Forensic Medical Examination in Female Children Alleged to be Sexually Abused

Abstract

INTRODUCTION: Child sexual abuse is a global public health problem and the medico legal examination is directed to provide an objective, unbiased opinion on alleged sexual contact. There are many factors influencing such opinion. Objective: The aim was to study the factors influencing the medico legal opinion in female children who alleges sexual abuse. METHODOLOGY: A retrospective descriptive study was done based on medico-legal case records of female children who had been referred for medico legal examination following alleged sexual abuse during past 3 years to the Teaching Hospital Ragama, Sri Lanka. Data analysis was done with Statistical Package for Social Sciences (SPSS). RESULTS: We studied the records of 353 child victims for this research. The main presenting complaint was concerns of the guardian 168 (48%). Majority, 261 (74%) presented for medico legal examination 72 hours after the incident. The perpetrator was known to the victim in 339 (96%) cases. Recent injuries were observed only in 40(11%) victims while there were 184(52%) victims with old injuries. 122 (73%) out of 168 victims who were brought due to concerns of the guardians had genital injuries and of them only 11 (9%) had recent injuries. Psychological impacts were observed among 149 (42%) children. Out of the 74 victims who had experienced physical threats, only 12 (16%) had supportive injuries. Firm positive medico legal opinion as per the complaint was given in 218 (62%). CONCLUSIONS: Paucity of medical evidence is well observed in child sexual abuse and is a challenge to the medical expert. The mere absence of physical findings does not necessarily exclude the allegations of sexual abuse. Proper insight in to the presentation, pattern and factors influencing medical opinion is needed for proper administration of justice.