ABSTRACT
Vaginal discharges are commonly seen in the prepubertal girl. Because of the anatomy of young girls, any offending agents have easy access to the genital area. The discharge can be caused by numerous organisms, including those associated with sexually transmitted disease. Also, chemical and mechanical reactions, as well as poor hygiene on the part of the child, may cause genital irritation. Treatment is based on the historical events and a physical examination that includes cultures of the discharge. The goal is to effectively treat the underlying cause of the discharge, either by initiating proper therapeutic measures or by teaching the child about proper hygiene.
Subject(s)
Nurse Practitioners , Vaginitis/etiology , Child , Child Abuse, Sexual , Child, Preschool , Female , Humans , Nursing Assessment , Patient Education as Topic , Physical Examination , Vaginitis/diagnosis , Vaginitis/therapyABSTRACT
Evaluation of developmentally disabled persons for physical signs of sexual abuse presents many challenges to the practitioner. This group is especially vulnerable to all types of abuse. A group of 35 mentally retarded females from a residential treatment facility was examined by the child abuse medical team at Harbor/UCLA Medical Center after one inpatient was found to be pregnant. Patients ranged in age from 13 to 55 years (median, 26 years; mean, 31.3 +/- 13.6 years). All of the women had some degree of disability, with 24 (69%) being categorized as profoundly retarded. No patient was able to provide a history. There were 13 (37%) patients who had genital findings we believe are consistent with prior vaginal penetration. Dilemmas which arose during evaluation included the significance of healed genital lesions in this population and the implications of the findings for the residential facility. While developmentally disabled persons need an advocate in the medical and legal systems, these patients can overwhelm the practitioner. Whenever possible, a team approach is recommended to decrease the work load and frustration and provide collegial support and affirmation of findings.
Subject(s)
Child Abuse, Sexual/diagnosis , Intellectual Disability/psychology , Activities of Daily Living/psychology , Adolescent , Adult , Child Abuse, Sexual/psychology , Diagnosis, Differential , Female , Humans , Institutionalization , Middle Aged , Physical Examination/methodsABSTRACT
Imperforate hymen, a condition in which the hymen has no aperture, usually occurs congenitally, secondary to failure of development of a lumen. A case of a documented simulated "acquired" imperforate hymen is presented in this article. The patient, a 5-year-old girl, was the victim of sexual abuse. Initial examination showed tears, scars, and distortion of the hymen, laceration of the perineal body, and loss of normal anal tone. Follow-up evaluations over the next year showed progressive healing. By 7 months after the injury, the hymen was replaced by a thick, opaque scar with no orifice. Patients with an apparent imperforate hymen require a sensitive interview and careful visual inspection of the genital and anal areas to delineate signs of injury. The finding of an apparent imperforate hymen on physical examination does not eliminate the possibility of antecedent vaginal penetration and sexual abuse.
Subject(s)
Anus Diseases/etiology , Child Abuse, Sexual , Hymen/injuries , Child, Preschool , Female , Humans , Perineum/injuries , Vaginal Diseases/etiology , Vaginal Diseases/pathologyABSTRACT
Review of more than 500 medical records of patients referred for sexual abuse evaluations revealed 10 cases of labial fusion. Patients ranged in age from 2 months to 5 years, and the duration of the fusion ranged from 2 weeks to 2 1/2 years. No child had vulvovaginitis, dermatitis, or known genital trauma (for instance, straddle injury). Urinary tract problems were present in three patients. History and/or physical findings were consistent with sexual abuse in six of the 10 patients. Anal findings were grossly abnormal and consistent with anal penetration in all patients with a positive finding on examination. Therapy with conjugated estrogen cream was instituted in nine patients, with resolution of symptoms occurring in six. The exact cause of labial fusion is unclear. Fusion secondary to fecal soiling may occur in the young infant. Older girls may develop fusion after trauma such as that associated with sexual abuse, particularly vulvar coitus.
Subject(s)
Child Abuse, Sexual , Vulvar Diseases/etiology , Administration, Topical , Child, Preschool , Estrogens, Conjugated (USP)/administration & dosage , Estrogens, Conjugated (USP)/therapeutic use , Female , Humans , Infant , Vulvar Diseases/drug therapyABSTRACT
Children who have been sexually abused develop a variety of emotional and physical complaints, often unrelated to the genital area. Emergency department records of children diagnosed as being sexually abused were reviewed for the period covering January 1984 through June 1985. Of 26,000 patients seen, 300 cases of sexual abuse were identified. Of these, 57 were patients who presented with initial complaints other than sexual abuse. The data were analyzed for age, sex, chief complaint, time of presentation, physical findings, and person accompanying the child. The most common presenting complaints of these 57 patients were abdominal pain (26%) and vaginal symptoms (26%) The latter included pruritus, discharge, and bleeding. Other complaints included rectal bleeding or constipation (9%), chronic urinary tract infection (5%), straddle injury (4%), and suicide attempt (2%). The remaining 26% included fever, respiratory infections, sore throat, asthma, bronchitis, obesity, mastoiditis, and weight loss. Because resident physicians are instructed to conduct complete anal and genital examinations on all patients, sexual misuse was often diagnosed with seemingly unrelated complaints. A protocol developed for use in the emergency department is described.
Subject(s)
Child Abuse, Sexual , Emergency Service, Hospital , Child , Child, Preschool , Female , Humans , Male , Physical Examination , Referral and ConsultationABSTRACT
Child sexual abuse is a problem of major proportion that has only recently come into public focus. The numbers of reported cases of sexual mistreatment have increased, especially in the last two years. The signs and symptoms of chronic abuse may differ from those seen in acute episodes of molestation. In 75 percent of the cases, the perpetrator is known to the child. The child abuse team at Harbor/UCLA Medical Center in Torrance, Calif., examines many victims of sexual abuse. The referrals come from a variety of agencies, including law enforcement and the courts (in 1984, 300 children were assessed). Recognition of abnormal anal and/or genital findings is an especially frustrating aspect of these cases. This article provides information on the identification and treatment of the patient who has been sexually abused.
