Differential diagnosis of child sexual abuse

Diagnostic clinical findings that provide direct evidence of child sexual abuse can rarely be ascertained in the context of an anogenital examination; however, the absence of genital lesions does not exclude sexual abuse. The cases described are intended to increase the certainty of the diagnosis in cases of suspected child sexual abuse, to illustrate the importance of forensic expertise and accentuate the need for interdisciplinary cooperation so that false diagnoses can be avoided. Following a description of the examination techniques in cases of suspected child sexual abuse, six exemplary case reports are presented where child sexual abuse was suspected. The suspicion could be refuted in each case by a medicolegal examination in the child protection outpatient department of the Institute of Legal Medicine Hannover. The certain diagnosis of child sexual abuse is of far-reaching importance. The interpretation of anogenital findings can be hindered particularly by normal anatomical changes in hymenal morphology, the hormonal influence on hymenal appearance, traumatic alterations and diseases. In order to avoid false diagnoses in the context of infantile anogenital examination and to guarantee the certainty of the diagnosis in cases of suspected child sexual abuse, the inclusion of medicolegal experts and a close interdisciplinary cooperation with pediatricians, pediatric gynecologists and dermatologists must be promoted.