How should a child be managed if sexual abuse is suspected?

  1. An examination of the anus and genital must be done only once. Younger children can be held on the mother’s lap with their legs pulled up to expose the genitalia. Older child are best examined in the lateral position, never in the knee–chest position which is often used by abusers. This examination is usually not urgent. All signs of sexual interference (bruising, tears, swelling or scarring) will be at or external to the hymen. Therefore, an internal digital examination should not be done. However, a vaginal examination may be needed under a general anaesthetic if there is severe trauma. Describe the shape and appearance of the hymen. The findings must be carefully documented. Swabs must be taken for culture.

A special Crime Kit to collect semen samples is available if the sexual abuse has taken place in the past 4 days.

  • Take blood for VDRL and HIV screen.
  • Consider prophylaxis for syphilis, Chlamydia, gonorrhoea, Trichomonas, Gardnerella and HIV.
  • Prescribe pregnancy prophylaxis within 72 hours of rape in girls who have already started menstruating.
  • Debrief and counsel to prevent post-traumatic stress disorder.

Cefotaxime IMI once, metronidazole (Flagyl) for 7 days and erythromycin for 10 days to prevent most sexually transmitted infections. AZT and 3TC for 28 days for HIV prophylaxis.

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