Introduction
Methods
Study setting
Procedure
Study design
Data extraction and analysis
Interpretation of reported findings
Genital signs of CSA in prepubertal girls and boys | Anal signs of CSA | |
---|---|---|
Non-specific signs | Erythema, hymenal bumbs/mounds | Perianal venous congestion, perianal midline tags |
Insufficient evidence | Edema | Anal/perianal erythema |
Limited evidence, CSA should be considered | Vaginal discharge, vaginal foreign body | |
Sign of trauma | Bruising, abrasions, genital/hymenal lacerations Genital injuries, predominantly to the penisa
| Dynamic anal dilatation or total dilatation of both internal and external sphincter in the absence of stool Anal/perianal bruising, anal lacerationa
|
Healed trauma | Hymenal transections | Perianal scars and tags outside the midline |
Results
Total | ||
---|---|---|
N = 54 (N = 43, 80% male) | ||
Age (median, min-max) | 3.2 (0–6) years | |
Pornographic images encrypted |
N = 27 (50%) | |
Nature CSAa
| Exposure of genitals to the child |
N = 49 (91%) |
Ejaculate on the child |
N = 38 (70%) | |
Fondling |
N = 53 (98%) | |
Licking the child |
N = 26 (48%) | |
Oral copulation |
N = 29 (54%) | |
Digital or penile penetration (or with a sex toy) of anus or vagina. |
N = 17 (31%) | |
Frequency of CSAb
| Less than 5 times |
N = 30 (55%) |
More than 5 times |
N = 11 (20%) | |
More than 10 times |
N = 9 (17%) | |
Unclear |
N = 4 (7%) | |
Mean estimated delay between last abuse and assessment in years (SD)b
| 1.2 (0.97) |
Physical complaints
Total | ||
---|---|---|
N = 26 (49%) (N = 21, 81% males) | ||
Number of physical complaints reported | 1–2 |
N = 21 (39%) |
3–4 |
N = 6 (11%) | |
Gastro-intestinal complaints |
N = 12 (22%) | |
Constipation N = 4 | ||
Abdominal pain (AP) N = 5 | ||
Constipation and abdominal pain N = 1 | ||
Other GI complaints N = 2 | ||
Anogenital or urological complaints |
N = 20 (37%) | |
Genital skin lesions N = 11 | ||
Genital pain N = 3 | ||
Genital skin lesions and pain N = 3 | ||
Other N = 3 | ||
Blood in diaper or anogenital area |
N = 2 (4%) | |
Skin lesions (non-anogenital) |
N = 4 (7%) | |
Other physical complaints |
N = 1 (2%) |
Physical examination
Total (N = 54) | Boys | Girls | |
---|---|---|---|
No abnormalities noted |
N = 29 (54%) |
N = 22 |
N = 7 |
Yes, but not related to anogenital area or CSA |
N = 5 (9%)
(cardiac murmur, dry skin on the extremities, palpable lymph nodes, hematoma shinbone, upper airway infection, depigmentation on torso)
|
N = 3 |
N = 2 |
Yes, related to anogenital area but non-specific for CSA |
N = 8 (15%)
(diaper rash which looks like candida, physiological phimosis, erythema around anus, erythema labia majora)
|
N = 6 |
N = 2 |
Yes, signs of (healed) trauma, possible related to CSA |
N = 0 (0%) |
N = 0 |
N = 0 |
Yes, clinician reported behaviors during examination possible worrisome for CSA |
N = 15 (28%)*
(child appears timid, child is a bit anxious, very anxious child and therefore not possible to examine, normal behavior up till genital examination than he panics, anxious and clingy therefore not fully able to perform the examination, resistant at the beginning but eventually able to examine him, shuts down when anus is examined (puts face into toy) not able to get contact at that moment, very anxious boy who does not want to undress and show his buttocks, did not seem to like it to be examined, child shuts down and becomes angry when physical examination is explained, a bit resistant and buzzy child who seems to know the knee—chest position without explanation)
|
N = 15 |
N = 0 |
Missing |
N = 1 (2%) |
N = 1 |
N = 0 |
Behavior during physical examination
Behavioral reactions noted | No behavioral reactions noted | Significance | ||
---|---|---|---|---|
Frequency of CSAa, d
| < 5 times | 8 (28%) | 21 (72%) | 0.55 |
> 5 times | 5 (25%) | 15 (75%) | ||
Nature of CSAa
| Oral copulation | 8 (29%) | 20 (71%) | 0.60 |
No oral copulation | 7 (28%) | 18 (72%) | ||
Vaginal/anal penetration | 8 (47%) | 9 (53%) | 0.041 | |
No vaginal/anal penetration | 7 (19%) | 29 (81%) | ||
Mean age at assessment in years (SD)b
| 3.3 (1.54) | 3.1 (1.31) | 0.57 | |
Mean age at start of CSA in years (SD)b, c
| 1.3 (0.88) | 1.5 (0.93) | 0.59 | |
Mean age at ending of CSA in years (SD)b, c
| 2.1 (1.15) | 2.0 (1.12) | 0.49 | |
Mean delay between last CSA and assessment in years (SD)b, c
| 1.2 (0.99) | 1.2 (0.99) | 0.54 |