I also want to bring your attention to a very sensitive topic,
that is the vulvovaginitis in girls can be cause
by sexually transmitted diseases.
However, any sexual activity with a child
where consent is not or cannot be given is abuse.
These includes sexual contact that is accomplished by force
or threat of force, regardless of the age of the participants.
This is also all sexual contact between an adult and a child,
regardless whether there is deception of the child
or the child understood the sexual nature of the activity.
It's all abuse.
Sexual abuse occurs in 1 in 5 girls in the US
and sexual abuse has been reported to occur multiple times.
57% of women and girls who state they'd been abused
reported the abuser was a family member
and 53% reported that the abuse occurred at home.
There are some specific findings that we see in the context of sexual abuse.
The hymen which we reviewed earlier may be disrupted,
but it's not always an indication of abuse.
Young girls may have vaginal discharge
or anal itching from sexually transmitted infections.
Healed genital injuries may be seen with long term abuse
such as skin tags or granulation tissue.
Also, anal dilation may be present.
In terms of looking for an STI.
The decision to conduct an STI evaluation must be made on an individual basis.
Not every child needs an STI evaluation
but if you have a high indexes suspicion, one should be performed.
It is also our duty to find out if there is an STI
but then to also report it to the proper authorities.
Let's now talk about situations that are high risk
for finding an STI in a young girl.
The child has or had symptoms or signs of an STI.
The suspected perpetrator or abuser is known to have an STI
or be at high risk for STIs.
Siblings, another child, or an adult in the household
has an STI or the patient or the parent request testing.
Lesions that are suspicious for herpes simplex
also require testing and evaluation.
The recommended laboratory tests include gonorrhea
from the pharynx, anus and vagina.
Chlamydia from the anus, and vagina.
Trichomonas vaginalis and bacterial vaginosis again from the vagina.
Serology for syphilis, HIV, and hepatitis B.
Lesions that should be cultured and sent for
NAAT with Herpes Simplex virus.
Remember that 5% of all the girls who have experience sexual abuse
will have an STI.
The American Academy of Pediatrics recommends forensic evidence collection
and a completion of rape evidence kit when sexual abuse has occurred.
This should occur within 72 hours or when there is bleeding or acute injury.
There are some psychological sequelae of a sexual abuse.
Some of the outcomes include emotional reactions
or symptoms of PTSD and also a distorted self-perception.