Department of Social Pediatrics, Child Abuse and Neglect Team, Emma Children's Hospital, Academic Medical Center Amsterdam, AMC, Meibergdreef 9 (h7-288), 1105 AZ, Amsterdam, the Netherlands.
Department of Medical Humanities, VU University Medical Center, Amsterdam, the Netherlands.
Eur J Pediatr. 2017 Oct;176(10):1365-1374. doi: 10.1007/s00431-017-2996-7. Epub 2017 Aug 26.
So far, a recognizable pattern of clinical symptoms for child sexual abuse (CSA), especially in young male children, is lacking. To improve early recognition of CSA, we reviewed physical complaints, physical examination, and tests on sexually transmitted infections (STIs) in confirmed victims (predominantly preschool boys) of CSA from the Amsterdam sexual abuse case (ASAC). We retrospectively analyzed the outcomes of the primary assessment using mixed methods: descriptive analysis of physical complaints, physical exams, and STI tests from medical files and a qualitative analysis on expert's interpretations of physical complaints and children's behavior during physical examination. We included 54 confirmed CSA victims, median age 3.2 (0-6) years, 43 boys (80%), and 11 girls (20%). Physical complaints were reported in 50%, of which gastrointestinal and anogenital complaints were most common. None of the children showed CSA-specific genital signs at physical examination. Most prominent finding during physical examination was a deviant behavioral response (anxiety, withdrawal, too outgoing) in 15 children (28%), especially in children who experienced anal/vaginal penetration. Testing for STIs was negative.
Physical complaints and physical signs at examinations were non-specific for CSA. Deviant behavioral reactions during physical examination were the most prominent finding. Precise observation of a child's behavior during physical examination is needed. What is known • Child sexual abuse (CSA) affects many children on both the short and the long term but remains unrecognized in most cases. • So far, there is a lack of studies on symptom patterns of CSA in male, preschool children. What is new • None of the children showed CSA-specific findings at physical and anogenital examination; STIs were not found in the confirmed victims of CSA. • The most prominent finding was the deviant behavioral response of the children examined, especially in children who experienced anal/vaginal penetration; therefore, precise observation of a child's behavior during physical examination is a crucial part of the evaluation of suspected CSA.
到目前为止，儿童性虐待（CSA）的临床症状模式，特别是在年幼的男童中，还没有被认识到。为了提高对 CSA 的早期识别，我们回顾了阿姆斯特丹性虐待案例（ASAC）中确诊的 CSA 受害者（主要是学龄前男孩）的身体投诉、体检和性传播感染（STI）检测。我们使用混合方法对初级评估的结果进行了回顾性分析：从医疗档案中对身体投诉、体检和 STI 检测进行描述性分析，以及对专家对身体投诉和儿童体检期间行为的解释进行定性分析。我们纳入了 54 名确诊的 CSA 受害者，中位年龄为 3.2（0-6）岁，其中 43 名男孩（80%）和 11 名女孩（20%）。报告了 50%的身体投诉，其中胃肠道和肛门生殖器投诉最为常见。在体检中，没有发现 CSA 特有的生殖器迹象。在体检中最突出的发现是 15 名儿童（28%）出现行为异常反应（焦虑、退缩、过于外向），尤其是经历过肛门/阴道穿透的儿童。性传播感染检测呈阴性。
体检时的身体投诉和体征对 CSA 不具有特异性。体检时的行为异常反应是最突出的发现。需要仔细观察儿童体检时的行为。 已知 CSA 影响许多儿童的短期和长期，但在大多数情况下仍未被发现。 目前，关于男童、学龄前儿童 CSA 症状模式的研究还很缺乏。 新发现 CSA 体检和肛门生殖器检查未发现 CSA 确诊受害者存在 CSA 特异性发现。 最突出的发现是受检儿童的行为异常反应，尤其是经历过肛门/阴道穿透的儿童；因此，仔细观察儿童体检时的行为是评估疑似 CSA 的关键部分。
