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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Sexual Abuse, Child
Molly Curtin Berkoff, Adam J. Zolotor, Kathi L. Makoroff, Jonathan D. Thackeray, Robert A. Shapiro, Desmond K. Runyan
Clinical Scenarios


Topics Discussed: children's health, examination of vagina, female genitalia, gynecological examination, hymen, pediatrics, sexual abuse, sexual abuse of child

Excerpt: "A 6-year-old girl is brought to the emergency department by her mother. The mother states her child said a male babysitter "touched her" in the genital area. The mother reported the case to the police and was advised to bring the child to the emergency department for a medical examination. No behavioral problems were reported. The emergency department nurse asked the child why she thought her mother brought her to the hospital, and the child reported because of "what happened" with the babysitter. No further details were obtained. On physical examination she is sexual maturity rating 1. You note mild erythema of the inner aspect of the labia minora. The hymen is well visualized and appears normal. There is no bleeding, discharge, or lesions seen around the genitalia or anus. There are no other concerning examination findings. Is the lack of findings reassuring?..."
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