• Frequently Asked Questions: Sexual Abuse Examination

    The Child Abuse Team at Cincinnati Children’s provides the following frequently asked questions (FAQs) and answers.

  • Doctors order X-rays to look for fractures. Specialized imaging, such as CAT scans and MRIs, may be ordered to look for bleeding in the brain, which can result from child abuse. Such imaging is the only real way to find these problems.

    The amount of radiation from X-rays and other more advanced forms of imaging is actually fairly small. Even a full skeletal survey, the most extensive form of ordinary X-ray that obtains an image of every bone in the body, is only equivalent to a year’s worth of every-day background radiation that your child would encounter by just walking around. A CAT scan is the equivalent of two years of background radiation. An X-ray of the hand amounts to only a day’s worth of background radiation. And X-ray of an arm is equivalent to about a week. The increased risk of cancer from even the most extensive of these procedures is fairly small.

    It depends on what happened. If the child has been fondled or penetrated with a finger, there is virtually no risk. If the abuse involved oral sex, infection is possible but very unlikely. If the abuse involved genital-to-genital contact, the risk is greater but still rare. The risk is greater in parts of the country, such as major metropolitan areas, where HIV infection is widespread. Likewise, a child is at increased risk for other sexually transmitted disease from genital-to-genital or oral-genital contact.

    Sometimes. In most cases, even when a perpetrator confesses, the physical examination of the child reveals no physical evidence of abuse. If vaginal penetration occurred, great force was used or the abuse was repetitive, it is more likely that physical evidence will be present.

    Sedation may be offered if the examination must be completed and your daughter is overly upset. Before sedation is considered, the physician, nurse or social worker will explain the examination to your daughter and attempt to reassure her. If the examination can be deferred, her examination will be rescheduled for a time when she may be more emotionally able to consent to the examination.

    The examination is not physically painful. It mainly involves visual examination with minimal physical contact. Unlike adult pelvic examinations, an internal examination is usually not required in young children.

    Oral contact, digital fondling, genital rubbing, vaginal penetration after puberty, rectal penetration, partial or attempted vaginal penetration, and penetration that has had time to heal.

    The examiner usually cannot determine the number of episodes that occurred. If evidence of chronic anal abuse is present, multiple episodes of abuse occurred. Vaginal injuries do not reliably differentiate between single episodes of abuse and multiple episodes.

    If the injuries are acute (redness, swelling, tenderness, fresh abrasions or tears), the examiner may reliably identify the injury as relatively recent, most likely having occurred within a few days of the examination. Dating injuries within hours or to specific days is usually not possible.

    Examination findings may differ when:

    • Acute injuries heal between examinations
    • One of the examinations was not optimal because the child was uncooperative
    • The skill levels of the examiners differ (Examiners with expert training will provide a more accurate and informative examination.)