The Medical Evaluation of Sexual Abuse in Children

A number of questions must be addressed in order to effectively manage cases of sexual abuse in children. The author discusses when sexual abuse should be sus-pected, why physicians are often reluctant to manage such cases, who should perform the medical examination, the possibility of children contracting various sex-ually transmitted diseases, bow to distinquish sexual fantasy f rom actual abuse, and reasons that a child might delay or re-tract a report of abuse. The treatment of sexually abused children is complex and requires adherence to a medical protocol in addition to a flexible approach. Treatment should focus on seven overall objectives (1,2).. Identify the sexually abused child. Some children will complain directly about the assault, while others exhibit various physical and emotional symptoms.. Manage the acute medical problems of the child, including physical injury, venereal disease, and pregnancy.. Obtain and record an accurate history of the assault, including the answers to the questions of who, when, what, where, and how. Dr. De Jong is clinical associate professor of pediatrics at Jeffer