Kotik Andrei, Zaitsev Konstantin, Shperber Aino, Hiss Jehuda
The National Center of Forensic Medicine, Assaf Harofeh Medical Center.
Harefuah. 2011 Dec;150(12):895-8, 936.
Sexual abuse includes obscenity, rape and sodomy. Forensic medical examinations routinely include the genital area, anus and the body of the victims for signs of recent or old injury.
To evaluate the incidence of physical evidence in forensic sexual abuse cases and to compare the Israeli findings to data from other countries, including the USA.
The study was conducted during one calendar year in Israel and included 95 children from infancy to 16 years of age, of whom 83% were females. Examination results were defined by the presence of physical injury or its absence. These findings were classified by their location in the anogenital area or other body areas and findings in the anogenital area were further classified by their likelihood to have been caused by a sexual assault. The results of the examination were related to parameters such as age and sex of the participants, length of time since the last assault, and the degree of proximity between the suspected assailant and the victim.
Evidence of physical abuse was found in 41 patients, in 37 (39%) of these cases physical abuse was detected in the anogenital area. In all these cases of anogenital abuse, 11 (12%) showed clear evidence of sexual assault and five of them had recent signs of injury; 80% of the recent injuries in the anogenital area were identified in patients within the first 24 hours after the assault.
The prevalence of clear evidence of sexual assault in the U.S. ranges from 3-23%, in Italy 9.5%, in Thailand 32% and in Denmark 40%. In Israel, as elsewhere in the world, few cases of sexual assault in children will have clear evidence of a sexual nature. A lack of physical evidence does not rule out sexual assault, therefore, finding physical evidence during an examination is the exception rather than rule. Questioning the victim and investigating the circumstances of the case are crucial elements in all instances of presumed sexual assault on children.
性虐待包括猥亵、强奸和鸡奸。法医检查通常包括对受害者的生殖器区域、肛门和身体进行检查，以寻找近期或陈旧性损伤的迹象。
评估法医性虐待案件中物证的发生率，并将以色列的调查结果与包括美国在内的其他国家的数据进行比较。
该研究在以色列进行了一整个日历年度，纳入了95名年龄从婴儿期到16岁的儿童，其中83%为女性。检查结果根据是否存在身体损伤来界定。这些发现按其在肛门生殖器区域或身体其他部位的位置进行分类，肛门生殖器区域的发现进一步按其可能由性侵犯导致的可能性进行分类。检查结果与参与者的年龄和性别、上次袭击后的时间长度以及疑似袭击者与受害者之间的亲近程度等参数相关。
在41名患者中发现了身体虐待的证据，其中37例（39%）在肛门生殖器区域检测到身体虐待。在所有这些肛门生殖器虐待病例中，11例（12%）显示出明确的性侵犯证据，其中5例有近期损伤迹象；肛门生殖器区域近期损伤的80%在袭击后24小时内被发现。
在美国，性侵犯明确证据的发生率在3%至23%之间，在意大利为9.5%，在泰国为32%，在丹麦为40%。在以色列，和世界其他地方一样，很少有儿童性侵犯案件会有明确的性特征证据。缺乏物证并不排除性侵犯，因此，在检查中发现物证是例外而非常规。询问受害者和调查案件情况是所有疑似儿童性侵犯案件的关键要素。
