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1.
David L. Ingram Susanne T. White Pauline R. Lyna Kimberly F. Crews J.E. Schmid V.Denise Everett G.G. Koch 《Child abuse & neglect》1992,16(6):847-853
Gardnerella vaginalis (GV) infection has been reported as being acquired via sexual contact in adults and as an indicator of sexual contact in female children (DeJong, 1985). The purpose of this study was to determine if GV infection was more commonly found in 191 female children who gave a history of sexual contact and/or were infected with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) (Group 1), compared with 144 female children evaluated for possible sexual abuse and found to have no such history or infection with GC or CT (Group 2), or 31 female children (friends of the authors) without such a history or GC or CT infection (Group 3). Vaginal GV was found in 5.3% of Group 1, 4.9% of Group 2 and 6.4% of Group 3 (p > .05). Also, vaginal GV infection was not related to the type of sexual contact or race, but did increase with age in white female children. Because vaginal GV infection is not more commonly found in children with a history of sexual contact than those without such a history, the finding of GV in a vaginal culture in an individual case would not be a reliable marker of sexual contact. Routine culturing for GV is not recommended as part of a sexual abuse workup. 相似文献
2.
Hendrika B. Cantwell 《Child abuse & neglect》1983,7(2):171-176
Inclusion of vaginal inspection in all physical examinations resulted in doubling identification of cases of child sexual abuse. Forty-five of 247 girls under 13 years of age were admitted because sexual abuse had been reported. Of the 202 girls not suspected, 45 additional cases of sexual abuse were discovered by suspicious findings on vaginal inspection. The horizontal diameter of the vaginal opening exceeding 4 mm correlated in three of four instances with a confirming history for past sexual abuse. It is recommended that physical examination of young girls routinely include inspection of the vaginal opening. Pediatric caregivers need to teach themselves the parameters of the normal to protect those children who are suffering sexual abuse in their environment. 相似文献
3.
Vaginal introital diameter in the evaluation of sexual abuse 总被引：3，自引：0，他引：3
Physical objective markers to aid in the diagnosis of sexual abuse are few. We therefore studied 242 females, ages 1 through 12 years, to determine if the vaginal introital diameter is useful in evaluating a child for sexual abuse. The children were divided into three groups: Group I, history of sexual contact and/or Neisseria gonorrhoeae; Group II, no history of sexual contact but at risk; and Group III, nonabused. A vaginal introital transverse diameter of greater than 4 mm was more prevalent among children in Group I (94%) than in Group II, (5%); or in Group III (0%) (chi 2, p less than .001). Eighty-eight percent of children who complained of penile-vaginal penetration had a vaginal introital diameter greater than 4 mm as compared to 18% of children with no penetration (chi 2, p less than .001). Forty-six percent of children who complained of fondling with penetration had a vaginal introital diameter of greater than 4 mm as compared to 14% in those without a history of penetration (chi 2, p less than .008). Fifty-eight percent of children with more than one encounter had a vaginal introital diameter greater than 4 mm as compared to 29% in those with one encounter (chi 2, p less than .006). In a logarithmic regression analysis, the greatest proportion of children with a vaginal introital diameter greater than 4 mm was observed in the penile-vaginal contact group (chi 2, p less than .00003). The test is not very sensitive but highly specific. The sensitivity drops precipitously at greater than 5 mm without losing the specificity. A vaginal introital diameter of greater than 4 mm is highly associated with sexual contact in children less than 13 years of age. 相似文献
4.
INTRODUCTION: The study of sexual transmitted diseases is more and more frequent in patient with suspicion of sexual abuse, and this help to the final medical diagnosis. Organisms like Neisseria gonorrhoeae and Treponema indicate a sure sexual contact. However the role of the rest of organisms in the sexual abuse is more difficult of specifying. OBJECTIVE: To know the role of the Gardnerella vaginalis in the diagnosis of sexual abuse in patient with this possible diagnosis. METHODS: Retrospective study of 135 girls with suspicion of abuse, visited from May of 1997 to February of 1998. Vaginal swabs were taken from 45 of 135 girls evaluated. RESULTS: In five patients the vaginal culture were positive to Gardnerella. The characteristics of these five patients are described (age, aggressor, type and duration of the abuse, physical exploration and final diagnosis). All our patients were the pubertal or prepubertal girls. In these patients the final diagnosis settled with the clinical history and the physical exploration, without keeping in mind the result of the culture. CONCLUSION: It is necessary to discard sexual abuse in all prepubertal girl with a positive culture with Gardnerella vaginalis, being difficult to specify the value of the Gardnerella in the adolescent patients. 相似文献
5.
D Muram 《Child abuse & neglect》1989,13(2):211-216
A comparison was made between the findings observed during the examination of female victims of sexual abuse with the sexual acts to which the perpetrator confessed to have performed. In Shelby County, TN, during the calendar years 1985-1987, 30 individuals confessed to have sexually assaulted 31 girls. The mean age of the girls was 9.1 years, and that of the offenders was 30 years. In 18 of the 31 cases the offender admitted to vaginal penetration. Specific findings were observed in 11 of these 18 (61%) girls, compared with only 3 of 13 (23%) girls when penetration was denied. Although specific findings were more commonly observed when the perpetrator admitted to vaginal penetration, in 7 of 18 girls (39%) the examiner described normal appearing genitalia (n = 2), or nonspecific abnormalities only (n = 5). The author concludes that all complaints of sexual abuse must be considered potentially valid and should be investigated further, even if the physical examination fails to detect any abnormalities. 相似文献
6.
OBJECTIVE: To study the differential effects of sexual abuse on Hispanic (HN) and African-American (AA) girls. METHOD: Sexually abused girls and their caretakers (N = 159), of which 52% (n = 82) were AA (mean age 9.8 years, SD = 3.4, R = 6-17) and 48% (n = 77) were HN (mean age 10.1 years, SD = 3.8, R = 6-18), were included in the study. The mother/caretaker was administered a demographic form, the Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child completed the FAM-C and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS). RESULTS: HN girls were found to have a greater number of sexually abusive episodes and waited longer to disclose their abuse while AA girls were more likely to have experienced vaginal penetration. The perpetrators of HN girls were older and more likely to be fathers or stepfathers. The mothers/ caretakers of HN girls perceived their children as having significantly more aggressive behavior, anxiety/depression, somatic complaints, internalizing and externalizing behaviors, and had a higher total score on the CBCL than did AA girls. The HN girls were more likely to see their family as dysfunctional with confusion regarding family values and rules. HN mothers/caretakers perceived their families as more conflicted regarding adaptability and family controls. CONCLUSIONS: HN girls experienced more emotional and behavioral problems, and both HN girls and their mothers/caretakers perceived their families as more disturbed and dysfunctional. 相似文献
7.
OBJECTIVE: A cross-sectional study of gender specific relationships between self-reported child sexual abuse and suicidality in a community sample of adolescents. METHOD: Students aged 14 years on average (N = 2,485) from 27 schools in South Australia completed a questionnaire including items on sexual abuse and suicidality, and measures of depression (Centre for Epidemiological Studies Depression Scale), hopelessness (Beck Hopelessness Scale), and family functioning (McMaster Family Assessment Device General Functioning Subscale). Data analysis included logistic regression. RESULTS: In boys, self-report sexual abuse is strongly and independently associated with suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts, after controlling for current levels of depression, hopelessness, and family dysfunction. In girls, the relationship between sexual abuse and suicidality is mediated fully by depression, hopelessness, and family dysfunction. Girls who report current high distress about sexual abuse, however, have a threefold increased risk of suicidal thoughts and plans, compared to non-abused girls. Boys who report current high distress about sexual abuse have 10-fold increased risk for suicidal plans and threats, and 15-fold increased risk for suicide attempts, compared to non-abused boys. Fifty-five percent (n = 15) of sexually abused boys attempted suicide versus 29% (n = 17) girls. CONCLUSIONS: A history of sexual abuse should alert clinicians, professionals and carers in contact with adolescents, to greatly increased risks of suicidal behavior and attempts in boys, even in the absence of depression and hopelessness. Distress following sexual abuse, along with depression and hopelessness indicate increased risk of suicidal behavior in girls, as well as boys. 相似文献
8.
OBJECTIVE: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS). METHODS: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse. RESULTS: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS. CONCLUSIONS: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse. 相似文献
9.
OBJECTIVE: The purpose of the present research was to explore the sexual behaviors of 2- to 7-year-old children through reports of day-care personnel. An overall aim of this exploratory study was to provide information about the frequencies of child sexual behaviors. Also, the aim was to explore any age and gender differences. METHOD: A representative sample of 364 Finnish children not screened for developmental delay, sexual abuse history or psychiatric problems (181 girls and 183 boys) in 190 day-care centers were studied using the "Day-Care Sexuality Questionnaire" (DCSQ), with 244 sexual and other behavior items. RESULTS: Age influenced more the extent of the 244 sexual behaviors of boys than of girls. In sexual behaviors increasing with age, girls showed behaviors with a more social character, whereas boys showed more explorative and information-seeking behaviors. Girls had a higher frequency of domestic and gender role exploring behaviors, whereas the boys tended to engage in explorative acting and information-seeking behaviors. CONCLUSIONS: The results suggest that child sexual behavior reported by day-care personnel may provide useful information about the development of children's sexuality. Implications for sexual abuse investigations were discussed. 相似文献
10.
Child sexual abuse is attracting increasing attention in the United Kingdom. In Leeds this is reflected in the work of two pediatricians who receive multiagency, direct referrals for children of all ages. Over two years 1,368 referrals were received for all kinds of abuse and neglect, including 608 for suspected sexual abuse (Hobbs & Wynne, 1987a), of which 337 (243 girls, 94 boys) were confirmed or probable cases. The abuses included genital touching, masturbation, oral, vaginal and anal penetration. Of these abuses, 30% (which were frequently multiple) involved and penetration by finger or penis; and 42% of 337 children exhibited one or more anal findings, rising to 60% of 115 children in the 0-5 years of age group. The diagnosis of abuse was made from results of multidisciplinary assessment including medical examination. Genital findings were present in 3% of boys and 50% of girls. Anal findings included erythema; swelling (tyre); laxity; shortening or eversion; reflex anal dilatation (dilatation); fissures; venous congestion; reversible and permanent skin changes; twitching; funnelling; hematoma and bruising; as well as signs of infection. The pattern of anal signs varied with the age of the child and chronicity of abuse, as judged from the history. Healing and resolution of anal physical findings on follow-up were observed from days to months after initial examination. The general absence of these findings in the group of children judged not to have been sexually abused supports a cause and effect hypothesis, but further research is required. Medical examination of every child where symptoms, signs, or situation raise the possibility of abuse or neglect must include anal inspection, but instrumental or digital examination is not recommended. 相似文献
11.
OBJECTIVES: The goal of the study was to assess the prevalence of date violence and rape in adolescents, to examine associations between date violence and rape and disordered eating behaviors and psychopathology, and to determine if these associations remain significant after controlling for sociodemographic characteristics and other physical and sexual abuse by an adult. METHOD: A Minnesota school-based sample of 81,247 boys and girls in 9th and 12th grades completed the 1998 Minnesota Student Survey. RESULTS: Overall, approximately 9% of girls and 6% of boys had experienced date violence or rape. Significant differences across race and grade were found. Date violence and rape is associated with higher rates of disordered eating behaviors and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Over 50% of youth reporting both date violence and rape also reported attempting suicide. Controlling for race and age, adolescents who have experienced both date violence and rape were more likely to use laxatives (OR: girls = 5.76; boys = 28.22), vomit (OR: girls = 4.74; boys = 21.46), use diet pills (OR: girls = 5.08; boys = 16.33), binge eat (OR: girls = 2.15; boys = 5.80), and have suicidal thoughts or attempts (OR: girls = 5.78; boys = 6.66) than their nonabused peers. These odds were weakened but remained significant after controlling for other abuse by an adult. Furthermore, a greater percentage of girls and boys who reported an abusive dating experience also reported repeat victimization (physical or sexual abuse perpetrated by an adult) when compared to their peers without an abusive dating experience. DISCUSSION: Abusive experiences during dating relationships may disrupt normal developmental processes, including the development of a stable self-concept and integrated body image during adolescence. This disruption manifests itself through thoughts, feelings, and behaviors. Further research should explore effects of adverse adolescent dating experiences. 相似文献
12.
OBJECTIVE: The purpose of this study was to examine the relationship between a history of physical and/or sexual abuse and current suicidality in college-age women. It was hypothesized that abuse history would significantly predict level of suicidality. A secondary hypothesis was that abuse status would predict attitudes about life and death. METHOD: Female college students (n = 707) were screened for histories of childhood (before age 15) and adulthood (after age 15) contact sexual abuse and physical abuse sequelae. Ninety-five women reported a history of childhood sexual abuse, 116 adult sexual abuse, 104 child physical abuse, and 55 adult physical abuse. Participants completed measures of attitudes about life and death and current suicidal ideation. RESULTS: Child physical abuse and child sexual abuse accounted for variance in current suicidal ideation. Adult sexual abuse explained variance in positive attitudes about life. Adult physical abuse, adult sexual abuse, and child sexual abuse accounted for variance in negative attitudes about life. Finally, child sexual abuse and adult sexual abuse accounted for variance in fear of death. CONCLUSIONS: Detailed assessment of female college students' abuse histories should facilitate understanding of their level of suicide risk. Patterns of attitudes about life and death may also be informative. 相似文献
13.
OBJECTIVE: This study examined specific aspects of child sexual abuse in relation to symptom severity among hospitalized patients diagnosed with bulimia nervosa. METHOD: Participants were 45 hospitalized bulimic women who reported a history of child sexual abuse. Structured interviews were conducted in order to obtain detailed information regarding specific features of the abusive event(s). Participants also completed instruments that measured depression and eating pathology. RESULTS: There were no significant differences in severity of depression or eating disturbance among women reporting differing abusive experiences including intrafamilial versus extrafamilial abuse, abuse with or without the use of physical force, one versus multiple incidents, early abuse versus abuse occurring after age 14, contact versus noncontact abuse, disclosed versus undisclosed, and combined physical/sexual abuse versus sexual abuse alone. CONCLUSION: The specific characteristics of child sexual abuse are not related to the level of symptomatology for hospitalized bulimic patients. This study suggests that differences in the nature of the abuse may not be as important as the fact that the abuse occurred in the first place. 相似文献
14.
Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry 总被引：1，自引：1，他引：1
From the child psychiatry outpatient department of a university medical center, 64 charts were reviewed in two phases: 29 were randomly selected from outpatient files, and 35 were examined after clinicians were asked to directly query sexual abuse. Although the reported sexual abuse rate for randomly selected charts was quite low (6.9%), reference to sexual abuse history in charts of children who were asked about molestation was 4.5 times more frequent (31.4%; 11.5% of all boys, 50% of all girls). Children with an identified sexual abuse history reported more psychological symptoms, had made more suicide attempts in the past, and were more likely than nonabused children to receive a diagnosis of major depression. 相似文献
15.
A comparative study using matched samples was conducted to investigate the relationship between sexual abuse and substance abuse. The sample included 48 adolescent psychiatric inpatients who had been sexually abused (abuse group) and 48 psychiatric inpatients without a known history of such abuse (control group) matched by age, race, sex, and primary psychiatric diagnosis. Statistically significant differences emerged between the groups in several areas. Abuse group subjects indicated more regular use of cocaine and stimulants, greater frequencies of alcohol and drug use, and more reported drunkenness and times high on drugs than their control counterparts. Explanations of the association between substance abuse and sexual victimization are explored. Discussion suggests the possibility of earlier coping strategies being related to later chemical use patterns. Implications for service delivery are offered. 相似文献
16.
OBJECTIVE: To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old. METHODS: Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse. RESULTS: The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position. CONCLUSION: Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?" 相似文献
17.
OBJECTIVE: The primary purpose of the present study was to examine the relationship between daily stressors and physical symptoms in college-age women with a childhood history of sexual abuse and women without a history of childhood sexual abuse. It was hypothesized that women with a history of childhood sexual abuse would be particularly susceptible to the effects of daily stressors on physical symptoms, and would show more covariation between daily stressors and physical symptoms, compared to women without a history of childhood sexual abuse. METHOD: Female college students (n = 491) were screened for histories of childhood (before age 15) and adulthood (after age 15) contact sexual abuse. Of these participants, 18 women with only a history of childhood sexual abuse were assigned to the SA group, and 27 women with no history of childhood or adulthood sexual abuse were assigned to the NA group. These women filled out self-report measures of daily hassles and physical symptoms for 28 consecutive days. RESULTS: During the 5 days preceding a highly stressful day, women in the SA group reported significantly more physical symptoms than during the 5 days preceding a day of low stress. For the NA group, there were no significant differences in reported physical symptoms between high- and low-stress days. CONCLUSIONS: The pattern of results for physical symptoms suggests that women with a history of childhood sexual abuse may be particularly susceptible to the effects of heightened daily stress, and may display this susceptibility in the report of physical symptoms. Possible explanations for these findings are discussed. 相似文献
18.
OBJECTIVE: The aim of this study was to test a model predicting the contribution of abuse-related characteristics and mediating variables such as coping and attributional style in the development of psychological sequelae in adults reporting a history of child sexual abuse (CSA). METHODOLOGY: Two hundred and eighty-five males and females from three settings (a nonpatient, psychiatric outpatient, and psychiatric inpatient) completed a battery of questionnaires that included a (1) Sexual History Questionnaire, (2) Ways of Coping Questionnaire, (3) Attributional Style Questionnaire, and (4) the SCL-90-R. RESULTS: Of the 285 participants, 33% reported unwanted or forced sexual contact before the age of 18 years. Participants who reported a history of CSA also reported higher levels of psychological distress when compared to those who did not report a history of abuse. In testing the model concerning the relationship between victim-offender characteristics, mediating variables and psychological distress in adulthood; two abuse-related characteristics (number of offenders and duration of abuse) were found to be directly associated with psychological distress in adulthood. Other abuse-related variables (i.e., relation with offender, force, resistance, age of onset, participation, and frequency of abuse) were found to be related to psychological distress in adulthood through the mediation of various coping strategies (i.e., Accepting Responsibility, Confrontive Coping) and attributions (i.e., internalization of the abuse). CONCLUSIONS: The results of the present study further our understanding regarding the relationship between abuse-related characteristics, mediating factors such as coping and attributional style and psychological distress in adults with a history of CSA. Future research should focus on the development of interventions that focus on variables amenable to psychotherapy to ameliorate the psychological sequelae of CSA. 相似文献
19.
OBJECTIVE: The aim of this study was to determine whether reported childhood sexual abuse is related to the severity of symptoms in patients who experience auditory hallucinations. METHOD: A sample of 26 adult male and females with psychotic disorders involving auditory hallucinations were interviewed and were asked to complete three self-report measures: the Dissociative Experiences Scale (DES-II and DES-taxon versions); the Beck Depression Inventory (BDI); and the Beliefs About Voices Questionnaire (BAVQ). They were also asked about any history of sexual abuse in childhood. RESULTS: A history of childhood sexual abuse was reported by 10 of the 26 patients (38.5%), and was associated with higher levels of depression and dissociation, as well as being linked to a tendency to regard the voices as more malevolent. The same three features were all associated with the age at first reported abuse, with a younger age of first experience being related to higher levels of psychopathology in all instances. CONCLUSIONS: These results require replication and refinement in future research, but indicate a need for greater attention to be paid to the possible role of childhood sexual abuse when understanding and treating auditory hallucinations. 相似文献
20.
OBJECTIVE: This study examined the influence of sexual abuse history, gender, theoretical orientation, and age on beliefs about the prevalence of childhood sexual abuse among clinical and counseling psychologists. METHOD: A mail survey design was used in this study. Participants were randomly selected from the American Psychological Association membership database. There were 615 psychologists who completed self-report measures on beliefs about the prevalence of childhood sexual abuse and demographic characteristics. RESULTS: Overall, clinicians' scores on the prevalence of childhood sexual abuse were moderate. There were significant gender differences on beliefs, suggesting that women were more likely believe that childhood sexual abuse is a common occurrence compared to men. Multiple regression analysis indicated that clinician characteristics (history of sexual abuse, gender, and theoretical orientation) were significantly related to beliefs about the prevalence of childhood sexual abuse. However, these characteristics only accounted for a small amount of the overall variance predicting beliefs. CONCLUSIONS: These results suggest that clinicians do not hold extreme beliefs regarding the prevalence of childhood sexual abuse. Moreover, certain clinician characteristics are associated with their beliefs, which in turn, may impact their clinical judgment and treatment decisions. Furthermore, much of the variance was unaccounted for in the model indicating that psychologists' beliefs are complex and are not unduly influenced by their personal characteristics. Implications for clinical practice and future research are discussed. 相似文献