Genital complaints in prepubertal girls are not rare, and all clinicians who examine children need to be familiar with the conditions that can cause genital redness, itching, discharge, bleeding, and pain. Physicians, nurse practitioners, nurses, and physician assistants who examine children must know the wide variations of normal in the appearance of the genital tissues so as to avoid unnecessarily raising the suspicion of sexual abuse if the child gives no disclosure.
Most cases of genital redness, itching, discharge, bleeding, or pain in prepubertal girls have benign causes and respond to the removal of irritants. [1] However, because a genital complaint such as discharge or bleeding may be caused by trauma to the area or a sexually transmitted infection, assessment of each patient requires the clinician to be sensitive to possible unspoken concerns of parents regarding suspicions of molestation. [2, 3]
When a child makes a statement or a disclosure of abuse and describes sexual touching, all 50 US states mandate that the clinician report suspected child sexual abuse to the local child protective services agency, law enforcement, or both. However, if concerns about possible abuse are based only on a physical sign or symptom, the child must be examined by a healthcare provider who is familiar with the nonabusive causes of the symptoms or signs. Understanding the wide variations in the appearance of the hymen and other genital tissues in prepubertal girls is also necessary.
In 2013, the American Academy of Pediatrics (AAP) published an updated clinical report on the subject of suspected child sexual abuse with guidance for the clinician in deciding when a report to protective services is necessary. [4] In 2016, Adams et al published updated guidelines for medical care of children with suspected sexual abuse, [5] and in 2018, these guidelines were updated further. [6] In 2022, the AAP released a policy statement on protection of children from sexual abuse by healthcare professionals and within the healthcare setting. [7]
Clinicians who wish to learn more about the specific examination for child sexual abuse can review the article Child Sexual Abuse in Emergency Medicine or the articles on the medical evaluation of sexual abuse listed in the references. [4, 5, 6, 7, 8]
For patient education resources, see the Women's Health Center, as well as Foreign Body, Vagina.