Botash A S
Department of Pediatrics, SUNY Health Science Center at Syracuse, USA.
Pediatr Ann. 1997 May;26(5):312-20. doi: 10.3928/0090-4481-19970501-10.
The complete physical examination of prepubertal children should always include a genital examination. Most children, even those who have been sexually abused, will have a normal genital examination. A child's acceptance and tolerance for this aspect of the examination will be enhanced by use of the techniques described. Sexually abused children may be identified through routine review of systems and history, including behavioral and psychosocial, and open-ended questions regarding sexual abuse. Regular genital examinations will also help to identify sexually abused children. Although the diagnosis of sexual abuse can never rely solely on physical findings, abnormal findings suspicious for sexual abuse are significantly more useful if there have been prior documented normal examinations. When sexually abused children initially present to their medical practitioner, the practitioner should obtain a complete medical and psychosocial history and perform a thorough examination. The practitioner need not be an expert in the interpretation of the possible legal significance of specific genital findings but should recognize normal, abnormal, and suspicious findings. Reassurance from a trusted practitioner relating to a normal body can be the most valuable treatment for a child's emotional healing. Practitioners need to be aware of the resources in their community for medical evaluations for sexual abuse, legal investigations, and mental health referrals. If there is a local center for child abuse evaluations, such as a Child Advocacy Center or Center of Excellence for child protection, practitioners should consider referrals to and consultations with these resources.
青春期前儿童的全面体格检查应始终包括生殖器检查。大多数儿童，即使是那些遭受过性虐待的儿童，生殖器检查结果也会正常。运用所述技巧会增强儿童对这方面检查的接受度和耐受性。通过对包括行为和心理社会情况在内的系统和病史进行常规回顾，以及提出关于性虐待的开放式问题，可能识别出遭受性虐待的儿童。定期的生殖器检查也有助于识别遭受性虐待的儿童。虽然性虐待的诊断绝不能仅仅依赖于体格检查结果，但如果之前有记录显示检查结果正常，那么可疑为性虐待的异常检查结果就会更有意义。当遭受性虐待的儿童首次就诊时，医生应获取完整的医疗和心理社会病史并进行全面检查。医生不必是解读特定生殖器检查结果可能具有的法律意义方面的专家，但应能够识别正常、异常和可疑的检查结果。来自值得信赖的医生关于身体正常的安慰，可能是对儿童情感康复最有价值的治疗。医生需要了解所在社区中有关性虐待医学评估、法律调查和心理健康转诊的资源。如果当地有儿童虐待评估中心，如儿童权益倡导中心或儿童保护卓越中心，医生应考虑将患者转介至这些机构并与之进行咨询。
