ABSTRACT
In most cases of child sexual abuse, the medicalexamination of the child is normal and few cases have identifiable forensic evidence3,6,7. Understanding the relationship of a child victim to a perpetrator may explain why the examination is normal, given that a perpetrator who is known to a child and who victimizes the child over a considerable period of time usually pursues a pattern of behavior to prevent detection. The perpetrator may wish to avoid physical injury to the child, opting instead to engage in repeated events of fondling or genital to genital contact without full penetration past the hymenal opening. To identify abnormal findings, the medical examiner must first therefore thoroughly understand normal female and male genital and anal anatomy and their variations, and guidelines have been published4,8. There are several normal, nonspecific, and specific findings seen after sexual abuse, and mandated reporters and investigators should have familiarity with their positive identification, diagnosis, and interpretation.
