nl_e17

Impression: “ Medical evaluation suggestive 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. Anogenital findings listed below:
• Marked, immediate dilation of the anus, with no stool visible or palpable in the rectal
vault, when the child is examined in the knee-chest position, provided there is no
history of encopresis, chronic constipation, neurological deficits, or sedation
• Hymenal notch/cleft in the posterior (inferior) portion of the hymenal rim, extending
nearly to the vaginal floor (often an artifact of examination technique, but if persistent
in all examination positions, may be due to previous blunt force or penetrating trauma)
• Acute abrasions, lacerations or bruising of labia, peri-hymenal tissues, or perineum
(may be from accidental trauma, or may be due to dermatological conditions such as
lichen sclerosus or hemangiomas)
• Bite marks or suction marks on the genitalia or inner thighs
• Scar or fresh laceration of the posterior fourchette, not involving the hymen (may be
caused by accidental injury)
• Perianal scar (rare, may be due to other medical conditions such as Crohn’s Disease, or
from previous medical procedures)
2. Child has given a spontaneous, clear, consistent, and detailed description of being
molested, with or without abnormal or positive physical findings on examination
3. Positive culture (not rapid antigen test) for Chlamydia trachomatis from genital area in
prepubertal child, or cervix in an adolescent female (assuming that perinatal transmission
has been ruled out)
4. Positive culture for Herpes Simplex Type 2, from genital or anal lesions
5. Trichomonas infection, diagnosed by wet mount or culture from vaginal swab, if perinatal
transmission has been ruled out
Note: if only anogenital examination findings are available, use this phrase: “Anogenital
findings are suggestive of blunt force or penetrating trauma.”