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Medical findings can then be categorized and interpreted using accepted classification systems such
as the Adams Classification System for Assessing Physical, Laboratory, and Historical Information
in Suspected Child Sexual Abuse (Adams, 2001). As a matter of consensus, this is the classification
adopted by this Technical Working Group. Given a set of findings, the suggested wordings of the
impressions are presented below and on the following pages. (Refer to Appendix B for the complete
Adams Classification System)
Impression: “Medical evaluation shows definite evidence of abuse or sexual
contact.”
If medical findings or combination of available information are any of the following listed
below,
use the above phrase in the Impressions.
1. Clear evidence of blunt force or penetrating trauma:
• Laceration of the hymen, acute
• Ecchymosis (bruising) on the hymen
• Perianal lacerations extending deep to the external anal sphincter
• Hymenal transection (healed): an area where the hymen has been torn through, to the
base, so there is no hymenal tissue remaining between the vaginal wall and the fossa or
vestibular wall
• Absence of hymenal tissue: wide areas in the posterior (inferior) half of the hymenal
rim with an absence of hymenal tissues, extending to the base of the hymen, which is
confirmed in the knee-chest position
Note: if only anogenital examination findings are available, use this phrase: “Anogenital
findings show clear evidence of blunt force or penetrating trauma.”
2. Finding sperm or seminal fluid in or on a child’s body
3. Pregnancy
4. Positive, confirmed cultures for N. gonorrhea from vaginal, urethral, anal, or pharyngeal
source
5. Evidence of syphilis acquired after delivery (i.e., not perinatally acquired)
6. Cases where photographs or videotape show a child being abused
7. HIV infection, with no possibility of perinatal transmission or transmission via blood
products or contaminated needles
Formatted: Bullets and Numbering