Sexual Abuse Examination

Shawn Wygant, Demosthenes Lorandos, Tonya Craft & Nancy Aldridge

Demosthenes Lorandos, Ph.D., J.D.

Perhaps one of the most difficult subjects lawyers, judges and experts face, in order to properly diagnose (or rule out) child sexual abuse, two distinct sets of skills and knowledge are required: those for the forensic interview (covered in Chapter 23 Child Sexual Abuse Interviews) and those for the physical examination–the topic of this chapter. Trying both emotionally and professionally, child sex abuse is so challenging to properly diagnose for a variety of reasons, including that (1) normal anatomy can look as if it’s been injured; (2) injuries from other causes can be mistaken for abuse; and (3) the vast majority of child sex abuse victims show no physical injuries. 

To help attorneys and judges navigate this quagmire, this Sexual Abuse Examination chapter, written from an evidentiary perspective, provides detailed guidance from the foremost authorities in this sub-field in medicine and forensic medicine. Particular topics include: 

Detailed protocols for conducting an examination and documenting and collecting evidence, including DNA evidence 

Comprehensive treatment on the import of the absence of physical findings 

A primer on the unique specialty of sexual abuse physical examination and the knowledge and skill required to perform it properly 

Detailed discussion of the pitfalls of misused statistics in diagnosing child sexual abuse, with real world examples to illustrate complex principles 

Detailed guidance on the requirements, nature, purpose, methodology & timing of the exam 

Comprehensive discussion of the requirements to properly interpret medical findings (and avoid erroneous interpretations) 

Guidance on what comprises definitive findings 

In addition to comprehensive guidance on the requirements of a physical examination, this chapter also provides a number of case digests that illustrate: (1) properly performed child sexual abuse examinations; (2) improperly performed examinations and the difficulty faced in trying to rectify their effect; and (3) examples of sexual examinations so poorly performed, they shock the conscience. 

Offering a thorough review of the literature in this field, as well as citations to caselaw from a variety of jurisdictions, the Sexual Abuse Examination chapter is a must-have resource for lawyers and judges in cases involving child sexual abuse suspicions, accusations, allegations or charges.