Evaluation Of Sexual Abuse Research Articles

Private clinical psychologists’ role in evaluation and treatment of childhood sexual abuse: A mixed methods study

BackgroundPsychologists play a significant role in addressing sexual violence against children and adolescents (SVCA) in Brazil. Most literature focuses on the role of public service psychologists in the intervention, resulting in the need to explore the role private clinical psychologists’ (PCP) play in SVCA treatment. ObjectiveThe study aims to: 1) investigate a possible relationship between sociodemographic factors, professional profiles, beliefs about SVCA, and PCPs’ decision to report the abuse, and 2) understand the role PCPs play in evaluating, reporting, and treating cases of SVCA. Participants and settingThe study sampled Brazilian PCPs. The quantitative phase consisted of 409 psychologists, and the qualitative phase consisted of 8 psychologists. MethodsThe study used a mixed-methods sequential explanatory design to achieve its goals. The quantitative phase consisted of the Sociodemographic and Professional Questionnaire, Scenario 7, and the Sexual Abuse Belief Scale (SABS) measures. The qualitative phase consisted of individual semi-structured interviews. ResultsThe descriptive statistics and a binary logistic regression model illustrated factors increasing the likelihood of reporting SVCA by PCPs, including a history of treating confirmed sexual violence cases, taking a course on sexual violence, receiving SVCA information during undergraduate studies, having a master and doctoral degree, and having a single relationship status. The thematic analysis resulted in four themes: The definition of sexual violence, the selectivity of the cases, educational under-preparation, and the need to build a performance network. ConclusionPCPs require professional development to treatment SVCA, and schools of Psychology need to improve their curriculum regarding SVCA education.

Child Sexual Abuse Documentation in Primary Care Settings.

Primary care providers (PCPs) can play an important role in the continuity of care for children who experience sexual abuse (SA). We performed a retrospective, chart-based study of children 3 to 17 years old with SA history. Primary care medical records were reviewed for 2 years after a subspecialty SA evaluation. Descriptive statistics and logistic regression were used to assess factors associated with documentation of SA history and mental health management by the PCP. Of 131 included patients, 43% had PCP documentation of their SA history, which was associated with care from resident providers (P < .01). There was greater mental health management and mental health referrals by PCPs for the group with documentation compared with the group without documentation (52% vs 23%, P < .001). Overall, child SA history was poorly documented in primary care settings. Identifying mechanisms to improve communication about a child's SA history with PCPs is important for the child's ongoing care.

Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse?

Anogenital herpes simplex virus (HSV) is most commonly acquired via sexual transmission, although other nonsexual modes of transmission have been proposed. When a child presents with a first-time outbreak of anogenital HSV, providers must consider sexual abuse. There are currently no evidence-based consensus guidelines to inform management of these patients. The purpose of this study was to describe how child abuse pediatricians (CAPs) evaluate children with anogenital HSV infection and determine whether any consistent practice patterns are followed. The patients included in this study were children between the ages of 0 and 12 years with a first-time outbreak of anogenital HSV who were medically evaluated by a CAP. Patient charts were retroactively reviewed for the period of January 1 2004 to May 1 2020. Twenty-two cases were referred for evaluation by a CAP in the chosen time frame. Fifteen were seen in person. Ten of these patients were interviewed, 15 had an anogenital exam with colposcopy, and 14 were tested for at least one other sexually transmitted infection. A diagnosis of sexual abuse was made for 1 patient. This study demonstrates that although nonsexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse, including interview, physical exam, and testing for sexually transmitted infections. Evidence-based concerns for sexual abuse should be reported to child protective services.

A Standardized Peer Review Program Improves Assessment and Documentation of Child Sexual Abuse.

Introduction:The objective was to assess the impact of interventions associated with ongoing expert peer review on the quality of child abuse medical providers’ written and photograph documentation in child sexual abuse cases.Methods:Pediatricians participated in a HIPAA compliant blind peer review process on a web platform developed to provide the American Board of Pediatrics maintenance of certification. Participants submit sequential photograph and written documentation of child sexual abuse examinations over 1 year. Documentation includes genital examination descriptions and interpretation of findings. Reviewers evaluate the photographic quality and written documentation of examination findings utilizing a numerical rating system. Each case cycle is reviewed by one of four experts in child abuse who received training in a uniform evaluation process. Reviewers follow each case throughout three cycles of documentation, selecting from several interventions that have been customized to address the quality issues noted. The third and final cycle includes summary comments from the reviewer.Results:Forty-one participants completed the program at the time these data were collected. A paired t test analysis of the combined scores of the three measures, such as Image Quality, Quality of Written Documentation, and Accuracy of Exam Interpretation, showed a statistically significant improvement (P < 0.001) between the first and last sets. In addition, each of the individual measures was statistically significant between the first and last case sets with a P value of <0.05 for each.Conclusion:Peer review with interventions customized to address quality issues improved the quality of the assessment and documentation of child sexual abuse evaluations.

Siblings Are Also at Risk for Abuse.

Approximately 9 of every 1000 children in the United States are identified as victims of maltreatment, including neglect, physical abuse, emotional abuse, or sexual abuse.1 However, many cases of maltreatment are not identified,2 which has severe consequences for affected children.3 Although it is important to evaluate any child at risk for abuse, identifying risk can be challenging. In this issue of Pediatrics, Kisely et al4 evaluated whether siblings of children with suspected abuse are themselves at increased risk. These researchers followed a large cohort of sibling pairs in Australia. They found a 60-fold increase in abuse reports for siblings of children who had themselves been reported as abused previously. The risk was even greater when the mother was <20 years of age. The type of abuse (eg, physical, sexual, neglect) was often concordant between sibling pairs.Sibling risk has previously been studied but not on the scale of this new publication. Lindberg et al5 collected data from almost 3000 children who were evaluated for physical abuse. Contacts, including siblings or others in the same environment (including day care) of physically abused children were at significantly increased risk for injury.5 This risk was even higher among twins.Armed with the knowledge of the increased risk to siblings, medical providers and child welfare professionals should advocate for evaluations of these children at high risk. In cases of physical abuse, the evaluation by Lindberg et al5 included head imaging for contacts aged <6 months or those with mental status changes, skeletal surveys for contacts aged <2 years, and physical examinations for all contacts aged <5 years. This evaluation by Lindberg’s team parallels the recommended evaluation for any child when there is concern for physical abuse, although it may be reasonable to perform head imaging on any infant at high risk for abuse, such as siblings.6,7 To conduct a thorough examination, providers should familiarize themselves with injuries that are most specific for abuse, such as facial bruises and frenular injuries.8Siblings of sexual abuse victims should also be evaluated. Although the American Academy of Pediatrics policy statement on sexual abuse does not mention siblings or contacts, the National Children’s Alliance (the accrediting body for children’s advocacy centers) recognizes that siblings and other household contacts of abuse victims are themselves at risk.9,10 Evaluations for possible sexual abuse typically involve a forensic interview (if a child is developmentally capable) and a sexual abuse evaluation performed by a provider with training in pediatric sexual abuse examinations.9,10 Children’s advocacy centers are present throughout the country to assist in these evaluations of both suspected sexual abuse victims and their siblings.10The finding that children are at increased risk for maltreatment if they live with a young mother can help inform prevention efforts. For example, some home visitation programs, such as Nurse-Family Partnership, which works with first-time mothers in poverty, can help target the risks seen with young mothers, including lack of support and lack of education, and may have some benefit to prevent physical abuse.11As pediatricians, we are advocates for children, so our evaluation for suspected child abuse or neglect should include asking about the presence of siblings or other children in that environment. Subsequently, we should follow-up to ensure that any siblings are appropriately evaluated for abuse themselves.

Forensic psychological evaluations of child sexual abuse: Process of disclosure and its chronicity in the Peruvian highlands

ObjectiveTo analyse the relationship between the characteristics of the victim, the aggressor and sexual abuse in children and adolescents with the disclosure process; as well as with the chronicity of the event in the Division of the Institute of Legal Medicine of the Junín region-Perú. Materials and methodsAs a general method of research, the scientific method was applied, carrying out a quantitative study, with a cross-sectional design. All forensic psychological evaluations from January to December of 2017 were analysed, of which only those that fulfilled the selection criteria were selected, leaving a total of 97 cases. ResultsData from 97 psychological examinations of minors who were victims of sexual abuse were obstructed. Of the victims, 89.7% were female, 99% of the aggressors were male, 47% of the cases of sexual abuse occurred within the family home setting and 5% of victims became pregnant. The highest frequency of recurrent events was when the mother was not living at home (aPR: 1.44; 95%CI: 1.34−1.56; P < .001), living outside the city (aPR: 1, 27; 95%CI: 1.11−1.45; P = .001), late disclosure of abuse (aPR: 2.94; 95%CI: 1.79−4.84; P < .001), and among those who unintentionally revealed the event (aPR: 1.37; 95%CI: 1.06−1.78; P = .001); in contrast, extra-family offenders were less frequent among those with multiple events (aPR: .63, 95%CI: .44−.91, P = .014), adjusted for sex and age. ConclusionsThe factors associated with recurrent sexual abuse were the victim's relationship with the mother, place of birth of the victim, disclosure latency, circumstance of the disclosure and type of link between victim and aggressor.

Optimizing Interdisciplinary Care of Pediatric Sexual Assault and Abuse in the Emergency Department: A Quality Improvement Approach

The Ann & Robert H. Lurie Children's Hospital of Chicago identified issues with team communication, consistency of services provided, and continuity of care within the sexual abuse and assault program in the emergency department (ED) which necessitated improvement efforts. The aim of this project was to engage an interdisciplinary team to define and delineate roles and streamline clinical workflows from ED presentation to nonacute follow-up. An interdisciplinary team was convened and utilized quality improvement methodology to complete a current state analysis, develop a future state design, and prioritize interventions for improvement. The project team focused on four interventions: (1) establish a team approach with delineated roles and responsibilities; (2) develop and implement consistent workflows to reduce unwarranted variation in care; (3) expand education on the sexual assault nurse examiner (SANE) program more broadly to the care teams in the ED; and (4) implement clinical decision support (CDS) tools to streamline the continuum of sexual assault services provided. Three of the interventions (all but education) were carried out as a comprehensive care guideline for patients presenting to the ED for evaluation. The ED implemented this care guideline in August 2019. The utilization of quality improvement methodology was effective in ensuring an organized, interdisciplinary team response for the evaluation of pediatric and adolescent sexual abuse and assault in the ED. It enabled strong buy-in from team members and ownership of the process with anticipated improvements in patient care and experiences.

Medical Evaluation of Child and Adolescent Sexual Abuse by Nancy Kellogg, Joyce Adams and Jordan Greenbaum, Evidentia Publishing, Huizen, The Netherlands, 2019. US$250, abridged version US$99. Available: https://www.evidentiapublishing.com/shop-1

Medical Evaluation of Child and Adolescent Sexual Abuse by Nancy Kellogg, Joyce Adams and Jordan Greenbaum, Evidentia Publishing, Huizen, The Netherlands, 2019. US$250, abridged version US$99. Available: https://www.evidentiapublishing.com/shop-1

Creation of a novel educational module to improve the proficiency of sexual assault evidence collection among pediatric emergency providers

Background: Of all sexual assaults in the US, 44% of them are perpetrated against victims less than 18 years of age. The standard adopted by the Ohio Department of Health is for forensic evidence collection to be performed or supervised only by a physician or nurse practitioner (NP) trained and experienced in the evaluation of child sexual abuse. Timing of evidence collection is essential. In a study of 273 children less than 10 years of age, no swabs collected after 9 hours were positive for semen. …

Building an adaptable resident curriculum for acute pediatric sexual abuse evaluations: A qualitative needs assessment

BackgroundResidents are undertrained to perform acute pediatric sexual abuse evaluations. The American Academy of Pediatrics has proposed development of an adaptable child abuse curriculum, though no such curriculum exists. ObjectivesOur goal was to perform a needs assessment for pediatric residents performing acute sexual abuse evaluations in an emergency department setting, thus laying groundwork for an adaptable curriculum. The objective was to explore pediatric resident training, knowledge, confidence, expectations, learning needs, and educational goals. Participants and SettingWe conducted a qualitative exploratory study of pediatric residents, faculty, and program directors at two academic health centers in New York City. MethodsUsing purposive and convenience sampling, we conducted focus groups and semi-structured interviews until saturation of ideas was achieved. Through an iterative process using constructivist grounded theory, themes were organized into a curricular model. ResultsWe conducted 3 resident focus groups (n = 21) and 7 interviews with emergency medicine, pediatric, and child abuse faculty. Themes emerged in three categories: barriers (e.g., knowledge deficits), facilitators (e.g., pre-learning), and educational goals. Despite recognizing the importance and increased availability of subspecialists, participants supported gradual autonomy for pediatric residents in the evaluation of suspected sexual abuse, with a goal of independent competency in history and examination skills, and supervised competency of forensic evidence collection. ConclusionsOur data support a multimodal, blended curriculum for the acute sexual abuse evaluation, including: (1) asynchronous pre-learning; (2) live workshops; (3) reference tools; and (4) modeled clinical experiences. Our proposed curricular model may be utilized by a variety of frontline clinicians.

Factors that prevent, prompt, and delay disclosures in female victims of child sexual abuse

BackgroundSeveral studies conducted in clinical and non-clinical settings have described why and when children disclose sexual abuse. Yet, there is incomplete understanding of how adolescents and young children may differ in factors that delay, prompt and deter disclosure that could inform strategies for clinical practice and prevention. ObjectiveThe aim of this study was to identify factors that prevent, prompt, and delay disclosure among pediatric patients presenting for acute and non-acute medical evaluations of sexual abuse or assault, and to examine any differences in disclosure tendencies among female adolescents and pre-adolescents. Participants and settingA chart review of a consecutive sample of pediatric patients presenting to the emergency department or outpatient clinic identified 601 patients who were diagnosed with sexual abuse and were willing to answer examiner questions about their disclosure. MethodsData collection included attainment of patient narratives which were utilized to gather information about abuse disclosures. Recursive abstraction was applied to categorize patient statements for further analysis, while Pearson chi square and logistic regression were utilized for quantitative data. ResultsYoung age (<11 years) at abuse onset was the strongest predictor of, and fear of consequences to self was the most common reason for, disclosure delay in both adolescent and pre-adolescent females. Severity of abuse, adult perpetrator, and self-blame predicted delays only in pre-adolescent females. ConclusionsSocial and moral development during middle childhood likely has a strong influence on disclosure tendency. Strategies to promote disclosure should consider reducing fear of consequences associated with the adult-child paradigm.

Role of Child Monitoring Centers in the evaluation of child sexual abuse

РЕЗЮМЕ Роль центров Mониторинга в оценке сексуального насилия против детей Acлы ЯЙЯК Бурсский технический университет, Турция Жестокое обращение с ребенком со стороны взрослого человека с целью его сексуального и психосексуального удовлетворения называется сексуальным насилием над ребенком. Известно, что дети из-за их основных характеристик являются группой, наиболее нуждающейся в защите как физически, так и психологически. В этой статье указанно, что деятельность Центров детского мониторинга, действующих в нашей стране с 2010 года, является основным центром оценки процесса сексуальное эксплуатации над детьми. Центры детского мониторинга - это специализированные центры для получения информации от детей, подозреваемых в сексуальной эксплуатации, посещения их семей и подготовки отчетов о других мероприятиях. В 28 различных регионах Турции, функционируют 31 таких центров. В этих центрах регулярно работают психологи, социальные работники, эксперты по развитию ребенка, врачи, медсестры и детские психологи. Здесь, проводятся судебномедицинские встречи, семейные встречи, судебно-медицинские экспертизы и психиатрические обследования. Ключевые слова: Ребенок, сексуальное эксплуатация, центр детского мониторинга, насилие, эксперт

Human Papilloma Virus Vaccination After Pediatric Sexual Abuse Evaluations in the Outpatient Child Sexual Abuse Subspecialty Clinic: A Quality Improvement Project.

The nonavalent human papilloma virus (HPV) vaccination prophylactically contributes to the prevention of nine types of HPV-associated oral and genital cancers. HPV vaccination rates remain lower than the national Healthy People 2020 goal of 80%. Victims of pediatric sexual abuse are at a higher risk for acquiring and developing HPV-related outcomes. Current research supports vaccination after sexual abuse as soon as eligible and suggests utilizing multiple types of medical encounters to increase vaccination rates.An institutional-review-board-approved quality improvement project was developed to determine the impact of promoting and providing HPV vaccination during the medical encounter after pediatric sexual abuse in a child protection team (CPT) clinic. Twenty percent of the 111 total clinic patients evaluated in the preintervention period and 21% of the 99 patients evaluated in the postintervention period were HPV vaccine eligible, illustrating a significant opportunity for impact. During the intervention period, 62% of patients who were vaccine eligible and presented for their CPT clinic visit received HPV vaccine. Barriers to vaccination in the outpatient CPT clinic setting included high appointment no-show rates, high social and medical visit complexity, and absence of an appropriate consenting caretaker. Implications for forensic nursing practice are discussed.

A Novel Scale to Communicate Perceived Likelihood of Child Sexual Abuse.

Child abuse pediatricians (CAPs) are often asked to determine the likelihood that a particular child has been sexually abused. These determinations affect medical and legal interventions, and are important for multisite research. No widely accepted scale is available to communicate perceived sexual abuse likelihood. In this study, we measure intra- and inter-rater reliability of a 5-point scale to communicate child sexual abuse likelihood. We developed a 5-point scale of perceived likelihood of child sexual abuse with example cases and medical-legal language for each risk category. We then surveyed CAPs who regularly perform sexual abuse evaluations using the abstracted facts of 15 actual cases with concern for sexual abuse. A subset of participants rated the same vignettes again, 1 month later. Of 512 invited participants, 240 (46.7%) responded, with 145 (28.3%) indicating that they regularly perform sexual abuse evaluations, 116 initially completing all 15 vignettes, and 36 completing repeat ratings at least 1 month later. The scale showed consistent stepwise increase in mean perceived likelihood of abuse and intention to report for each increase in scale rating. Inter-rater agreement was substantial (Fleiss' weighted kappa 0.64) and test-retest reliability among 36 participants was almost perfect (Cohen's kappa=0.81). We introduce a scale of perceived sexual abuse likelihood that appears to reflect CAPs' perceptions and intention to report. This scale may be a reasonable metric for use in multicenter studies. CAPs demonstrated substantial inter- and intrarater reliability when evaluating sexual abuse likelihood in case vignettes. While this scale may improve communication of sexual abuse likelihood among experts, its examples should not be used as a legal standard or a clinical criterion for sexual abuse diagnosis.

Evaluation of Sexual, Physical, and Emotional Abuse in Women Diagnosed with Temporomandibular Disorders: A Case-Control Study.

To compare the prevalence of physical and sexual abuse in women with temporomandibular disorders (TMD) vs women without TMD. Forty women (age range 16-45 years) with idiopathic TMD were selected from the Occlusion Clinic at the Pontifical Catholic University of Rio Grande do Sul Faculty of Dentistry and were compared to 40 TMD-free women within the same age range. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axes I and II and the Sexual Abuse History Questionnaire (S/PAHQ) were used to collect data. Women with TMD diagnosed with myofascial pain had higher levels of chronic pain grade, disability points, chronic pain intensity, depression, and nonspecific physical symptoms with and without pain (ie, somatization). Women with TMD were significantly less educated, had lower family income, and were older than women without TMD. They also had significantly older partners, but there were no differences in the partners' occupation or education levels. Regarding emotional abuse, women with TMD reported significantly more insults and diminishing/humiliation in front of other people than the controls. The prevalence of physical and sexual abuse was higher in the TMD group, but this difference was nonsignificant. Emotional abuse, more than physical and sexual abuse, is an important risk factor for the development of TMD, even when controlling for education level, income, age, ethnicity, marital status, and occupation. Emotional abuse, as well as physical and sexual violence, should be assessed routinely in women suffering from chronic TMD.

Recognizing, diagnosing, and preventing child maltreatment: an update for pediatric clinicians.

Despite an increasing understanding of the impact of emotional trauma and physical abuse on children, clinicians and hospitals still sometimes miss the diagnosis of abuse. The literature in 2017 focused on creating standardized approaches to recognition and diagnosis of physical abuse and occult injury, including using the electronic medical record to provide triggers for consultation of the hospital Child Protection Program. The American College of Radiology updated their standardized approach to the evaluation of physical abuse in the child, and other authors gave us screening tools for commercial exploitation, as well as guidance about how to recognize risks for emotional abuse in families. The opioid epidemic and legalization of marijuana are both impacting children, and providers are searching for ways to provide support for parents with substance use disorders whilst considering the safety of children.This article reviews relevant publications during the past year about issues of child maltreatment. It is intended to guide those providers in primary care or other medical disciplines who care for children and families. Child maltreatment cases are still not always diagnosed, either because of provider bias (leading to under evaluation), or because clinicians lack experience or understanding of proper evaluation approaches. There are many new tools to assist in recognition of abuse, including screening instruments and flags that can be used in the electronic medical record to trigger a consult with the Child Protection Program. The evaluation and diagnosis of sexual abuse continues to evolve, with the literature providing advice about what is or is not normal on physical exam, as well as advice for providers who work with adolescent sexual assault victims. The debate about the validity of abusive head trauma (AHT) diagnoses continues, with sweden being the most recent center of controversy. With the opioid epidemic having such a significant effect on families and children, clinicians are struggling to support parents with substance use disorder while protecting children from the impact of their parents' disease. The past year in child abuse literature has yielded increased clarity in screening and diagnostic recommendations across the fields of physical abuse, AHT, sexual abuse, and commercial sexual exploitation of children (CSEC). The body of literature surrounding emotional abuse and neglect continues to grow, especially in light of the burgeoning opioid epidemic. Critically, the year's research reflects an evolving understanding of effective prevention and intervention initiatives to address child maltreatment.

Are one-stop centres an appropriate model to deliver services to sexually abused children in urban Malawi?

BackgroundThe Republic of Malawi is creating a country-wide system of 28 One-Stop Centres (known as ‘Chikwanekwanes’ - ‘everything under one roof’) to provide medical, legal and psychosocial services for survivors of child maltreatment and adult intimate partner violence. No formal evaluation of the utility of such services has ever been undertaken. This study focused on the experiences of the families served at the country’s first Chikwanekwane in the large, urban city of Blantyre.MethodsOne hundred seven families were surveyed in their home three months after their initial evaluation for sexual abuse at the Blantyre One Stop Centre, and 25 families received a longer interview. The survey was designed to inquire what types of initial evaluation and follow-up services the children received from the medical, legal and social welfare services.ResultsAll 107 received an initial medical exam and HIV testing, and 83% received a follow-up HIV test by 3 months; 80.2% were seen by a social welfare worker on the initial visit, and 29% had a home visit by 3 months; 84% were seen by a therapist at the initial visit, and 12% returned for further treatment; 95.3% had an initial police report and 27.1% ended in a criminal conviction for child sexual abuse. Most of the families were satisfied with the service they received, but a quarter of the families were not satisfied with the law enforcement response, and 2% were not happy with the medical assessment. Conclusions: Although a perception of corruption or negligence by police may discourage use of service, we believe that the One-Stop model is an appropriate means to deliver high quality care to survivors of abuse in Malawi.

Child Sexual Abuse: Management and Prevention, and Protection of Children from Sexual Offences (POCSO) Act.

Child Sexual Abuse is an alarming reality and is being increasingly reportedin India as well as globally. Pediatricians and allied medical professionals are often the first point of contact with abused children and their families. They have a key role in detecting Child Sexual Abuse, providing immediate and long-term care and support to the victims and their families. India has adopted the Protection of Children from Sexual Offences Act (POCSO) in 2012. It is a comprehensive law on sexual abuse, which expands the scope and range of forms of sexual offences, makes reporting of abuse mandatory and defines guidelines for the examination of victims. Pediatricians and health care professionals need to acquire necessary expertise for clinical evaluation of child sexual abuse, and its prevention, management and reporting.

Anogenital warts in pediatric population.

The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

Cinsel istismarda istismarcı-kurban ikilemi ve adli değerlendirme: Bir olgu sunumu

Cinsel istismarda istismarcı-kurban ikilemi ve adli değerlendirme: Bir olgu sunumu