Condiloma acuminado en niños; forma de adquisición: informe de 64 casos / Condilomata acuminata in children; acquisition way: report of 64 cases

Se estimularon 64 pacientes niños y adolescentes. Un 64 por ciento del sexo femenino y 6 por ciento de varones. El 40 por ciento correspondió a preescolares. En el 90 por ciento se encontraron datos positivos de contacto sexual, siendo un familiar o persona relacionada con la familia el responsable de esta situación

Quantitative observations of hymens in prepubescent females selected for non-abuse.

The maximum hymenal opening was evaluated quantitatively in 111 prepubescent females during routine physical examinations in a pediatric subspecialty office. For comparison, an additional 53 females referred by child protective agencies were also examined. Analysis of data show "non-abused" groups may be separated statistically from "abused" groups on the basis of area of hymenal opening. The mean area for the "non-abused, non-masturbate" group was 6.4 mm2. The upper limit of area (mean + 3 S.D.) of hymenal opening in this group was 24.1 mm2. A child having a hymenal opening diameter of 6.94 mm or less has a 99% chance of being in the "non-abused" group. The area of hymenal opening for "non-abused" groups did not change with increasing age, height or weight. A skilled pediatrician knowledgeable in the area of sexual abuse may obtain clinically relevant information with ordinary office equipment and trained personnel. Regular and repeated observations of genitalia during routine health maintenance examinations are vital baseline measurements for the physical and mental health of young female patients.

[Child abuse with fatal sequelae in an Essen autopsy sample]. / Kindesmisshandlung mit Todesfolge im Essener Sektionsgut.

In the Institute of Forensic Medicine in Essen/Germany 24 cases of lethal child battering or neglect have been observed over 17 years from 1973 to 1989. The medicolegal and morphologic findings in these cases are presented and compared to the literature. The patterns of abuse/neglect in Essen compare to those frequently reported in the literature: skull/brain traumas caused by blunt impact, multiple hematomas, bone fractures, and symptoms of malnutrition, vitamin deficiency, and general neglect. In many cases the abuse could be shown to have been chronic. In the seven years 1983-1989 the cases of lethal child mistreatment and neglect amounted to 0.18 percent of all autopsies. Five cases of lethal sexual assault in children during the same period are compared to the mistreated cases.

Child abuse intervention in the emergency room.

The pediatrician and other emergency room caregivers are often on the frontlines in the identification and treatment of child abuse and neglect. The ability to recognize the possibility of intentional injury is crucial because immediate intervention may be necessary to prevent further harm to the child. The evaluation requires a careful taking of history, thorough physical examination, and detailed documentation. Reporting of suspected abuse or neglect is mandated and must be made to appropriate authorities. Follow-up of medical treatment, services, and available therapy should be emphasized to assure the continued safety of the child.

Concave hymenal variations in suspected child sexual abuse victims.

The purpose of this study was to describe and analyze the characteristics of, and the clinical correlates to, concave hymenal variations in a large number of suspected child sexual abuse victims. Thirteen hundred eighty-three female child and adolescent suspected sexual abuse victims were comprehensively evaluated. Photocolposcopy was used for the anogenital examinations. Concave hymenal variations were found in 174 patients (12.6%). Sixty-one (35.1%) were anterior. Of these, 40 (65.6%) were curved and smooth, and 21 (34.4%) were angular and/or irregular. One hundred (57.5%) were posterior/lateral. Of these, 33 (33%) were curved and smooth, and 67 (67%) were angular and/or irregular. Thirteen patients (7.5%) had multiple hymenal concavities. Posterior/lateral location was associated with penile-vaginal contact (P = .004), penetration (P = .006), stranger perpetrator (P = .032), hymenal rim narrowing (P less than .001), and posterior fourchette abnormality (P = .049). Angular and/or irregular features were associated with penile contact (P = .005), vaginal contact (P = .035), penile-vaginal contact specifically (P less than .001), penetration (P = .046), abnormal general physical examination (P = .018), and hymenal rim narrowing (P less than .001). Logistic regression analysis demonstrated that age-specific prevalence trends for posterior/lateral (P less than .001) and angular and/or irregular (P = .011) concavities were consistent with acquired anatomic findings. An interobserver exercise with five "blinded" raters evaluating photographs of 49 patients showed significant agreement among observers in sorting posterior/lateral and angular concavities into the diagnostic categories "suggestive of trauma" and "trauma."(ABSTRACT TRUNCATED AT 250 WORDS)

The diagnosis of child sexual abuse.

OBJECTIVE: To examine how the history, psychological evaluation, medical examination, and child's response to the examination contributed to a diagnosis of child sexual abuse by an interdisciplinary team. DESIGN: Patient series. SETTING: Subspecialty clinic for evaluating prepubertal children alleged to have been sexually abused. PARTICIPANTS: One hundred thirty-two children alleged to have been sexually abused and their parents or guardian, evaluated consecutively in a subspecialty clinic between September 1989 and June 1990. MEASUREMENTS/MAIN RESULTS: A social worker interviewed the parents, a psychologist interviewed the child, and a pediatrician obtained a medical history and examined the child. Parents completed a Child Behavior Check list and the child's response to the physical examination was noted. Both a disclosure by the child and abnormal physical findings were significantly and independently associated with the team's diagnosis of sexual abuse, whereas the presence of sexualized behavior, somatic problems, and the child's response to the examination did not make an additional contribution to the diagnosis. CONCLUSIONS: The findings support the need for a skilled psychological interview and a medical examination of a child alleged to have been sexually abused to make the diagnosis of sexual abuse. An interdisciplinary team appears to be a valuable approach for evaluating these children and their families.

[Child victims of sexual abuse in Cameroon]. / Les enfants victimes de sévices sexuels au Cameroun.

Reports of sexual abuse in children are infrequent in the French-speaking nations of black Africa. This study was undertaken to determine the incidence of sexual abuse in children in Yaounde, describe the profile of victims, and identify factors associated with sexual abuse. Seventeen female rape or attempted rape victims were enrolled over an 8-month period. Most (57.05%) were 7 to 15 years of age and lived in underprivileged neighborhoods. Genital bleeding (12 cases), hymenal tears (14 cases) and/or perineal tears were the main lesions found. Most of the rapists were young adults (19-45 years old in 70.5% of cases) who were neighbors, relatives or friends of the family, and single (58.82%). The motivations of the rapists were unclear. This medicosocial reality which is new in Cameroon needs attention.

Genital injuries resulting from sexual abuse: a longitudinal study.

Three children who incurred genital injuries as a result of sexual assaults were followed up on a longitudinal basis to document the anatomical changes which ensued. The subjects, who were 4 months, 4 years 5 months, and 9 years of age, were followed up for periods ranging from 14 months to 3 years. A multi-method examination approach and a 35-mm camera mounted on a colposcope were used to examine and record their injuries. Signs of the acute damage disappeared rapidly, and the wounds healed without complications. Following the resolution of the acute injuries, the changes created by the trauma remained relatively stable throughout the prepubertal years. The most persistent findings were irregular hymenal edges and narrow rims at the point of the injury. Over time the jagged, angular margins smoothed off. Disruption of the hymen exposed underlying longitudinal intravaginal ridges whose hymenal attachments created mounds or projections. There was little apparent scar formation. Even the injuries to the posterior fourchettes healed with minimal scar tissue and left only the slightest evidence of the trauma. With the onset of puberty, the hymenal changes in the oldest subject were obscured by the hypertrophy of this membrane. An examination technique which used a Q-tip to separate the redundant tissues demonstrated that the signs of trauma had survived.

The pathology and medicolegal aspects of sexual activity.

The pathology of injury and its complications related to sexual activities has changed remarkably when compared with that of the past, which usually involved assaults or murders of female victims of varying ages, with moderate to serve beatings that may have accidentally resulted in the victim's death. Serial murderers, serial rapists, and molesters of both boys and girls have become much more prevalent in the last two decades in the United States. Unorthodox sexual behavior, such as "fisting," has increased in frequency, as has sexual violence related to cults, such as satanism. All of these present many challenges to medicolegal investigators. This report describes general and specific pathological sexual activities and injuries, some characteristics and methods of the perpetrators, and some specific cases as examples.

Genital findings in prepubertal girls selected for nonabuse: a descriptive study.

This project was designed to collect normative data on the genital anatomy from a sample of nonabused prepubertal girls. A total of 114 girls between the ages of 10 months and 10 years were examined and photographed with a colposcope. After screening for the onset of puberty and the possibility of undetected abuse, 93 subjects remained. Examination techniques included a supine labial separation approach, a supine labial traction method, and a prone knee-chest position. Common genital finding included erythema of the vestibule (56%), periurethral bands (50.6%), labial adhesions (38.9%), lymphoid follicles on the fossa navicularis (33.7%), posterior fourchette midline avascular areas (25.6%), and urethral dilation with labial traction (14.9%). The hymenal orifice opened more frequently during the knee-chest (95.2%) and the labial traction (90.5%) methods than with the supine separation (79.3%) approach. Hymenal findings included mounds (33.8%), projections (33.3%), and "septal remnants"/midline hymenal tags (18.5%). Intravaginal findings of vaginal ridges (90.2%) and rugae (88.7%) were found primarily through the labial traction approach. The cervix was visualized without the use of speculum in 69% of the children during the knee-chest examination. Unusual findings included posterior fourchette friability (4.7%), anterior hymenal clefts (1.2%), and notches of the hymen (6%). One child had an imperforate hymen (1.2%) and 2 (2.5%) had hymenal septa. A vaginal discharge was detected in 2 (2.6%) and a foreign body in 1 (1.3%). Tables that include the vertical and horizontal hymenal orifice diameters by age group and by method are presented.

Frequency and significance of physical evidence in legally proven cases of child sexual abuse.

Clinicians have long recognized and attorneys have disputed that physical evidence of injury, sexually transmitted diseases, and seminal fluid are often absent in cases of child sexual abuse. To determine the frequency and significance of physical evidence in legally "proven" felony cases with penetration, a retrospective review of sexual abuse court records was done. A total of 45 randomly selected cases were reviewed; 39 (87%) had resulted in conviction of the perpetrator for felony. Charges of vaginal rape were made in 32 cases, and charges of oral and/or anal sodomy in 23 cases. No significant difference in rate of felony conviction was found in cases with or without physical evidence. Of 32 cases without physical evidence, 30 (94%) resulted in felony convictions, whereas only 9 of 13 cases (69%) with physical evidence resulted in a felony conviction. Multiple variables describing the abuse situation were not shown to effect the legal outcome of the cases. Of cases that resulted in felony convictions, physical evidence was present in only 23% (9 of 39). These results should be helpful for the clinician in counseling the family of the sexual abuse victim and the attorney who prosecutes child sexual abuse cases.