Ano-genital signs and symptoms when child sex abuse should be suspected or considered

Ano-genital signs and symptoms

• features where sexual abuse should be suspected - to suspect child maltreatment means a serious level of concern about the possibility of child maltreatment but is not proof of it
  
  
  • sexual abuse should be suspected if a girl or boy has a genital, anal or perianal injury (as evidenced by bruising, laceration, swelling or abrasion) and the explanation is absent or unsuitable
    
    
  • sexual abuse should be suspected if a girl or boy has a persistent or recurrent genital or anal symptom (for example, bleeding or discharge) that is associated with behavioural or emotional change and that has no medical explanation
    
    
  • sexual abuse should be suspected if a girl or boy has an anal fissure, and constipation, Crohn's disease and passing hard stools have been excluded as the cause
    
    
• features where sexual abuse should be considered - to consider child maltreatreatment means that one possible explanation for the alerting feature or is included in the differential diagnosis
  
   
  • sexual abuse should be considered if a gaping anus in a girl or boy is observed during an examination and there is no medical explanation (for example, a neurological disorder or severe constipation)
    
    
  • sexual abuse should be considered if a girl or boy has a genital or anal symptom (for example, bleeding or discharge) without a medical explanation
    
    
  • sexual abuse should be considered if a girl or boy has dysuria (discomfort on passing urine) or ano-genital discomfort that is persistent or recurrent and does not have a medical explanation (for example, worms, urinary infection, skin conditions, poor hygiene or known allergies)
    
    
  • sexual abuse should be considered if there is evidence of one or more foreign bodies in the vagina or anus. Foreign bodies in the vagina may be indicated by offensive vaginal discharge

Reference:

• 1. NICE (July 2009). When to suspect child maltreatment