A Practical Guide to the Evaluation of Sexual Abus

by Angelo P. Giardino; Martin A. Finkel; Eileen R. Giardino; Toni Seidl; Stephen Ludwig

• ISBN13: 9780803948150
• ISBN10: 0803948158
• Format: Hardcover
• Copyright: 1992-10-09
• Publisher: Sage Publications

Summary

Carefully developed and thoroughly field tested, this volume is a guide to aid practitioners in the identification, evaluation, and documentation of suspected sexual abuse of children. It will be invaluable to a broad range of professionals, including pediatricians, doctors, nurses, health care and child protection workers, clinical social workers, and psychologists.With over 45 medical illustrations, the manual reassures caregiving professionals in their role as health care provider and/or child advocate. It provides a solid reference showing how to proceed with medical and psychological assessment and gives practical guidelines for doing physical and genital examinations, pertinent laboratory studies, and proper documentation.

Table of Contents

Foreword

The Problem

The Evaluation

Interview and History

Physical Examination and Laboratory Specimens

Differential Diagnosis of Anogenital Findings

Sexually Transmitted Diseases (STDs) - Julie Lippmann and Ester Deblinger-Sosland

Mental Health Evaluation

Documentation and Conclusions - /f002Extended Contents/f001 Suzanne M Sgroi

Foreword - Chapter One: The Problem

Definition

Scope of the Problem

Incidence and Prevalence

Categories Included in Sexual Abuse

Conceptual Models

Preconditions for Sexual Abuse

Characteristics of the Perpetrator

Longitudinal Progression of Sexual Abuse

Child Sexual Abuse Accommodation Syndrome

Long-Term Effects of Sexual Abuse

Issues of Power and Control

Brief - Chapter Two: The Evaluation

Approach to Evaluation of Sexual Abuse

Emergent Evaluation

History

Physical Examination

Laboratory Studies

Documentation

Brief - Chapter Three: Interview and History

Interview as Diagnostic and Therapeutic

The Interview Process

Compliance with Legal Responsibilities

Brief - Chapter Four: Physical Examination and Laboratory Specimens

Physical Examination

Familiarity with the Prepubertal Examination

Laboratory Findings

Lack of Evidence

Basic Anatomy and Development

Estrogen Effect on Female Genitalia

Huffman Stages

Outward Sexual Development

Tanner Stages

Normal Female Genitalia

Male Anatomy

Anal Anatomy

Variables Affecting Physical Evidence

Findings in Sexual Abuse

Degree of Physical Contact

Extragenital Trauma

Fondling and Digital Penetration

Male Abusive Findings

Anal Examination Findings

Penile Contact with Genitalia and Anus

Oral-Genital Contact

Penile Penetration

Summary of Abuse Findings

Accidental Trauma

Preparing for the Physical Examination with the Child

Genital and Perianal Examination

Examining the External and Internal Structures

Collection of the Specimens

Forensic Evidence

Brief - Chapter Five: Differential Diagnosis of Anogenital Findings

Framework for Consideration

Anogenital Erythema, Excoriation, Pruritus

Anogenital Bruising

Anogenital Bleeding and//or Bloody Vaginal Discharge

Nonbloody Vaginal Discharge

usual Anatomic Appearance - Chapter Six: Sexually Transmitted Diseases

Gonorrhea

Chlamydia Trachomatis

Syphilis

Condyloma Acuminata

Trichomoniasis

Herpes Genitalis

HIV

Pediculosis Pubis

Gardnerella Vaginalis

Chancroid and Granuloma Inguinale

Candida

Brief - Chapter Seven: Julie Lippmann and Ester Deblinger-Sosland: Mental Health Evaluation

Referrals

Purpose of the Mental Health Evaluation

Interviewing the Child

Aspects of Validation

Assessment of Emotional Impact

Interviewing Other Family Members

Feedback and Recommendations for Treatment

Prognosis

eatment - Chapter Eight: Documentation and Conclusions

Detail of the Medical Record

Recording the History

Recording the Physical Examination

Court Testimony

Conclusion

In Brief