Jones Jerry G, Worthington Toss
Department of Pediatrics, University of Arkansas College of Medicine, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
J Pediatr Adolesc Gynecol. 2008 Aug;21(4):207-11. doi: 10.1016/j.jpag.2007.10.010.
The injuries of sexually abused and assaulted girls seldom require surgical repair, and genital and anal injuries due to other causes appear to require repair uncommonly. We sought to determine the causes of genital and anorectal injuries requiring surgical repair in relation to such variables as injury sites and severity.
Retrospective study
A large tertiary care children's hospital
Forty-four girls less than 21 years of age who required surgical repair of genital injuries between June 1986 and April 2007 were identified.
Information collected included the victims' ages, trauma mechanisms, and sites and severity of injuries.
Injuries requiring repair of the genital and anal areas were uncommon in the 20 year period of this study. Although most injuries were due to straddle and impalement mechanisms, sexual abuse or assault was identified in 25% of the girls. The remaining 11% were victims of motor vehicle accidents. Straddle/impalement injuries involved only the external genitalia, vestibule, perineum, or posterior fourchette of 21 of the 28 girls (76%) with those injuries. The injuries of 9 of the 11 sexually abused/assaulted girls (82%) also involved the hymen, vagina, anus, or rectum. Injuries due to sexual abuse/assault and motor vehicle accidents (MVA) had average severity scores of 2.1 and 2.2, respectively, while straddle injuries had an average severity score of 1.4. (Exact Pearson chi-square P < 0.003.) The ages of the girls were unrelated to the severity of their injuries.
Although straddle/impalement was the most commonly found mechanism of genital and anorectal injury requiring surgical repair, sexual abuse or assault was identified in 25% of the girls. Sexual abuse and assault should always be considered and assessed appropriately when such injuries are found. Consultation of a social worker or child abuse specialist may be appropriate, especially when injuries clearly not due to an MVA involve the vagina or anorectum. A suspicion of sexual abuse or assault should be reported to the legally mandated state agency in accordance with the laws of state.
遭受性虐待和性侵犯的女孩所受伤害很少需要手术修复,而其他原因导致的生殖器和肛门损伤似乎也很少需要修复。我们试图确定需要手术修复的生殖器和肛门损伤的原因与损伤部位和严重程度等变量之间的关系。
回顾性研究
一家大型三级儿童专科医院
确定了1986年6月至2007年4月期间44名年龄小于21岁、需要对生殖器损伤进行手术修复的女孩。
收集的信息包括受害者的年龄、创伤机制以及损伤的部位和严重程度。
在本研究的20年期间,需要修复生殖器和肛门区域的损伤并不常见。尽管大多数损伤是由骑跨伤和穿刺伤机制导致的,但25%的女孩被认定遭受了性虐待或性侵犯。其余11%是机动车事故的受害者。骑跨/穿刺伤仅累及28名有此类损伤女孩中的21名(76%)的外生殖器、前庭、会阴或后阴唇系带。11名遭受性虐待/性侵犯女孩中的9名(82%)的损伤还累及处女膜、阴道、肛门或直肠。性虐待/性侵犯和机动车事故(MVA)导致的损伤平均严重程度评分分别为2.1和2.2,而骑跨伤的平均严重程度评分为1.4。(精确Pearson卡方检验P<0.003。)女孩的年龄与损伤严重程度无关。
尽管骑跨/穿刺伤是需要手术修复的生殖器和肛门损伤最常见的机制,但25%的女孩被认定遭受了性虐待或性侵犯。当发现此类损伤时,应始终考虑并适当评估性虐待和性侵犯。咨询社会工作者或儿童虐待专家可能是合适的,尤其是当明显不是由机动车事故导致的损伤累及阴道或直肠时。应根据州法律向法定的州机构报告对性虐待或性侵犯的怀疑。