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Injuries Indicative of Abuse
Sexual Abuse: Signs and Symptoms
Originally placed online by the Harvard med students -- Thank you!
Medical Indicators
Psychosocial Indicators
Adams Classification Table, April 2003: Physical and Laboratory Findings
Used with permission of Joyce Adams, MD
Key point to remember in evaluating children and adolescents who may have been sexually abused:
As many as 85-95% of children who give a clear history of sexual abuse may have normal or
nonspecific physical examinations, due to healing of trauma or acts that do not result in trauma.
Female Genitalia Anus Penis/Scrotum Other
Class 1 Normal or
Unrelated to Abuse
Found in newborns:
Periurethral or
vestibular bands
Hymenal tags
Hymenal bump or
mound
Linea vestibularis
Hymenal cleft/notch
in the anterior (superior)
half of the hymenal rim,
on or above the 3
o’clock and 9 o’clock
line, patient supine
Estrogen changes (i)
Normal variants:
Septate hymen
Failure of midline
fusion/perineal groove
Class 1 Normal or
Unrelated to Abuse
Tag at 6 o’clock from
redundant perineal
raphe
Thickening of
perineal raphe
Blue tint from
underlying veins
Normal variants:
Diastasis ani
Perianal skin tag
Increased perianal
skin pigmentation
Anal dilation with
stool present
Venous congestion, or
venous pooling, in
perianal tissues (vi)
http://www.pathguy.com/adams.htm (1 of 10) [6/5/2005 8:46:54 PM]
Class 1 Normal or
Unrelated to Abuse
Circle of brown
pigment around shaft of
penis from healed
circumcision
Raised, dark line
along penis/scrotum
(median raphe)
Class 1 Not related to
abuse:
Candida infections
Strep infections
Urinary tract
infections
Vaginitis caused by
enteric or respiratory
organisms
Gardnerella vaginalis
cultured from vagina, in
the absence of any other
signs of bacterial
vaginosis
Also, conditions such as
urethral prolapse, lichen
sclerosis, genital
hemangiomas, Crohn’s
Disease, and Bechet’s
Disease may be
mistaken for abuse.