Lichen sclerosus Mistaken for Sexual Abuse--Prevention of Victimization.

This case report describes the forensic examination of 7 girls aged between 4-11 years with suspected sexual abuse. The children had been reported by local pediatricians, hospital physicians or authorities such as the youth welfare office and police due to mucosal changes in the anogenital area. All children presented with a clearly delimited, porcelain-like white discoloration of the skin in the anal and genital area with atrophic conversion to parchment-like skin. The markedly vulnerable skin exhibited very different manifestations of hemorrhagic dermal and mucosal defects in the area of the labia, the clitoris, the perineum and the perianal region. The hymen was intact in all cases. The skin changes are typical of lichen sclerosus et atrophicus, which is more common in prepubertal girls and post-menopausal women. Due to the chronic course, affected persons can develop sclerotic plaques, synechia of the labia minora and stenoses of the urinary tract and of the vaginal orifice, so that an early diagnosis is crucial. This condition is not infrequently taken by attending physicians as a sign of suspected sexual abuse, as the relevant findings are not recognized correctly. Furthermore, there are far-reaching consequences for the affected families, who are often faced with criminal prosecution, a breakdown of social familial structures and an enormous psychological burden for the affected persons. To avoid victimization there is an urgent need for more information about the differential diagnoses of sexual abuse and a call for interdisciplinary co-operation when evaluating abnormal anogenital findings in children.