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False Allegations of Child Abuse
● Vaginal bleeding (may be from other sources, such as urethra, or may be due to vaginal
infections, vaginal foreign body, or accidental trauma)
Suggestive of Abuse
● 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 faginal floor. (often an artifact of examination technique, but if persisting 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 pervious medical procedures)
Clar 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 aeras in the posterior (inferior) half of teh hymenal rim
with an absence of hymenal tissues, extending to the base of the hymen, which is
confirmed in the knee-chest position.
http://www.pathguy.com/abuse.htm (14 of 17) [6/5/2005 8:41:13 PM]