Abstract
Examinations of young children for suspicions of sexual abuse are challenging for the involved medical specialists because the consequences of the interpretation of the findings can be severe and dramatic. A broad knowledge of differential diagnoses including rare pathologies like urethral prolapse and failure of the midline fusion of the perineum, known as perineal groove, is essential in order to avoid unnecessary diagnostics and treatment, prejudgment, and to reduce patient family’s anxiety. We report two independent cases of girls aged 7 months and 5 years suffering from these rare pathologies, one presenting with painless lower genital tract bleeding, the other showing a lesion of the perineum as random finding during a neuropediatrician’s consultation. In both cases, the pathologies were initially misdiagnosed as injuries due to sexual assault, and judicial investigation procedures were initiated. In this paper, the characteristic symptoms and morphology of urethral prolapse and perineal groove are presented to enhance the awareness of these pathologies among forensic experts and help to establish the correct diagnosis.
Highlights
After an assumed sexual abuse, medical findings in pediatric gynecological exams are rare, and the proof is generally hard to bring
Beside the knowledge of typical injuries caused by penetration, a broad expertise regarding differential diagnoses, such as normal variants, infections, and even rare pathologies, e.g., urethral prolapse and failed fusion of the perineum, is essential to avoid mistakes [2,3,4]
We report on two cases of young girls with no history of recent trauma presenting suspected vaginal bleeding and an apparent lesion of the perineum, respectively
Summary
After an assumed sexual abuse, medical findings in pediatric gynecological exams are rare, and the proof is generally hard to bring. Keywords Vaginal bleeding · Child sexual abuse · Urethral prolapse · Perineal groove · Failed fusion of the perineum · Sexual assault The physician detected an obvious abnormality of the external genital organs of unknown origin, and interpreted the findings as traumatic.
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