Back to Basics: The Identification of Genital Anatomic Structures and Forensic Evidence Collection Kits in Cases of Suspected Child Sexual Abuse

The genitalia examination and collection of forensic evidence are essential components of the medical evaluation when sexual abuse is suspected. In addition to a complete history/interview, the medical visit for a suspected child sexual abuse victim usually includes a detailed examination of external genitalia and anus as well as, if indicated, the collection of forensic evidence. It is important that medical and nursing professionals are able to correctly identify normal genital and anal structures before they can identify abnormal physical findings in either the prepubertal or adolescent patient. Additionally, medical and nursing professionals are expected to accurately collect and preserve forensic evidence when possible.

A topical review of literature that examines: 1) if physicians and nurse practitioners could identify basic anatomic structure of external genitalia, and 2) the timing and yield of forensic evidence collection kits.

Physicians vary in their ability to correctly identify prepubertal genital anatomic structures. Over a series of studies, on the same photograph of female prepubertal genitalia, 59 to 64% of physicians correctly identified the hymen from; 76 to 90% correctly identified the labia minora, and 63 to 78%correctly identified the urethra. On a second photo, deemed more clear, 71% of pediatric chief residents correctly labeled the hymen. Pediatric nurse practitioners performed similarly to the physicians correctly identifying the hymen 59%, labia minora 88% and urethra 81%. Looking at photographs of male prepubertal genitalia, 93% of pediatric chief residents correctly identified the basic structures while only 22% correctly recognized hypospadias. Literature reviewed on forensic evidence collection kits support an extended window for evidence collection of up to 96 hours after suspected sexual contact especially of clothing and other non-body surfaces.

Medical and advanced practice nursing professions have to improve the educational processes of clinicians who evaluate and treat children suspected of abuse. Physicians and nurse practitioners experienced difficulty in correctly labeling and identifying basic external genital structures on a photograph of a prepubertal child’s genitalia. Additionally, extending the time frame from suspected sexual contact to examination to a window of up to 96-hours post assault may increase the yield of recovering forensic evidence in both pre and post-pubertal patients.