed and observed. RESULTS: Female infants and children composed 94.5% instances of sexual abuse were most common between 4 and 7 o'clock in the afternoon. Unlike adult cases, assailants were in most cases acquaintances (55.5%), and the crimes were committed most often at the homes of either victim or assailant (50.9%). 38.2% of victims had been directed to the National Police Hospital from police stations, 21.8% from other hospitals. Diagnosis resulted in 5.5% of cases with no observable symptoms, 18.2% with lacerations, among these cases 1 instance (1.8%) requiring surgical repair. 1 case each of Gonorrhea and genital herpes were found, with no instances of pregnancy. CONCLUSION: Child sexual abuse results in life-long bodily and psychological stress for both the victim and his/her family. Witnesses are in some cases unable to testify in legal proceedings, and the gathering of evidence is more difficult than in adult cases. This could lead to frequent social and legal negligence. Cooperation among such numerous and various professional institutions as hospitals, child guidance clinics, child psychiatrists, police, prosecutory offices and the courts is requisite to the settlement of these cases. Since the gynecologist plays the leading role in the identification and treatment of child and infant sexual abuse victims, and is often the first to come in contact with these cases, careful attention is required in the processes of inspection, inquiry, evidence collection, treatment and diagnosis.

Updated Epidemiologic Analysis of Sexual Assault Victims

PURPOSE: It is important for the physician and a rape counselor to understand epidemiology studies of the incidence, prevalence, spread, prevention, and control of sexual assault in a local community or a specific group of individuals. We did this study in order to find an effective treatment for the sexual assault victims and to establish a data base on them. METHODS: We prospectively evaluated sexually assaulted patients who visited the Medical Supportive Center for Women at the National Police Hospital from Oct. 11, 2001, to Oct. 10, 2002. The data were obtained from the records of the ER (emergency room) and OB & GY (obstetric & gynecologic) clinic; a total of 169 patients were evaluated. RESULTS: The mean age was 20.1 years old. The age distribution of sexual assault victims was divided into four: 14 cases under 7 years of age (8.3%), 26 cases between ages 7 and 13 years (15%), 43 cases between ages 14 and 19 years (26.3%), and 86 cases over 20 years of age (52.6%). Of the patients, 157 (92.9%) were unmarried and 117 (69.2%) were examined within 1 hour after visiting the hospital. The physical injuries were 15 vaginal injuries (26.9%), 34 ruptures of the hymen (16.9%), 1 sexually transmitted disease (0.6%), 57 abnormal sensations of the genital organ (28.3%), and 55 minor injuries including abrasions, contusions, and lacerations (27.3%). The psychological injuries were 105 phobias (21.4%), 92 anxieties (18.8%), 68 angers (13.9), 51 guilts (10.4%), and the like. Eighty-eight patients (52.1%) were acquainted with the assailant. CONCLUSION: Optimal management of sexual assault victims should involve continuous epidemiologic analysis and the estalishment of an assault-victim data base.

Overview of Sexual Assault Evidence Collection (SAEC) Program

Cases of sexual assault are often difficult to investigate and prosecute. The collection of evidence is a crutial factor when determining if such a case will go forward. Evidence contained in a rape kit plays a significant role in whether or not a crime of sexual assault can be prosecuted. It is important not only that the evidence be collected properly but also that the kit itself provide for the proper collection of evidence and materials. Because most hospital emergency departments throughout the country use their own kits, or none at all, there is a vast inconsistency in evidence collection. Different kits collect different amounts of evidence. For this reason, we established a kit committee to evaluate the contents of victim evidence collection kits. We propose that most hospital emergency departments and some clinics across the country be provided with rape kits to be used during forensic medical examinations of sexual assault victims and that those kits should be supplied the Sexual Assault Evience Collection (SAEC) Program, commonly referred to as the Rape Kit Program.

A Case Report and Review of Tetanus

Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.