49. Evaluating a Female Child Suspected of Sexual Abuse: A Summary for Gynecology Residents

Background Child sexual abuse is a global health problem. Up to 1 in 5 women report having been sexually abused as a child and 82% of all victims under the age of 18 are female. Despite this, Gynecology residents can lack the experience and knowledge to identify and manage child sexual abuse. Methods A literature search of the clinical guidelines and law regarding the evaluation of sexual abuse in female children was conducted using the terms ‘sexual abuse/assault’ and ‘child/children’ on Google Scholar and Pubmed. This was followed by review of the contemporaneous publications relating to the medical, ethical and legal considerations when evaluating this population as well as the universal standards required for management of sexual abuse including forensic evidence collection and trauma-informed care. Results Current guidelines and law relating to the evaluation of child sexual abuse differ according to state. Other factors influencing variability in care include the age and developmental stage of a child, their level of sexual maturity or pubertal status, and alleged sexual contact. This summary of recommendations with diagrams is aimed at Gynecology residents and encompasses the present best practices to conducting female anogenital examination in children, initial and follow up testing for sexually transmitted infections (STI), prophylactic treatment of STI including HIV, emergency contraception and collection of forensic evidence. Comparison is made to adults of the unique issues surrounding consent, mandatory reporting, trauma-informed communication, and medical examination in the pediatric population. Also explored is the significance of high-quality documentation, indications for specialist input, mental health resources available and the components of comprehensive follow up. Conclusions Evaluating female children in the setting of sexual abuse represents a challenge for many medical providers and Gynecology residents may encounter this more frequently owing to the nature of their work. Since the presence of a specialist in Pediatric and Adolescent Gynecology (PAG) outside of dedicated children's hospitals is rare, further education of residents to support competency and comfortability in evaluating such concerns is essential. High standards of up-to-date medicolegal knowledge, skills, sensitive and professional care are therefore presented, which aim to enable children to rebuild control over their bodies and regain the autonomy which they are not afforded during sexual abuse. Such empowerment can help reduce the risk of re-traumatization and encourage a child lifelong recovery and health by ongoing confidence in providers for their needs.