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17 year old boy examined acutely due to a history of anal penetration. A midline laceration (a) and discharge (b) were seen. Culture for gonorrhea was positive.
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Interpreting the significance of anal findings in child sexual abuse can be difficult. The aim of this study is to compare the frequency of anal features between children with and without anal penetration. This is a retrospective blinded review of consecutive charts of children seen for suspected sexual abuse at a regional referral center from Janu...
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There is uncertainty about the nature and specificity of physical signs following anal child sexual abuse. The study investigates the extent to which physical findings discriminate between children with and without a history of anal abuse.
Retrospective case note review in a paediatric forensic unit.
Cases: all eligible cases from1990 to 2007 alleg...
Citations
... A presente revisão identificou sinais e sintomas de ordem física e psicossocial. Dentre os sinais e sintomas físicos mais evidenciados no estudo foram as ISTs (Al-Jilaihawi et al., 2018;Kellogg et al., 1998;Kohlberger e Todesca, 2007;Rahman et al., 2015;Anderson et al., 2014;Hobbs e Wynne, 1986;Hunter et al., 1985;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Hobbs e Wynne, 1989;Reading et al., 2014) seguido dos achados anais, com destaque para a dilatação anal (Al-Jilaihawi et al., 2018;Myhre et al., 2013;Smith et al., 2018;Anderson et al., 2014;Hobbs e Wynne, 1986;Hobbs e Wynne, 1989;Hobbs e Wright, 2014), fissuras anais (Myhre et al., 2013;Anderson et al., 2014;Hobbs e Wynne, 1986;Hobbs e Wynne, 1989;Hobbs e Wright, 2014;Reading et al., 2014), alterações himenais (Al-Jilaihawi et al., 2018;Kellogg et al., 1998;Kohlberger e Todesca, 2007;Rahman et al., 2015;Anderson et al., 2014;Hobbs e Wynne, 1986;Hunter et al., 1985;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Hobbs e Wynne, 1989;Reading et al., 2014) e as infecções genitais (Delago et al., 2012;Kellogg et al., 1998;Reinhart e Adelman, 1989;Smith et al., 2018;Bosschaart et al., 2017;Anderson et al., 2014;Taylo e Higginbotham, 2020;Hobbs e Wynne, 1989;Reading et al., 2014). Além destes, a dor genital (Delago et al., 2008;Delago et al., 2012;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Reading et al., 2014), disúria (Delago et al., 2008;Delago et al., 2012;Reinhart e Adelman, 1989;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Reading et al., 2014), hematomas genitais (Kellogg et al., 1998;Smith et al., 2018;Anderson et al., 2014;Mendoza e Hernández, 2009;Hobbs e Wynne, 1989) e o eritama (Kellogg et al., 1998;Smith et al., 2018;Hobbs e Wynne, 1986;Anderson et al., 2014;Mendoza e Hernández, 2009;Hobbs e Wynne, 1989;Hobbs e Wright, 2014) foram sinais e sintomas muito presentes nos estudos. ...
... A presente revisão identificou sinais e sintomas de ordem física e psicossocial. Dentre os sinais e sintomas físicos mais evidenciados no estudo foram as ISTs (Al-Jilaihawi et al., 2018;Kellogg et al., 1998;Kohlberger e Todesca, 2007;Rahman et al., 2015;Anderson et al., 2014;Hobbs e Wynne, 1986;Hunter et al., 1985;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Hobbs e Wynne, 1989;Reading et al., 2014) seguido dos achados anais, com destaque para a dilatação anal (Al-Jilaihawi et al., 2018;Myhre et al., 2013;Smith et al., 2018;Anderson et al., 2014;Hobbs e Wynne, 1986;Hobbs e Wynne, 1989;Hobbs e Wright, 2014), fissuras anais (Myhre et al., 2013;Anderson et al., 2014;Hobbs e Wynne, 1986;Hobbs e Wynne, 1989;Hobbs e Wright, 2014;Reading et al., 2014), alterações himenais (Al-Jilaihawi et al., 2018;Kellogg et al., 1998;Kohlberger e Todesca, 2007;Rahman et al., 2015;Anderson et al., 2014;Hobbs e Wynne, 1986;Hunter et al., 1985;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Hobbs e Wynne, 1989;Reading et al., 2014) e as infecções genitais (Delago et al., 2012;Kellogg et al., 1998;Reinhart e Adelman, 1989;Smith et al., 2018;Bosschaart et al., 2017;Anderson et al., 2014;Taylo e Higginbotham, 2020;Hobbs e Wynne, 1989;Reading et al., 2014). Além destes, a dor genital (Delago et al., 2008;Delago et al., 2012;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Reading et al., 2014), disúria (Delago et al., 2008;Delago et al., 2012;Reinhart e Adelman, 1989;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Reading et al., 2014), hematomas genitais (Kellogg et al., 1998;Smith et al., 2018;Anderson et al., 2014;Mendoza e Hernández, 2009;Hobbs e Wynne, 1989) e o eritama (Kellogg et al., 1998;Smith et al., 2018;Hobbs e Wynne, 1986;Anderson et al., 2014;Mendoza e Hernández, 2009;Hobbs e Wynne, 1989;Hobbs e Wright, 2014) foram sinais e sintomas muito presentes nos estudos. ...
... Além destes, a dor genital (Delago et al., 2008;Delago et al., 2012;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Reading et al., 2014), disúria (Delago et al., 2008;Delago et al., 2012;Reinhart e Adelman, 1989;Mendoza e Hernández, 2009;Taylo e Higginbotham, 2020;Reading et al., 2014), hematomas genitais (Kellogg et al., 1998;Smith et al., 2018;Anderson et al., 2014;Mendoza e Hernández, 2009;Hobbs e Wynne, 1989) e o eritama (Kellogg et al., 1998;Smith et al., 2018;Hobbs e Wynne, 1986;Anderson et al., 2014;Mendoza e Hernández, 2009;Hobbs e Wynne, 1989;Hobbs e Wright, 2014) foram sinais e sintomas muito presentes nos estudos. A gravidez foi outro sinal evidenciado (Myhre et al., 2013;Hunter et al., 1985;Mendoza e Hernández, 2009, porém não refere a idade da vítima. Quanto aos sinais e sintomas de ordem psicossocial, os problemas escolares (Habigzang et al., 2008;Conceição et al., 2020;Doğangün et al., 2016;Reading et al., 2014), regressão das habilidades de banheiro (Bosschaart et al., 2017;Anderson et al., 2014;Hunter et al., 1985;Taylo e Higginbotham, 2020), sobretudo em crianças menores, alterações de comportamento (Al-Jilaihawi et al., 2018;Conceição et al., 2020;Doğangün et al., 2016) e problemas emocionais (Habigzang et al., 2008;Hobbs et al., 1995;Bosschaart et al., 2017;Conceição et al., 2020;Chaffin et al., 1997;Doğangün et al., 2016) se sobressaíram. ...
A violência sexual infantil é um fenômeno universal e silencioso, presente em todos os países. Na violência, a criança não é capaz de compreender ou decidir sobre o ato, sendo utilizados meios de coerção ou indução, ou ainda que possa incorrer em ato que seja, para a sociedade, considerado ilegal. Assim, objetivou mapear na literatura quais os sinais e sintomas da violência sexual evidenciados em crianças. Trata-se de uma revisão integrativa, realizada em outubro e novembro de 2021, nas bases de dados MEDLINE/PubMed, COCHRANE LIBRARY, CINAHL, SCOPUS, Web of Science, LILACS e PsycINFO, por meio do cruzamento dos descritores “abuso sexual na infância”, “delitos sexuais”, “sinais e sintomas”, “trauma sexual”, “criança”, “pré-escolar” e “recém-nascido”, nas línguas português, espanhol e inglês, não foi considerado limite temporal para seleção dos artigos. Os resultados foram analisados criticamente de forma descritiva. Foram selecionados 23 artigos para amostra. Os achados identificaram os sinais e sintomas de violência sexual em crianças tanto na dimensão da agressão física quanto psicossocial. Na primeira, destaca-se as lesões anogenitais, geniturinários e as infecções sexualmente transmissíveis, enquanto que na dimensão psicossocial nota-se a presença de alterações emocionais, cognitivas e comportamentais. Dentre os sinais e sintomas mais encontrados nesta revisão no eixo físico, destacaram-se os sinais e sintomas genitais e as ISTs. Entre os psicossociais, destacaram-se sintomas emocionais e comportamentais. Esse estudo aponta evidências científicas que podem contribuir na prática de profissionais que trabalham com o público infantil na identificação dessa violência.
... Folliculitis is common among adolescents who shave their pubic hair and sometimes progresses to ulcerative lesions and cellulitis. Anal dilatation is further clarified as a normal finding in some children after 1-2 min when they are placed in the prone knee chest position or have stool in the anal vault (McCann, Miyamoto, Boyle, & Rogers, 2007;Myhre et al., 2013). ...
... After speculum examination, one patient (3.7%) demonstrated a new genital injury-an abrasion to the labia [40]. [41] Until further studies are performed, use of a speculum should be delayed until after toluidine dye application [40]. ...
Background and aim. Sexual violence refers to a specific constellation of crimes including sexual harassment, sexual assault, and rape. This study was carried out to establish the role of histocytopathologist in establishing rape cases in Nigeria. Methods. One of the first interventions is the macroscopic analysis that consists of evaluating evidence/garments collected (from the victim, corpse, aggressor, and crime scene) to the laboratory in order to perform a search for blood, semen, hair, saliva, sweat, tissues, fibers, and other elements through meticulous and sequential observation, evaluating and establishing strategies to find biological spots. Coloscopic analysis was done using the histological stain; Toluidine blue. Results. Identification by microscopy (e.g., spermatozoa), comparison microscopy (e.g., hairs and fibers), serological analyses (e.g. conventional ABO grouping or species identification), and biochemical analyses (e.g. phosphoglucomutase) played a fundamental role in the investigation of crime for many years and are still used today in some circumstances. In the forensic analysis of male on male rape, microscopic examination for spermatozoa is initially undertaken, followed by DNA analysis if any body fluids are identified. Conclusion. The role of a histocytopathologist in rape diagnosis include detection of biological evidence using microscopic techniques, assessment of a crime scene using Alternative Light Sources, use of fluorescent contrast techniques and use of histochemistry and staining methods to detect and analyze biological evidence. Cite this article.
... Physical findings included perianal erythema, swelling of the perianal tissues, laxity and reduced tone of the anal sphincter, large tears, and skin changes, complete anal dilatation with the relaxation of both the internal and external anal sphincters, fissures, abrasions, and hematoma and/or bruises, venous congestion, pigmentation [6]. In a study made by Myhre et al. with 198 children "belonging to the anal penetration group," there was a "positive association between the following features and anal penetration: anal soiling, fissure, laceration, and total anal dilatation" [12]. These findings, although some of them "with no expert consensus on interpretation concerning sexual contact or trauma" in Adam's classification of the victims [11], are essential to highlight the suspect of sexual violence (e.g., rape). ...
... There are some differences between the authors on this point. Some authors generally prefer the exam in the prone knee-chest position [12]. Sakelliads et al. [6] suggest that the examination of boys "may be performed with the patient in the sitting, supine or standing position. ...
... Two questions arise at this point. First, to what extent would the findings related by Sakelliadis et al. [6], Myhre et al. [12], or Adams' criteria [11] will be sufficient for the conviction of the offender in a court of law? The second question is: What standard should be used for forensic examination to reach an objective conclusion beyond a reasonable doubt? ...
Introduction: Most cases of sexual violence against male children involve anal coitus. This type of violence has been proven in Brazilian courts based on the presence of sperm in the anus. However, other findings can also confirm this. This review aims to describe some forensic aspects of this crime and propose a rational form of evidence collection. Methods: An extensive search in databases (from 2009 to May 2022) like Medline, Cochrane Central, Scopus, Web of Science, and Science Direct were used, searching the following keywords: child abuse, rape, boys, and forensics. Results: From the sources found, only 24 were considered appropriate for this paper. Discussion and Conclusion: The absence of sperm research on the anus isolated is insufficient to exclude rape in a male child and increases the need for other methods to prove rape. Therefore, we propose a system of points based on some diagnostic criteria that should be analyzed together: the child's testimony, physical signs found in the anus, and the presence of spermatozoa in the anal cavity.
... More recent studies have explored the frequency of anal features that are suspicious of anal penetration in children. [15][16][17] Clotilde et al., [2015] describes the anal lesions found in children under 15 years during a paediatric gastroenterology consultation when the presenting complaint was related to digestive disease. 17 Whilst there is utility to studies looking at control groups in anal examinations, they studied only 100 children and of these it is likely that a proportion had underlying stigmata of gastroenterological disease on examination. ...
Background:
There is a lack of clarity around the prevalence of anal injuries sustained following anal penetration. The aim of this study was to identify the prevalence of injury amongst clients attending Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK following anal penetration and identify predisposing or protective factors such as age, sex and pubertal status. This should facilitate an evidence-based approach to providing evidence statements in court for allegations of anal penetration.
Method:
This was an observational retrospective study analysing the forensic medical examination (FME) case notes of 239 clients between January 2015 and December 2016. Subjects were excluded if the nature of alleged assault was unclear. Data was extracted from the FME case notes on to a data collection proforma and statistical analysis undertaken.
Results:
Of the 239 subject, 156 [65.3%] were female and 83 [34.7%] male. Subjects were predominantly post-pubertal, 185 [79.4%]. The alleged assaults were categorised in to penile anal, digital anal and object anal; penile anal assault was the most common type, 177 [75.97%]. No association was found between type of assault and presence of anal injury. Anal injuries did not occur more frequently in one sex than another [21.15% female, 21.69% male]. Logistic regression indicated pre-pubertal children were less likely to have injury [(odds ratio = 0.34, 95% CI (0.078, 0.70), p = 0.016)], although this was not significant when adjusted for time since assault. Most pre-pubertal children presented more than 72 h after alleged assault, [68.2% female, 73.1% male] The presence of anal injury was significantly associated with time since assault across all subjects, with those examined after 72 h less likely to have injury [p = 0.0016]. A greater proportion of single suspect assaults [22.8%] resulted in anal injury than multiple suspect assaults [13.9%]. Whilst there was alcohol consumption in most alleged assaults against post-pubertal subjects [56.1% female, 50.9% male], there was no statistically significant data to associate alcohol consumption with anal injury. And, the same was true of drug consumption. Among post-pubertal females 96.21% of assaults involved threats or violence, comparable with 71.70% amongst post-pubertal males. The data did not suggest threats and violence increase the rate of anal injury.
Conclusion:
The study identifies a statistically significant relationship between time since assault and prevalence of anal injury. Further, a relationship between pubertal status and prevalence of anal injury was found. The low prevalence of anal injury amongst pre-pubertal children suggests that absence of injury at the time of examination, following allegation of anal assault, is a common finding. Importantly, whilst not demonstrating statistical significance, it should be noted that the majority of assaults reported in the study did not result in anal injury. The study provides contemporary evidence in the field of forensic medicine which can be used in court proceedings in allegations of anal assault.
... 40 In the study of Smith et al. 29 Anal contamination, anal fissure, anal laceration, and total anal dilatation findings are closely associated with anal penetration. 41 The detection rate of anal laceration, which is a strong indicator of sexual abuse, is only 0.08-4.6% by simple examination. ...
... by simple examination. 29,41 However, researchers claim that these rates can be further improved with assistive techniques such as rectoanal endosonography. 42 In this study, it was found that 130 (97%) cases who underwent anal examination had normal examination findings: 3 cases (2.2%) had chronic fissures, and 1 case (0.7%) had acute fissures. ...
Objective: This study aimed to evaluate the sociodemographic characteristics and the mental, anogenital, and physical examination findings of child and adolescent sexual abuse victims and to discuss them in the light of the literature.
Materials and Methods: This study included a total of 134 children and adolescent cases between the ages of 0 and 18 who were victims of sexual abuse, from among the reports prepared in the Forensic Medicine Clinic of Bolu Abant Izzet Baysal Training and Research Hospital between 2015 and 2019.
Results: This study included 134 cases: 113 (84.3%) were female and 21 (15.7%) were male. The mean age was 13 ± 3.4 years (min: 3, max: 17). The average age of the defendants was 25.6 ±13 years (min: 12, max: 75), and all the defendants were male. The defendants were strangers in 60 cases (4.8%). Sexual abuse mostly occurred as vaginal penetration in 46 cases (34.3%). Sixty–nine (51.5%) cases were exposed to abuse more than once. Depression due to sexual
abuse developed in 14 (10.4%) of the cases.
Conclusion: Considering that many child abuse victims have normal examination findings, it should not be forgotten that the interview and psychiatric examination with the child are as valuable as the genital examination.
Keywords: Depression, post-traumatic stress disorder, sexual abuse of child, sexual offenses
... Child and adolescent sexual abuse (CSA) is considered a public health problem worldwide, not only affecting the victims but also their families and society [1][2][3][4]. Some of the most common consequences of CSA include physical health problems such as sexually transmitted infections, injuries, and unwanted pregnancies [5,6]; and mental health problems such as anxiety and depression [7,8], post-traumatic stress disorder [9], attention deficit hyperactivity disorder [10,11], personality disorders [11], and severe mental disorders such as schizophrenia [12]. ...
Child and adolescent sexual abuse (CSA) is an international public health problem. Despite the importance of CSA, there is no consensus definition, and the lack of consensus is related to difficulties in conducting prevalence studies as well as research in other areas. To establish a consensual definition, legal aspects such as the age of sexual consent and the difference in age or power between victim and aggressor as well as aspects related to sexual freedom and sexual indem-nity must be considered. Therefore, the main goal of this research was to analyze the age of sexual consent in the legal systems of Spanish-speaking countries and to examine whether the Romeo and Juliet clause is established. To achieve the proposed aims, we employed the legal interpretation method, and we analyzed the current Criminal Codes of the 21 Spanish-speaking countries. From the results, it is found that the age of sexual consent varies between countries, establishing valid sexual consent between 13 and 18 years. In addition, only six countries have the Romeo and Juliet clause that protects sexual freedom in adolescents. Finally, we discussed the lack of consensus on the age of sexual consent and the limitations presented by the Romeo and Juliet clause.
... Child and adolescent sexual abuse (CSA) is considered a public health problem worldwide, not only affecting the victims but also their families and society [1,2,3,4]. Some of the most common consequences of CSA include physical health problems such as sexually transmitted infections, injuries and even unwanted pregnancies [5,6]; and mental health problems such as anxiety and depression [7,8], post-traumatic stress disorder [9], attention deficit hyperactivity disorder [10,11], personality disorders [11], and severe mental disorders such as schizophrenia [12]. ...
Child and adolescent sexual abuse (CSA) is an international public health problem. Despite the importance of the CSA, there is no consensus definition, and the lack of consensus is related to difficulties in conducting prevalence studies, as well as research in other areas. To establish a consensual definition, legal aspects such as the age of sexual consent and the difference in age or power between victim and aggressor, aspects related to sexual freedom and sexual indemnity must be considered. Therefore, the main goal of this research was to analyze the age of sexual consent in the legal systems of Spanish-speaking countries and to examine whether the Romeo and Juliet clause is established. To achieve the proposed aims, we employed the legal interpretation method, and we analyzed the current Criminal Codes of the 21 Spanish-speaking countries. From the results, it is found that the age of sexual consent varies between countries, establishing valid sexual consent between 13 and 18 years. In addition, only six countries have the Romeo and Juliet clause that protects sexual freedom in adolescents. Finally, we discussed the lack of consensus on the age of sexual consent and the limitations presented by the Romeo and Juliet clause.
... does not exclude the possibility of sexual abuse, since many types of assaults do not cause injuries, or if there are any, they can heal completely by the time of examination. [8][9][10][11] The diagnosis and assessment of violence against children have to be done, with increased attention and appropriate professional knowledge. [12] The misinterpretation of examination findings may have significant consequences for the child's mental health, relationships with family and friends, and in case of needed further protection against ongoing abuse. ...
Introduction: Child abuse does not include only physical assaults. It is any form of maltreatment by an adult, which is violent or threatening for the child, any act against the physical and emotional wellbeing of a child's life. Generally, crimes against youth divided into physical, sexual, or emotional abuse. Material and methods: This study aimed to perform a retrospective analysis of all the cases related to sexual assaults against minors for the last five years, by materials of the clinic of Forensic medicine and Deontology in Sofia, Bulgaria. Results: For the period 2015-2019, a total of 10139 forensic medical examinations performed at the clinic. Out of them, we have carefully examined all the cases related to different forms of sexual assaults against children-by gender, by age, and by the perpetrator of the crime. Discussion and Conclusion: Crimes against youth are а socially significant problem, because nevertheless the type of maltreatment, they can affect equally the victim's life and the society as well in the future. The injured child may trigger various reactions and mechanisms to deal with the stress-by physically harming himself or committing suicide, by becoming alcohol or a drug addict, or by becoming the perpetrator of a different type of crime.
... Furthermore, a large body of literature has reported the short-term and long-term consequences of CSA on both the physical and mental health of the victims [5][6][7][8]. These consequences include anal injury and sexually transmitted infections [9], anxiety and depression [10], post-traumatic stress The lack of research on male CSA, and more specifically, on male-on-male CSA, can be partially explained by the under-reporting of this type of abuse due to sociocultural attitudes such as social stigma attached to abuse, potential humiliation, and threats to families [23,28,30,31]. This lack of reporting is even greater in middle-income countries, such as Colombia, where homophobia tends to be highly prevalent due to the cultural ideals of 'machismo' and hegemonic masculinity [32]. ...
Child and adolescent sexual abuse (CSA) is an important global health problem, especially in non-Western low-and middle-income countries. A number of studies have indicated that, in Latin American countries, male CSA is phenomenon of great concern. However, research on this topic is seriously lacking, and more specifically, on male-on-male CSA. We carried out a qualitative and quantitative secondary analysis of 680 cases of alleged male-on-male CSA that occurred between the years 2017 and 2018 in the Caribbean Region of Colombia. We analyzed the contents of forensic interviews with the alleged victims, conducted by professionals working at the Colombian Institute of Legal Medicine and Forensic Sciences. Our findings indicated a high prevalence of cases of alleged male-on-male CSA among young minors. Most of these cases were allegedly perpetrated by offenders known to the victim and involved high levels of violence. Evidence-based and culturally grounded preventative actions, such as training-based programs for teachers and parents among other public health initiatives are needed to address this type of CSA. Further research is also required to gain a more fine-grained understanding of the cultural and social context of CSA in the Caribbean Latin American countries.
