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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
1. H. K. DeVore and C. J. Sachs, “Sexual Assault,” Emergency Medicine Clinics of North America, vol. 29, pp. 605–620, 2011.
2. E. Choudhary, D. Gunzler, X. Tu and R. M. Bossarte, “Epidemiological Characteristics of Male Sexual Assault in a Chriminological Database,”
Journal of Interperson Violence, vol. 27, no. 3, pp. 523–546, 2012.
3. L. E. Saltzman, K. C. Basile, R. R. Mahendra, M. Steenkamp, E. Ingram and R. Ikeda, “National Estimates of Sexual Violence Treated in Emergency
Departments,” Annals of Emergency Medicine, vol. 49, no. 2, pp. 210–217, February 2007.
4. D. Light and E. Monk-Turner, “Circumstances Surrounding Male Sexual Assault and Rape,” Journal of Interpersonal Violence, vol. 24, no. 11, pp.
1849–1858, 2009.
5. G. R. Pesola, R. E. Westfal and C. A. Kuffner, “Emergency Department Characteristics of Male Sexual Assault,” Academic Emergency Medicine, vol.
6, no. 8, pp. 792–798, August 1999.
6. G. H. Lipscomb, D. Muram, P. M. Speck and B. M. Mercer, “Male Victims of Sexual Assault,” Journal of the American Medical Association, vol. 267,
no. 22, pp. 3064–3066, 10 June 1992.
7. M. E. Kobernick, S. Seifert and A. B. Sanders, “Emergency Department Management of the Sexual Assault Victim,” The Journal of Emergency
Medicine, vol. 2, pp. 205–214, 1985.
8. A. A. Ernst, E. Green, M. T. Ferguson, S. J. Weiss and W. M. Green, “The Utility of Anoscopy and Colposcopy in the Evaluation of Male Sexual
Assault Victims,” Annals of Emergency Medicine, vol. 36, no. 5, pp. 432–437, November 2000.
9. “2010 STD Treatment Guidelines,” Centers for Disease Control and Prevention, 2010. [Online].
10. J. E. Draughon, “Sexual Assault Injuries and Increased Risk of HIV Transmission,” Advanced Emergency Nursing Journal, vol. 34, pp. 82–87, 2012.
Chapter 12
Pediatric/Adolescent Patient
Sexual Assault Examination
Dale P. Woolridge, MD, PhD
Normal Physical or Congenital Findings that Can Be Confused
with Child Sexual Abuse
Hymen note: All females have a hymen. Stating “no hymen present” is incorrect per Reece1 and Pillai.2
Hymenal Shapes
Imperforate hymen (classically appears as blue-domed mass at puberty)
Annular (most common morphology at birth—80% in the study by Berenson of 468 neonates)3,4
Of note in the study by Berenson, anterior clefts in the hymen were common in normal patients
but NO posterior clefts were noted. This supports the tenet that posterior clefts are caused by trauma.
Crescentic (most common morphology in preadolescents)
Fimbriated (19% in the study by Berenson)
Physical Findings
Hymen Variants
Septal remnants
Distal vaginal atresia
Vaginal septum (associated with other urogenital abnormalities)
Vaginal ridges
Ambiguous genitalia
Urethral prolapse
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Periurethral Bands
Labial Adhesions
Midline fusion defects
Child Sexual Abuse
Likelihood of finding physical
evidence of abuse depends on the
following factors:
• Use of force
• The size and age differences of
the perpetrator and the patient
• Whether a foreign object was
placed/forced into the mouth,
vulva, or anus
• Positioning of the child and
use of lubricants during the
• Type of abuse and its
frequency and chronicity
(McCann found that in
children with genital injury
from sexual assault, healing
occurred rapidly and little scar
formation resulted; irregular
hymenal edges and narrow
rims at the point of injury were
the most persistent findings7)
• Whether the child resisted
Pediatric/Adolescent Patient Sexual Assault Examination