Aims To review all penetrative child sexual abuse (CSA) cases presenting to a local unit over 12 months and audit against national guidelines for sexually transmitted infection (STI) screening and Forensic medical examination appropriateness and timing.
Methods This was a retrospective audit of all penetrative CSA cases including oral, anal and vaginal penetration presenting to the unit over 12 months from January 2010.
The medical reports were reviewed for demographic data including age, gender and relationship to perpetrator and the local database was searched for any previous medical reports on the same children. The Hospital’s results server was checked for any STI results relevant to the cases and the findings were audited against national guidelines for both STI screening and for forensic medical examination appropriateness and timing.
Results 3% of all 1289 child protection referrals seen in the 12 month period were penetrative CSA cases. 60% of cases were female and 76% were under 13 years of age. 23% of cases had another child aged 11 to 16 years as the perpetrator and 89% of these were non-relations. 35% had previous child protection medicals performed within 3 months to 8 years. 20% (7 cases) were forensic medical examinations and 1 of these was deemed by the author to have been seen out of the appropriate forensic sampling window. 40% of the forensic cases where emergency contraception was indicated as part of the medical care were seen more than 5 days after the incident. We performed STI screening on 82% of cases as per local protocol and of those tested there was a 6% STI rate
Conclusions A large number of penetrative CSA cases are seen yearly, many are re-referrals and a significant number are perpetrated by other children. Forensic medical examinations were indicated in 20% of cases however these often fell outside the window for timely emergency contraception and appropriate forensic sampling. A significant minority of cases seen also had an STI when screened.
We suggest particular attention should be given to timing of medical examinations to optimise not only forensic sampling but also medical care and emphasise the importance of appropriate STI screening.