Genital and anal conditions confused with child sexual abuse trauma

A variety of anal or genital diseases in children may have an appearance that suggests the child was sexually abused. It is essential that a careful physical examination be performed and the possibility of causes other than child abuse be considered. There are serious consequences for the child, the family and the suspected person when a diagnosis of child abuse is made. Sexual abuse may be confused with congenital defects, infections, injuries and skin disorders. Seven cases are presented in which the child was referred for evaluation of possible child abuse, however the observed condition was due to other causes. A review of the literature on conditions mistaken for child abuse injuries is presented. Various skin disorders and symptoms such as erythema (redness) and excoriations (abrasions) may be caused by conditions other than child abuse. Congenital abnormalities of the genitals may be mistaken for genital or anal scars; it is advised to be cautious in diagnosing midline lesions of the genitals or anus, as these may actually be congenital malformations. Accidental injury may be mistaken for child abuse. In African and Middle Eastern children where female circumcision is performed, there may be unusual genital scarring. When genital infections are present it is necessary to obtain a detailed history in order to distinguish innocent actions from sexual abuse. Urethral conditions that involve bleeding may have causes other than child abuse, such as urethral prolapse, hemangioma, and polyps. It is important for physicians to be aware of other potential diagnoses when these abnormalities are discovered. (Consumer Summary produced by Reliance Medical Information, Inc.)