TY  - JOUR
T1  - HAs this prepubertal girl been sexually abused?
AU  - Berkoff M, Zolotor AJ, Makoroff KL, Thackeray JD, Shapiro RA, Runyan DK
Y1  - 2008/12/17
N1  - 10.1001/jama.2008.827
JO  - JAMA
SP  - 2779
EP  - 2792
VL  - 300
IS  - 23
N2  - Context 
                  The legal and social sequelae of interpreting genital findings as indicative of sexual abuse are significant. While the absence of genital trauma does not rule out sexual abuse, the physical examination can identify genital findings compatible with sexual abuse.Objectives 
                  To determine the diagnostic utility of the genital examination in prepubertal girls for identifying nonacute sexual abuse.Data Sources 
                  Published articles (1966-October 2008) that appeared in the MEDLINE database and were indexed under the search terms of child abuse, sexual or child abuse and either physical examination; genitalia; female, diagnosis; or sensitivity and specificity; and bibliographies of retrieved articles and textbooks.Study Selection 
                  Three of the authors independently reviewed titles of articles obtained from MEDLINE and selected articles for full-text review.Data Extraction 
                  Two authors independently abstracted data to calculate sensitivity, specificity, and likelihood ratios for the diagnosis of nonacute genital trauma caused by sexual abuse in prepubertal girls.Results 
                  Data were not pooled due to study heterogeneity. The presence of vaginal discharge (positive likelihood ratio, 2.7; 95% confidence interval, 1.2-6.0) indicates an increased likelihood of sexual abuse. In the posterior hymen, hymenal transections, deep notches, and perforations prompt concerns for genital trauma from sexual abuse, but the sensitivity is unknown. Without a history of genital trauma from sexual abuse, the majority of prepubertal girls will not have a hymenal transection (specificity close to 100%).Conclusions 
                  Vaginal discharge as well as posterior hymenal transections, deep notches, and perforations raise the suspicion for sexual abuse in a prepubertal girl, but the findings do not independently confirm the diagnosis. Given the broad 95% confidence intervals around the likelihood ratios for the presence of findings along with the low or unknown sensitivity of all physical examination findings evaluated, the physical examination cannot independently confirm or exclude nonacute sexual abuse as the cause of genital trauma in prepubertal girls.
SN  - 0098-7484
M3  - doi: 10.1001/jama.2008.827
UR  - http://dx.doi.org/10.1001/jama.2008.827
ER  -