Elvik S L, Berkowitz C D, Nicholas E, Lipman J L, Inkelis S H
University of California, Los Angeles, Harbor-UCLA Medical Center, Torrance.
Child Abuse Negl. 1990;14(4):497-502. doi: 10.1016/0145-2134(90)90098-e.
Evaluation of developmentally disabled persons for physical signs of sexual abuse presents many challenges to the practitioner. This group is especially vulnerable to all types of abuse. A group of 35 mentally retarded females from a residential treatment facility was examined by the child abuse medical team at Harbor/UCLA Medical Center after one inpatient was found to be pregnant. Patients ranged in age from 13 to 55 years (median, 26 years; mean, 31.3 +/- 13.6 years). All of the women had some degree of disability, with 24 (69%) being categorized as profoundly retarded. No patient was able to provide a history. There were 13 (37%) patients who had genital findings we believe are consistent with prior vaginal penetration. Dilemmas which arose during evaluation included the significance of healed genital lesions in this population and the implications of the findings for the residential facility. While developmentally disabled persons need an advocate in the medical and legal systems, these patients can overwhelm the practitioner. Whenever possible, a team approach is recommended to decrease the work load and frustration and provide collegial support and affirmation of findings.
对发育障碍者进行性虐待身体迹象的评估给从业者带来了诸多挑战。这一群体特别容易遭受各类虐待。在港湾/加州大学洛杉矶分校医学中心，一组来自寄宿治疗机构的35名智力发育迟缓女性在一名住院患者被发现怀孕后接受了儿童虐待医疗团队的检查。患者年龄在13岁至55岁之间（中位数为26岁；平均年龄为31.3±13.6岁）。所有女性都有一定程度的残疾，其中24人（69%）被归类为重度智力发育迟缓。没有患者能够提供病史。有13名（37%）患者的生殖器检查结果我们认为与既往阴道贯通伤相符。评估过程中出现的难题包括该群体中愈合的生殖器损伤的意义以及这些发现对寄宿机构的影响。虽然发育障碍者在医疗和法律系统中需要一名倡导者，但这些患者可能会让从业者应接不暇。只要有可能，建议采用团队协作方式以减轻工作量和挫败感，并提供同事间的支持以及对检查结果的确认。
