Sexueller Missbrauch von Kindern Bedeutung und Stellenwert der klinischen Diagnostik

Medical involvement in the diagnosis and treatment of child sexual abuse (CSA) has a well defined role within a multidisciplinary concept. Due to the frequency of normal anogenital findings in victims of CSA, forensic aspects are of limited value in diagnosing CSA. In selected cases however, medical findings may play an important role in corroborating a child's history. Correct evaluation of normal findings, normal variations, and abuse related findings and several differential diagnoses require a sound pediatric gynecology background. In some cases physical sequelae of CSA (injuries, infections, and pregnancy) need to be diagnosed and treated accordingly.The majority of abused children have an altered and distorted body image. It is of paramount importance to reassure the child that his body is normal, physically undamaged, intact or that it will heal (primary therapeutic aspect of the examination). Thus the medical examination has an enormous potential to incorporate a therapeutic message into the diagnostic procedure. By communicating with the psychosocial und jurisdictional system, physicians may initiate proper child protection and therapy. Therefore medical evaluation of sexually abused children must be integrated into a multiprofessional concept of child protection.