Jan E. Paradise

Predictive accuracy and the diagnosis of sexual abuse: A big issue about a little tissue

WHY ARE SO MANY PEDIATRICIANS and others concerned nowadays about small variations in the shape and size of girls’ hymenal orifices? To pose such a question may seem ingenuous, but the answer is not self-evident and deserves careful consideration. The origins of this concern are to be found in pediatricians’ 25year commitment to identifying and caring for abused and neglected children, and in the American legal system’s principal reliance on criminal proceedings, with their attendant high standard of proof, to provide legal remedies for victims of sexual abuse. Historically, physical findings have been hallmarks of child abuse. Physically abused children are identified by a physician’s observation of injuries in a characteristic pattem-fractures, bums, bruises. Neglected children may be identified on the basis of poor growth, measured and documented by a clinician. As reports of child sexual abuse have increased dramatically in the 1980s pediatricians have been called on to evaluate and treat large numbers of victims of this most recently recognized type of abuse. Perhaps because of their customary reliance on physical findings to diagnose abuse and neglect, and certainly in response to expectations by parents. investigating social workers and police officers, prosecutors, defense attorneys, juries, and psychotherapists that physical abnormalities will be detected, physicians have lately come under substantial pressure to discover objective abnormalities that might clarify or corroborate children’s assertions that they have been molested. This is the context for the report by White and her colleagues (1989) of their investigation of the hymenal orifice diameters of sexually abused girls. Their attempt to determine whether certain physical findings can be used to objectify the diagnosis of sexual abuse is admirable. The potential implications of their conclusions, especially when considered in association

Personal Values about Sex among Virginal and Experienced Urban Adolescent Girls: Implications for Reducing STD Rates

Personal Values about Sex among Virginal and Experienced Urban Adolescent Girls: Implications for Reducing STD Rates