Three questions most frequently asked by parents, Department of Family and Children Service (DFCS) case workers, and law enforcement personnel about the medical-forensic examination of suspected child sexual abuse victims are:
1) Who needs one?
2) Why do they need one?
3) Is it painful or traumatizing?
These are very important questions that every parent, DFCS case worker, and law enforcement officer should know the answers to. In this blog post we will answer those questions and provide the evidence-based rationale to facilitate a better understanding of who should receive medical-forensic care to help ensure pediatric patients get the sub-specialty medical-forensic care to which they are entitled FREE of charge to them.
WHO?
Suspected Child Sexual Abuse: No Disclosure Required
At The Cottage, our providers follow the nationally recognized, evidence-based guidelines established for the care of abused children and adolescents. According to those guidelines, if there is any suspicion of sexual abuse, regardless of whether or not the child or adolescent has made a disclosure or denial related to the allegations or suspicions, he/she should have a medical-forensic examination performed by a properly trained, pediatric medical-forensic provider in a child-friendly environment. No disclosure is required. A mere suspicion of child sexual abuse should trigger a referral to The Cottage for evaluation. Suspected child sexual abuse victims are not required to have a referral from law enforcement, DFCS, nor their primary care provider to receive care at The Cottage. Parents can make a referral simply by calling The Cottage to make an appointment.
Contact Children
The clinical practice guidelines also recommend that all “contact children” also have a medical-forensic examination conducted by a properly trained pediatric medical-forensic provider. A “contact child” is any child or adolescent who has had any type of in-person contact with the alleged perpetrator. To ensure the safety, health, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.
Children Residing in or Visiting Home with Child Pornography
The clinical practice guidelines also state ALL children and adolescents residing in a home or who frequently visits a home where child pornography was discovered/confiscated should be scheduled for a medical-forensic evaluation with a properly trained, pediatric medical-forensic provider. To ensure the health, safety, and well-being of these children and adolescents, they should all have specialized medical-forensic examinations in the absence of disclosure and even when they deny any history of abuse.
WHY?
Pediatric medical-forensic providers have special equipment and specialized training to perform and document forensic-medical examinations on child and adolescent patients. The main objective of the medical-forensic evaluation is to ensure the health and well-being of the child or adolescent. First, it is not uncommon for children and adolescents to deny the abuse and subsequently test positive for a sexually transmitted infection (STI) and/or have significant genital findings. Secondly, children sometimes fail to have any symptoms of STI’s, and if left untreated, could lead to serious infections and sterility in adulthood. Finally, children and adolescents who have been abused often worry that they are different from their peers. The medical-forensic exam will help to reassure your child or adolescent that everything is okay with their body, and it also provides an opportunity to document any significant physical and/or forensic findings, which may be utilized as evidence in investigations and legal proceedings to convict or exonerate the accused. Our providers at The Cottage are highly trained and experienced in diagnosing and treating medical conditions related to abuse and also distinguishing these conditions from those that mimic abuse.
Is It Traumatizing or Painful?
No part of the medical-forensic examination should cause your child or adolescent any pain, nor should it be traumatizing in any way. It is important for you and your child or adolescent to understand that the genital exam is very different and far less invasive than an adult pelvic exam, and it is absolutely in no way comparable to a “pap smear.” Vaginal speculums are not inserted inside children and young adolescents. Patients are never forced, and they are given as much time as necessary to feel comfortable with the exam. If your child or adolescent is very resistant, the exam can be rescheduled for a later date or not done at all. Most children and adolescents are cooperative when they are reassured that the decision to have the exam is ultimately their own. Please be assured that your child or adolescent will always be treated with dignity and respect.