Child sexual abuse: What the urologist needs to know

Purpose: We define what the urologist needs to know regarding child sexual abuse. Materials and Methods: Based on our experience in treating numerous child v ictims of sexual assault and a review of the contemporary literature, the d ata concerning child sexual abuse incidence, risk factors, clinical present ation, child interview, physical examination and management were analyzed. Results: It is estimated that at least 1 in 4 girls and 1 in 10 boys will s uffer victimization by age 18 years. There are no predicting socioeconomic factors. In legally proved cases of child sexual abuse the majority of vict ims have no diagnostic physical findings. Examination findings change depen ding on the position of the child, degree of relaxation, amount of labial t raction and time to perform the evaluation. Findings that are consistent bu t not independently diagnostic of abuse include chafing, abrasions or bruis ing of inner thighs or genitalia, scarring, tears or distortion of the hyme n, a decreased amount of or absent hymenal tissue, scarring of the fossa na vicularis injury to or scarring of the posterior fourchette/posterior commi ssure and scarring or tears of the labia minora. In all 50 states physician s are mandated by law to report to child protection services whenever they suspect that a child has been sexually abused. Conclusions: The urologist must routinely examine the anogenital area of ch ildren during routine urethral evaluation and include child sexual abuse as part of the routine urological history.