Anogenital Findings in Confirmed Victims of Child Sexual Abuse Materials

OBJECTIVE The purpose of this study is to describe the medical evaluation including history, physical examination, and diagnostic testing results in children/adolescents who are confirmed subjects of child sexual abuse materials (CSAMs) and to compare these findings with age-matched controls who are suspected victims of sexual abuse without CSAMs. METHODS This retrospective case-control study examined anogenital findings and disclosure patterns in children who were aged no more than 17 years, who were evaluated for sexual abuse/assault at an urban children’s hospital, and who had additional history of being photographed and/or videotaped while performing sexual acts. Two control patients per study patient were matched by age (± 6 months), gender, acute vs nonacute examination, and type of sexual contact. Photo documentation of all anogenital examinations was reviewed by 2 child abuse pediatricians blinded to the clinical history. RESULTS There were 22 cases and 44 controls. Girls comprised 91% (60/66) of the patients. Fourteen cases (14/22; 64%) disclosed details of sexual abuse. Eight cases (36%) did not make a disclosure of sexual abuse; 4 were preverbal. Although half of the cases (12/22; 55%) were evaluated within 120 hours of the most recent sexual abuse contact, only 1 had an abnormal anogenital examination. There were no significant differences in examination findings or diagnostic tests when cases were compared with controls, but more than one-third of cases were preverbal or denied abuse. CONCLUSION Children with objective evidence of sexual abuse via CSAMs were unlikely to have examination findings of trauma and were frequently unable/unwilling to fully disclose their abuse.