ABSTRACT
A 4-year-old obese boy was referred to your office for evaluation of sexual abuse. His mother was concerned that his penis ‘has been rubbed off’ after a court-ordered visit with his father. The parents were divorced and lived apart. The child reportedly stated to the mother that his father ‘hurt my pee pee’ and the mother noticed a change in his genitals (Image 45a). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig45a.jpg"/>
What does the image show?
What are the possible causes for this finding?
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig45b.jpg"/>104The penis is tethered by ligaments to the underlying bone and the accumulated fat overlying the anterior pubic bone can surround and obscure the penile shaft and glans. With pressure applied laterally to the fat, the circumcised penis is revealed (Image 45b) with concomitant erythema of the glans and shaft secondary to chronic irritation within the fat pad. 1
The erythema depicted is nonspecific for sexual abuse and is likely related to chronic irritation. This finding neither confirms nor disputes the child’s disclosure. A variety of findings have been described as the result of sexual abuse of boys, including genital burns, bruises, incised wounds, lacerations or scars and other traumatic lesions. There can be accompanying physical abuse as well, with other findings including anal findings, non-anogenital bruises, fractures, burns, mouth injuries, brain and retinal haemorrhages and poor nourishment or underweight. 2
