Medical advances in child sexual abuse.

This volume is the first of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The six articles in this issue explore methods for medical history evaluation, the rationale for when sexual examinations should take place, specific hymenal findings that suggest a child has been sexually abused, the healing of genital injuries, approaches to interpretation of medical findings, and the neurological harm of sexual abuse. From the initial history to the process of the medical examination, the mechanics of what a genital examination might show, and the neurobiological consequences, it is demonstrated that the harm of sexual abuse is has more effect on the brain than the genital area.

Conducting the medical history.

A key portion of the medical evaluation of child sexual abuse is the medical history. This differs from interviews or histories obtained by other professionals in that it is focuses more on the health and well-being of the child. Careful questions should be asked about all aspects of the child's medical history by a skilled, compassionate, nonjudgmental, and objective clinician. Often the diagnosis of sexual abuse is based only on the medical history. The history can be further understood by knowledge of how children are abused and their reactions to it. By addressing the child's and parent's concerns, reassurance can also be provided about what is normal and abnormal with the child's body.