Child sexual abuse – gynecological evaluation

Sexual abuse is the most detrimental form of child maltreatment. Physician is obliged to objectively document finddings as well as inform public prosecutor about the crime.
A patient, aged 14 years, 3 years after menarche, came to a childhood and adolescent gynecology ambulatory because of a lack of menstruation in the last 2 months. According to Tanner scale: Th4 A4 P4. The gynecological examination showed that the girl had regular sexual contacts, about which she did not inform the doctors. A full gynecological examination together with USG showed a 9 week pregnancy. The examination was carried out three times and each time no FHR was shown – graviditas obsoleta.
Further psychological and medical examination showed that the girl was sexually abused by her neighbour, whom the girl\'s father allowed to abuse the girl in return for alkohol. In a gynecological clinic D&C was performed. The case qualified for sexual abuse was reported to the local prosecutor office. The culprit was detained and legal support was granted for the family. Gynecological examination performed in the girl\'s two sisters revealed lack of hygienic and educational care. Fortunately in the girls no traces of sexual abuse were detected. The patient lives in home run by nuns where she also continues her education.
The described case is one of the more drastic and obvious cases of sexual abuse in adolescents which has been observed in childhood and adolescent gynecology ambulatory. Between 1994-2005 the ambulatory doctors met 64 cases of suspected sexual abuse.
Somatic symptoms may not be observed in sexually abused children so psychological evaluation is necessary in each suspected case. In conclusion, there are doctors\', teachers\' and psychologists\' important task to provide quick and relible identification of a crime to enable therapy of a victim and legal action against a criminal.