nl_e17

Impression: “Medical evaluation does not exclude sexual abuse.”
If medical findings or combination of available information are any of the following listed
below, use the above phrase in the Impressions.
1. Normal or non-specific findings (see Appendix B) in combination with significant
behavior changes, especially sexualized behaviors, but child unable to give a history of
abuse
2. Herpes Type I anogenital lesions, in the absence of a history of abuse and with an
otherwise normal examination
3. Condyloma accuminata, with otherwise normal examination; no other STDs present, and
child gives no history of abuse (Condyloma in a child older than 3-5 years is more likely to
be from sexual transmission, and a thorough investigation must be done)
4. Child has made a statement but statement is not sufficiently detailed, given the child’s
developmental level; is not consistent; or was obtained by the use of leading questions
concerning physical findings with no disclosure of abuse
One cannot automatically conclude that no abuse has happened if anogenital findings belong
in the normal or non-specific category, especially if physical findings are the only information
available to the examiner at that time. Possible explanations for normal or non-specific
findings include:
• No abuse happened
• Abuse happened but did not cause injury (e.g., fondling above clothes, oral sex)
• Abuse happened and caused injuries but those injuries have since healed completely
In cases where the examining physician does not have access to additional information,
continue to stress the importance of the child’s disclosure by including the following caveat
after the summary of findings:
“Please correlate medical examination findings with the patient’s disclosure.”
Certain types of molestation do not result in visible injuries. Examples include: fondling, oral
sex, intracrural intercourse. In cases where the child gives a spontaneous, clear, consistent,
and detailed description of such abuse, use this phrase:
“The anogenital findings seen in this patient are to be expected in a child who
describes this type of molestation.”