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Medical examination in child sexual abuse

Medical examination in child sexual abuse The medical examination is important for at least four reasons: it reassures the victim and parents that the child is normal and healthy; it detects, treats, or prevents medical conditions as a result of the sexual contact; it provides evidence for the protection of the child; and it provides evidence to prosecute the offender (De Jong, 1998). Even though the medical examination is necessary in many (and some would argue all) cases of sexual abuse, “it is not unusual to hear physicians state that children are not upset by current sexual abuse evaluation procedures” (Berson, Herman-Giddens, & Frothingham, 1993, p. 42). The few available studies instead indicate that the majority of children experience some distress. In a study of medically examined children, 57% described some pain associated with the exam and 50% described some fear (Lazebnik et al., 1994). A further 14% of children said that they experienced a lot of fear or pain, and 20% stated that they would be afraid to undergo a second exam. The intensity of fear of having to undergo a second (hypothetical) exam was related to a general fear of doctor visits, as well as fear and pain associated with the just completed examination. Waibel-Duncan and Sanger (1999) also found that 62% to 80% of children reported mild to moderate levels of examination distress, whereas 93% to 100% of guardians said that their children experienced it as distressing. Importantly, children receiving more information and more accurate information prior to the examination were scored by staff as less distressed during the examination. Finally, Berliner and Conte (1995) found that although children who had a medical examination had very positive views about the way they were treated by physicians, they were significantly more likely than those not undergoing an examination to report more symptoms an average of 3.5 years post-disclosure. It is likely, however, that this finding is because children undergoing medical examinations also suffered worse abuse. These studies suggest that a significant minority of children experience this examination as extremely distressful and that half to three-fourths of children experience it as somewhat distressful. As such, researchers and clinicians must consider how to lower the levels of distress. Waibel-Duncan and Sanger (1999) found that one important method was by providing education to the children and their parents prior to the examination. Hogan (1996) also reports on the use of an oral dose of midazolam as a conscious sedative in children experiencing high levels of distress. These and other methods can be considered for lowering distress.

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