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Sexual Assault—or Mimic?

By Gregory Wallace, DO | April 18, 2012
Dr Wallace is a Hospitalist at Cincinnati Children's Hospital Medical Center in Cincinnati and a staff physician at the Northern Kentucky Children's Advocacy Center in Bellevue, Ky.

A 7-year-old girl was brought to the Child Advocacy Center (CAC) for a sexual assault examination. The newly assigned Child Protective Services (CPS) worker reported only what the child had disclosed to a friend’s grandmother the evening before the visit.

The child had indicated that her stepfather had sexually assaulted her. She told the forensic interviewer at the CAC that she had been “raped” by her stepfather. When asked what rape meant, she giggled and shrugged her shoulders. She offered no other detail of the alleged assault.‬‬‬‬

(MORE: Intraparenchymal Hemorrhage: Child Abuse—or Mimic?)

The physical examination was completed and the child cooperated for the entire examination. She was not clean and was intellectually fairly low–functioning but was otherwise healthy. The examination showed no indication of any genital injury. There was very minimal erythema on the perineum, which was consistent with her poor hygiene.

The initial report to the CPS worker was that the examination was normal and that the child appeared to have been coached.

Do you suspect actual abuse?  ‬‬‬‬‬

(Discussion on the next page.)

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