Sexual Abuse

Dear Lisa,

Can a female abuse victim receive blisters inside her vagina from possibly fondling?

“Hope"

Dear “Hope”,

In most cases it is difficult to tell if a victim was sexually abused based solely on the findings of a physical examination. There are a few reasons for this. Generally a perpetrator who abuses a child does not intend to harm the child physically because of the desire to reengage the child in activities over time. (1) In addition, injuries to the genital area resulting from sexual assault heal very quickly. (2) To complicate matters even more, children tend to not report the abuse immediately because many times they are threatened by the perpetrator or embarrassed and ashamed by the abuse. (1) As a result, abnormalities are typically not found when the child is examined. Research studies have shown that when sexually abused children victims were examined, many of them had normal physical findings. (3)

On the other hand, suspicious physical findings on the examination of a child’s genital area many times turns out to be normal findings for the child’s age. (1) The appearance of the vaginal in the child changes according to their age. In infants the hymen may appear thicker and redundant. These changes are due to maternal hormones which affect the appearance of the vagina for the first few months of life. (4) These findings reappear when a child approaches puberty. In prepubertal girls, the hymen tends to appear more vascular and reddened. (5) In addition, the appearance of the hymen is very variable from one person to the next. All of these normal changes may appear to be abnormal. Because of the many potential variations in appearance, it is necessary for a child who is suspected to have been sexually abused to see a doctor who specializes in this area of medicine. (1)

The victim’s report of the story about what happened is many times the only evidence that can be examined and the most important part of the investigation. It is important to remember that when children report abuse they describe their experience from the developmental perspective of a child who does not have a complete understanding of what is going on. Because of this, they may not report the event as accurately as adults would like them to. (1) Children commonly report that someone “put something inside of them”. This may be interpreted as vaginal penetration to an adult, but to a child this may include contact which is limited to placing “something” in the vaginal area without true penetration. (1) Any type of genital contact is inappropriate, regardless of the degree of penetration, but from a legal standpoint these details become very important.

Children can contract Sexually Transmitted Infections as a result of inappropriate sexual contact. (1) The spread of sexually transmitted diseases occurs when a child comes into contact with infected genital secretions or sexual organs. (1) Therefore the presence of a sexually transmitted infection tells you that the child came into contact with the germ, but it does not tell you exactly what type of contact occurred. For example a child can catch a Sexually Transmitted Disease when they are fondled by a perpetrator whose hands have infected secretions on them. The only scenario where a sexually transmitted infection in a child may not be caused by sexual abuse is in the case of an infant. An infant can catch a Sexually Transmitted Infection from its mother during birth. (6) Sexually transmitted infections can present themselves as lesions, sores, wart like growths, or with pain with urination. In most cases Sexually Transmitted infections are asymptomatic which means that the person does not develop any symptoms at all. (7)

So to answer you question specifically, in most cases no physical evidence of sexual assault is found and a lot of weight falls upon the child’s story and witness accounts. If physical evidence of abuse is found, a child should be examined and the results documented by a doctor who specializes in the area. Since suspicious findings on physical examination of the genital area many times end up being normal, it would be important to have your child examined by a health care professional with experience in that area. What may appear to be blisters to you, may be a normal finding. If the lesions truly are blisters, then screening for Sexually Transmitted Diseases (STD) should be performed. If a child is determined to have an STD this tells you that the child was in contact with the germ, but this does not tell you exactly which type of contact occurred, whether it be fondling or penetration.

All sexual contact with a child, regardless of which type, is considered sexual abuse. Even if there was no physical contact, children exposed to sexual activities via photographs or inappropriate exposure potentially can develops significant psychological problems. (1) These types of activities should be taken very seriously because they may be the perpetrator’s way of preparing a child for future sexual abuse. (1)

The American Academy of Pediatrics recommends the collection of forensic evidence within 72 hours of the sexual abuse. (1) Therefore, if you think your child has been abused, it would be important to contact your Pediatrician for an evaluation and referral to a doctor who specializes in this area. Child Protective Services should be contacted if sexual abuse is suspected. The Child Protective Services case workers are trained to deal with this very sensitive subject and can provide a family with the necessary social support services that are needed.

References:
(1)Giardino A. Finkel M. Evaluating Child Sexual Abuse. Pediatric Annals. 2005. 34(5):382-393.
(2)McCann J, Voris j. Simon M. Genital injuries resulting from sexual abuse; a longitudinal study. Pediatrics. 1992;89(2):307-317.
(3)Muram D. Medical evaluation of Child victims of sexual abuse. Curr Opin Obstet Gynecol. 1989;1(2):250-258.
(4)Berenson A, heger A, Andrews S. Appearance of the hymen in newborn. Pediatric. 1991;87(4):458-465.
(5)Huffman JW. The Gynecology of Childhood and Adolescence. Philadelphia, PA:WB Saunder; 1969.
(6)Davidson M. Sexually Transmitted Infections. Screening and Counseling. Clinician Reviews. 2006;14(6):56-60.
(7)Fortenberry J. Sexually Transmitted Infections. Pediatric Annals. 2005. 34(10):803-810.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Safe.