ABSTRACT
Clinicians in any field arrive at a diagnosis by relying on a detailed assessment of: the patient’s complaint; the past medical, family, and social histories; the medical examination; and diagnostic testing. Providing medical care for children who have been sexually abused involves gathering enough information to formulate a differential diagnosis, narrowing the possibilities, and coming to a conclusion “within a reasonable degree of medical certainty.” Physical or behavioral indicators supporting a diagnosis of child sexual abuse can often be found when an experienced clinician elicits a detailed medical history from the accompanying parent or caregiver. Conditions or complaints may be discovered which had been mistakenly attributed to other causes prior to the disclosure of sexual abuse. An adult’s perception of what constitutes “penetration” is formed by experience: something passing through the hymen and into the vagina, or into the anal canal.
