nl_e17

False Allegations of Child Abuse
abuse could do the same thing. One of our medical students has a daughter who was
diagnosed as an intersex by the family doctor and the family was on its way to genetic
counselling. Asked for my opinion first, I demonstrated the ease with which labial adhesions
could be separated with a wet Q-tip. The term "friability" has different meanings in clinical
medicine ("bleeds easily when manipulated") and pathology ("crumbly").
Note 11: There's more tissue here than usual. This can be normal, or the result of inflammation
from another cause, or the result of deformation of the hymen from trauma.
Note 12: I believe the authors are referring to the posterior portion of the hymen.
Note 13: Nonspecific vulvovaginitis in children can result from systemic illness, poor hygiene, or
"just happen". Finding gram-negative diplococci on gram smear is not evidence of gonorrhea in
the female. A negative culture / gene probe rules out untreated gonorreha.
Note 14: A genuine anal fissure is very painful. This will not be a surprise finding on
examination. Resources suggest all fissures are longitudinal, i.e., radiating out from the anal
opening; however, deep ones can be transverse.
Note 15: Flattened anal folds would only result from abuse which would produce additional
evidence trauma, with deformation of the underlying connective tissue (marked remodelling in a
scar) or marked associated local edema (obliterating the folds by stretching). The idea that
fondling will flatten mucosal folds is as ridiculous as claiming that rubbing your lips will lead to
an area that doesn't wrinkle when you pucker your mouth.
Note 16: Thickening (i.e., increased prominence) of the anal folds would be typical of a chronic
dermatitis / mucositis. The trauma would have to be equivalent to what would produce a rash or
signs of injury on the lips.
Under development
Overall Assessment of the Likelihood of Sexual Abuse (1994)
Class 1: No evidence of abuse
● Normal exam, no history, no behavioral changes, no witnessed abuse
● Nonspecific findings with another known etiology, and no history or behavioral changes
● Child considered at risk for sexual abuse, but gives no history and has nonspecific
behavior changes
http://www.pathguy.com/abuse.htm (10 of 17) [6/5/2005 8:41:13 PM]