Kindergynäkologische Aspekte des sexuellen Missbrauchs

 

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Zusammenfassung

Kenntnisse körperlicher Verletzungen und Symptome, die durch sexuelle Übergriffe hervorgerufen werden können, sind für jeden Kollegen oder Kollegin, die sich in der Kindergynäkologie engagiert, von großer Bedeutung. Dieser Artikel soll einen Überblick über epidemiologische, klinische und rechtliche Aspekte des sexuellen Missbrauchs von präpubertären Mädchen geben. Die aussagekräftige Durchführung einer kindergynäkologischen Untersuchung bei Verdacht auf sexuellen Missbrauch wird ebenso beschrieben, wie Symptome im Extragenitalbereich sowie der Genital- und Analregion, die nach sexuellen Übergriffen registriert werden können. Zudem werden Normvarianten und Differenzialdiagnosen dargestellt. Die optimale Sicherung von eventuell vorhandenem Beweismaterial für forensische Untersuchungen wird beschrieben. Rechtliche Aspekte wie Entbindung von der Schweigepflicht, Bruch der Schweigepflicht und Erstattung einer Anzeige werden diskutiert.

Genital findings in sexually abused prepubertal girls

Abstract

Childhood sexual abuse is defined as the involvement of dependent, developementally immature children and adolescents in sexual activities that they do not fully comprehend, to which they are unable to give informed consent or that violate the social taboos of family roles. Essential to the diagnosis of sexual abuse is an awareness of the problem and knowledgement of its manifestations. The evaluation of the sexually abused girl usually is performed in a pediatric and adolescent gynecology outpatient department. Thus, the gynecologist will be part of a multidisciplinary approach to the problem and will need to be competent in the basic skills of history taking, physical examination, selection of laboratory tests und differential diagnosis. Findings secondary to sexual abuse are often subtile. Acute tears or bruisings are rare, because force is seldom part of sexual acts committed against a child. A vaginal opening of greater than 5 mm is not common and may indicate vaginal penetration. An intact hymen not necessarily exclude vaginal intercourse. Lack of physical evidence never rules out abuse because sexual acts may leave no physical findings.

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