Sexual Assault Evidence Research Articles

Outcome of CPS referral for sexual abuse in children with condylomata acuminata

The incidence of condylomata acuminata in children has increased dramatically.1 Genital warts are associated with, but not specific for, sexual abuse and therefore present a dilemma for the physician. Clinicians frequently report presumed noncongenital cases to Child Protective Services (CPS) for further investigation. To determine the outcome of these cases, charts of 88 children with condylomata acuminata were reviewed. Sixty-four percent (56/88) of the children were referred to CPS for suspicion of child abuse or neglect; 26 of these 56 referrals were on the basis of genital warts alone. Sexual abuse was considered substantiated by CPS in 19% (5/26) of the children referred for warts alone. No consistent criteria seemed to lead to CPS substantiation of abuse. In the absence of other evidence of sexual abuse or neglect found on careful social, psychological, and medical evaluation, CPS referral is unlikely to be further able to differentiate abusive from nonabusive wart acquisition.

A Theoretical Analysis of Nonverbal Communication and Victim Selection for Sexual Assault

Research has suggested that (a) victims of sexual assault evidence significant passive and submissive personality structures, (b) such submissive affective traits are characteristic of victims prior to their assaults, (c) sexual assault offenders look for visual cues of vulnerability when selecting a victim, (d) females high and low in submissiveness exhibit different clothing and body language behaviors, and (e) males form differing perceptions of females who are high versus low in submissive personality traits. Propositions associated with theories of self enhancement, communication, perception, and impression formation were united to form a more comprehensive theoretical perspective upon nonverbal communication. This perspective, when analyzed against the results of the abovementioned sexual assault research, provided a logical explanation of the victim selection process wherein nonverbal appearance cues (both body adornment and body language) play a paramount role.

Anogenital Warts in Children

Seventy-three children with anogenital warts were examined for sexual abuse during a 2-year period. Our data suggest that nonsexual transmission is common, particularly in children under 3 years of age. Approximately 25% of these children were younger than age 1 year, and another 50% were between the ages of 1 and 3 years. No evidence of sexual abuse was detected in 66 children.

Anogenital warts in children. Clinical and virologic evaluation for sexual abuse

Seventy-three children with anogenital warts were examined for sexual abuse during a 2-year period. Our data suggest that nonsexual transmission is common, particularly in children under 3 years of age. Approximately 25% of these children were younger than age 1 year, and another 50% were between the ages of 1 and 3 years. No evidence of sexual abuse was detected in 66 children.

Sexualized Doll Play among Young Children: Implications for the Use of Anatomical Dolls in Sexual Abuse Evaluations

The use of anatomical dolls in sexual abuse evaluations remains controversial because of concerns that the dolls induce normal, nonabused children to act out in sexual ways that are likely to be misinterpreted as evidence of sexual abuse. This study examines the incidence of explicit sexual doll play in a large, demographically diverse sample of 2- to 5-year-olds. The 6% incidence of demonstrations of apparent sexual intercourse found in this sample compared favorably with the rate of less than 2% across prior studies of anatomical doll play among presumably nonabused children. However, higher rates of explicit sexual play were associated with being older, poor, black, and somewhat with being male, with over 20% of some subgroups of children displaying such behavior. These results are interpreted as evidence that anatomical dolls are not overly suggestive to young, sexually naive children, but are useful in assessing sexual knowledge and exposure to sexual intercourse.

Evaluation and Diagnosis of Sexual Abuse of Little Girls

In recent years, increasing evidence of sexual abuse of children has created a new field of medicolegal inquiry requiring a new expertise. In psychoanalysis, one of our specific tasks is to address the issues of diagnosis and of the pathogenic effect of sexual abuse as it is ultimately reflected in the intrapsychic dynamics of the developing ego. My hypothesis is that it may be possible to determine early in the treatment whether sexual abuse has taken place. The case of a two-and-three-quarters-year-old girl, suspected of having been molested by her father, is presented in depth. The evolution of material confirming the diagnosis is presented by way of documenting evidence of sexual abuse. Issues elaborating the difficulty in making the diagnosis are also explored. Finally, a synthesis of diagnostic considerations useful for arriving at a diagnosis of sexual abuse is presented in the hope that these factors will serve as diagnostic guidelines.

The sexually abused battered child.

A total of 130 children were identified in whom both evidence of sexual abuse and non-accidental, non-genital physical injuries (bruises, fractures, scratches, burns and scalds, including failure to thrive) were found. There were 77 girls and 53 boys with mean ages 5.7 and 6.8 years respectively and the peak age between the second and seventh birthdays; this reflects previous reports indicating that physical and sexual abuse predominantly involves young children. Patterns of injury that suggested sexually motivated assault included bruises, scratches, and burns around the lower trunk and genitalia, thighs, buttocks, and upper legs including knees. Pinch and grip marks were found where the child was held. The sexual abuse often involved attempted or achieved penetration of mouth, vagina, or anus, and physical signs were seen relatively more often than in sexually abused children as a whole. Four children died and sexual aggression and child death in the domestic setting may be linked. One in six of 769 physically abused children (16.9%) and one in seven of 949 sexually abused children (13.6%) have suffered both forms of abuse.

Pediatric Bowenoid Papulosis: Risks and Management

A 34-month-old Haitian girl had a six-month history of asymptomatic vulvar papules. Histologic features and DNA probe studies were diagnostic of bowenoid papulosis. Resolution of the lesions was enhanced by cryotherapy. This is the third reported patient with prepubertal bowenoid papulosis. Sexual abuse should be suspected, but not assumed, in pediatric patients with this condition. Our patient had no evidence of sexual abuse. Bowenoid papulosis has been associated with cervical intraepithelial neoplasia and rarely with squamous cell carcinoma. Close gynecologic follow-up is recommended.

Dermatologic Conditions Misdiagnosed as Evidence of Child Abuse-Reply

In Reply.— Lichen sclerosus et atrophicus is one of a number of diagnoses that can be mistaken for evidence of sexual abuse. We appreciate the comments of Drs Anders, Smith, and Koblenzer in providing the opportunity to discuss this condition. As the authors point out, misdiagnosis in child abuse may have even more serious ramifications than in many other areas of pediatrics. It is paramount that professionals who specialize in child abuse be familiar with differential diagnoses that include other conditions that might present as apparent physical or sexual abuse. Indeed, one must be familiar with endocrinologic and metabolic disorders, inflammatory bowel diseases, and infectious diseases as well as the field of dermatology. We, too, have seen several patients with lichen sclerosus et atrophicus who have been mistakenly diagnosed and referred to us because it was believed that the children were being abused sexually. Recently, we evaluated a 6-year-old girl

Bacterial vaginosis in virginal and sexually active adolescent females: Evidence against exclusive sexual transmission

Sixty-eight sexually active and 52 virginal asymptomatic adolescent girls were evaluated for bacterial vaginosis and various laboratory indicators of bacterial vaginosis in a 3-month observational noninterventive study. Sixteen of 120 (13%) subjects had bacterial vaginosis during the study. There was no significant difference in the prevalence of bacterial vaginosis or in the prevalence of isolation of Gardnerella vaginalis between the sexually active and virginal groups. Only a few cases of bacterial vaginosis (one of eight), wet mount clue cells (four of 11), sniff tests (two of eight), and abnormal vaginal fluid succinate/lactate ratios (none of 6) persisted for 3 months in the absence of therapy. These results are discussed in light of several recent reports that suggest using the isolation of G. vaginalis or the diagnosis of bacterial vaginosis as evidence of sexual abuse in children. It is concluded that bacterial vaginosis should not be considered an exclusively sexually transmitted disease. The presence of the condition is neither proof of sexual activity nor warrants male sexual partner therapy. In addition, therapy seems unwarranted for the incidental finding of bacterial vaginosis in the patient without symptoms.

Condylomata Acuminata in the Evaluation of Child Sexual Abuse

To the Editor.— I would like to comment on the recent article by Rock et al on condylomata acuminata in children, 1 and the subsequent editorial by Bender, 2 speaking from the point of view of a pediatrician involved in the study and evaluation of child sexual abuse and sexually transmitted diseases (STDs) in children. Rock et al document evidence of sexual abuse in three of their five cases, approximately the percentage of good documentation that has been obtained in other pediatric cases. 3 Another case (No. 3) appears most likely to have been congenitally transmitted, since the patient was less than one year of age. Beyond one year of age, however, I believe that condylomata acuminata must be considered nearly always as a sexually transmitted phenomenon, unless the presentation is very atypical. Examples of atypical genital lesions would be common wart growths that occasionally appear on the buttocks or

Characterization of a Monoclonal Antibody to a Conserved Epitope on Human Seminal Vesicle-Specific Peptides: A Novel Probe/Marker System for Semen Identification1

A novel sperm-coating antigen from the human seminal vesicles was discovered. We identified a monoclonal antibody MHS-5, recognizing an epitope with characteristics of a forensic semen marker: conservation in all vasectomized or normal semen samples tested (421); absence in all human tissues or biological fluids other than semen; and immunolocalization on the surface of ejaculated sperm. Western blots of ejaculates allowed to liquefy for 5 min demonstrated the MHS-5 epitope to be located on peptides of a wide range of molecular masses from 69 to 8 kDa. After 15 h of semen liquefaction, immunoreaction peptides of higher molecular mass were undetectable in semen, while peptides of lower molecular mass from 8 to 21 kDa retained antigenicity. Three peptides of 10, 11.9, and 13.7 kDa were the most immunoreactive species in semen liquified for 15 h. Using the MHS-5 monoclonal, an enzyme-linked immunosorbent assay (ELISA) was developed sensitive to 1 ng of seminal protein. This assay showed that the MHS-5 antigen was undetectable in semen of common domestic animals and monkeys but was present in chimpanzee, gorilla, and orangutan semen. ELISA of homogenates from human organs and reproductive tissues demonstrated the antigen only in samples of seminal vesicles. Epididymal sperm obtained at vasovasostomy lacked the MHS-5 epitope, a fact that, together with immunolocalization on ejaculated sperm, demonstrated that the MHS-5 antigen functions as a "sperm-coating antigen." The MHS-5 monoclonal detected semen in sexual-assault evidence obtained six months previously and in mixtures of semen with vaginal or cervical fluid. Assay systems employing the MHS-5 monoclonal may be useful for identification of semen in sexual-assault casework. The MHS-5 epitope resides on novel seminal vesicle-specific peptides whose functions, aside from sperm coating, are uncharacterized.

Controversies Surrounding the Rape Kit Exam in the 1980s: Issues and Alternatives

Based on a study of 130 organizations in Florida that deal with survivors of sexual assault, controversies that surround the “rape kit exam”—medical examination for purposes of evidence collection—are identified and discussed. After an overview of the rape kit examination and typical sites and personnel for performing it, the article focuses on issues relative to the exam including the following: (1) evidence that should be collected and why; (2) hospitals as friends or foes; and (3) who can and/or should perform the exam and why. The article concludes with recommendations for improving services to survivors of sexual assault relative to the rape kit exam. Among these are suggestions for standardizing the rape kit and protocol across legal jurisdictions, ceasing routine plucking of victims' public hairs, removal of the site for the exams from hospital emergency departments or creation of separate sections of the department for the sole use of rape victims, simplification and reduction of hospital admitting and record-keeping procedures, centralization of the exam for given geographic areas, specialization of staff who perform the exam, and utilization of trained nurse examiners in place of physicians for conducting the exam.

Presumptive Screening Test for Seminal Acid Phosphatase Using Sodium Thymolphthalein Monophosphate

The use of sodium thymolphthalein monophosphate for presumptive seminal acid phosphatase testing is discussed. Recent evidence reveals that the dye (o-dianisidine) used in conjunction with alpha-naphthyl phosphate for seminal acid phosphatase testing is a carcinogenic hazard. Numerous tests for seminal acid phosphatase were conducted with swabs from sexual assault kits to compare both substrates. Results of tests using sodium thymolphthalein or alpha-naphthyl phosphate correlated exactly. Sodium thymolphthalein is an effective alternative for preliminary seminal fluid analysis because of its high degree of selectivity and stability, and because it eliminates the potential health hazard.

Genetic Markers in Semen. III: Alteration of Phosphoglucomutase Isozyme Patterns in Semen Contaminated with Saliva

Contamination of semen by saliva can result in the alteration of seminal phosphoglucomutase (PGM1) isozyme patterns. The alteration is characterized by the gradual loss of the a and b isozyme bands the concomitant generation of anodal bands; eventually, all PGM activity is lost. The conversion of PGM isozyme patterns has been shown to be due to a dialyzable heat-labile factor in saliva and a nondialyzable heat-labile factor in semen. The implications of this conversion for PGM typing in sexual assault evidence are discussed.

Techniques for Extraction of Spermatozoa from Stained Clothing: A Critical Review

Abstract The location of spermatozoa on the clothing of rape victims is of primary concern to the criminalist seeking evidence of sexual assault. The identification of acid phosphatase, spermine, and choline is of secondary importance relative to finding intact spermatozoa. A number of techniques for extraction of spermatozoa are available. In this study these techniques have been compared in an effort to determine their relative merits.