Child sexual abuse--genital tract findings in prepubertal girls. I. The unaided medical examination.

In a prospective study 205 prepubertal girls (mean age, 5.4 years) determined by Child Protective Services to be victims of sexual abuse were examined. Sixty-five girls (32%) had normal-appearing genitalia, 45 girls had nonspecific findings, and 95 girls had findings considered to be specific for sexual abuse. Whereas normal-appearing genitalia were most often observed in girls reporting digital assault, specific findings were more commonly observed in girls reporting genitogenital assault. Overall it was possible to document the presence of abnormal genital findings indicating or strongly suggesting sexual abuse in only 46% of the patients in this study group. Failure to document findings suggestive of abuse in half of the girls highlights the limitations of the medical evaluation in validating sexual abuse.