Child Sexual Abuse Exam Results in West Alabama

ABSTRACT

Child sexual abuse (CSA) is a common problem, and allegations of CSA require a thorough multidisciplinary investigation which includes a comprehensive medical evaluation. Although most CSA victims will have normal exams, some will have physical injuries, sexually transmitted infections (STIs), and/or other problems. We are reporting the results of the examinations of 573 children evaluated in the West Alabama Child Medical Evaluation Program (WACMEP). This is the first report of CSA exams coming from Alabama and one of a few from a smaller medical center. Most were victimized by a single, older male perpetrator who was known to the family, often related, and had unsupervised access to the child. One-fourth (24.1%) of the children had significant exam findings, including 7.5% with a STI. Females were more likely to have significant findings including most of the STIs. Other historical factors statistically linked to an increased risk of having significant exam findings included being African-American, providing a clear history of abuse, and/or reporting vulvar pain or vaginal symptoms such as discharge, itching, or bleeding. The incidence of significant findings including STIs was similar to previously reported studies from larger urban centers across the United States, United Kingdom, and New Zealand.

KEYWORDS:

• Sexual abuse
• child sexual abuse
• sexually transmitted infections
• medical examination

Acknowledgments

We would like to thank Haley Overstreet, MD for her enormous effort toward data input and Prachi Baodhankar, MD for her assistance with the literature search.

Disclosure of Interest

The authors report no conflicts of interest.

Ethical Standards and Informed Consent

All procedures followed were in accordance with the ethical standards of the Office for Research Compliance and the Institutional Review Board for the Protection of Human Subjects at The University of Alabama and with the Helsinki Declaration of 1975, as revised in 2000. Prior to each examination, consent for performing the exam was obtained from the legal guardian(s) of each patient seen in the clinic and from the patient when the patient was 14 years of age or older. Assent was obtained from patients who were from 8 through 13 years of age. This was a retrospective chart review study and the IRB Committee granted us a Waiver of Informed Consent to allow us to analyze the deidentified data for the study.

Additional information

Notes on contributors

Michael A. Taylor

Michael A. Taylor, MD, FAAP is Professor and Director of the Child Abuse Pediatrics Division, Dept. of Pediatrics, UAB School of Medicine, Birmingham, AL.

John C. Higginbotham

John C. Higginbotham, PhD, MPH is the Associate Dean for Research and Health Policy, Professor and Chair of the Department of Community and Rural Medicine and the Director of the Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL.