Cinsel Saldırıya Uğramış Çocukta Erken ve Geç Muayene Bulgularının Değerlendirilmesi

In this paper, we evaluated procedures for performing and timing of the examination in sexually assaulted child. Priority management in admission must be considered for protecting the child’s health, since sexually abused child were already physical and psychological disturbed. We have to avoid receiving repeated history and unnecessary examinations, unless necessary. It almost certain that the management may not complete in a short time, repeated psychological examinations are inevitable in this situation. Examination should be considered as beginning of management and a part of the treatment procedure. Anogenital examination should be performed at early period and at once, and is important to avoid duplication of the same examination. In cases of acute sexual assault, emergent examinations are needed to identify injury, collect forensic evidence, prevent infections and for pregnancy prophylaxis. Since several signs may appear after a certain time in sexual assault, it is appropriate that control examinations should be performed after a period. As a result; while avoiding from repeated examinations, to avoid further trauma in abused child we may cause incomplete examination and elongation of management. One kept in mind that taking history for examination is different from expression of the crime.

Evaluation of the early and late examination in sexually assaulted child

In this paper, we evaluated procedures for performing and timing of the examination in sexually assaulted child. Priority management in admission must be considered for protecting the child’s health, since sexually abused child were already physical and psychological disturbed. We have to avoid receiving repeated history and unnecessary examinations, unless necessary. It almost certain that the management may not complete in a short time, repeated psychological examinations are inevitable in this situation. Examination should be considered as beginning of management and a part of the treatment procedure. Anogenital examination should be performed at early period and at once, and is important to avoid duplication of the same examination. In cases of acute sexual assault, emergent examinations are needed to identify injury, collect forensic evidence, prevent infections and for pregnancy prophylaxis. Since several signs may appear after a certain time in sexual assault, it is appropriate that control examinations should be performed after a period. As a result; while avoiding from repeated examinations, to avoid further trauma in abused child we may cause incomplete examination and elongation of management. One kept in mind that taking history for examination is different from expression of the crime.

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  • Symes L. Abuse across the lifespan: prevalence, risk, and protective factors. Nurs Clin North Am. 2011;46(4):391-411.
  • Celbis O, Ozdemir B, Kaya A. Examination of sexually assaulted child. Turk Arch Ped 2011; 46: 104-10.
  • Celbis O, Karaca M, Ozdemir B, Baransel Isır A. Cinsel suçlarda muayene. Harran Tıp Fak Der 2004;1(4):48-52.
  • Celbiş O. Çocukların adli tıbbi muayenesi. içinde: Yakıncı C, Selimoğlu MA (eds). Çocuk hastalıklarında klinik tanı. Adana: Nobel kitabevi. 2009: 421-34.
  • Polat O. Tüm boyutlarıyla çocuk istismarı. Ankara: Seçkin yayıncılık, 2007.
  • Troiano M. Child abuse. Nurs Clin North Am. 2011;46(4):413-22.
  • Gavin Andrews, Justine Corry, Tim Slade, Cathy Issakidis, Heather Swanston. Child sexual abuse. In: Comparative Quantification of Health Risks. Majid Ezzati, Alan D. Lopez, Anthony Rodgers and Christopher J.L. Murray (eds). Volume 2. World Health Organization, 2004, Geneva. 1851-1940. http://www.who.int/publications/cra/chapters/volume2/1851-1940.pdf (SET: 21.02.2012)
  • Finkelhor D. The international epidemiology of child sexual abuse. Child Abuse Negl 1994; 18: 409-17.
  • Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child 1994; 4: 31-53.
  • Elder DE. Interpretation of anogenital findings in the living child: Implications for the paediatric forensic autopsy. J Forensic Leg Med. 2007 Nov;14(8):482-8. Epub 2007 Jul 20.
  • Eckert LO, Sugar N, Fine D. Factors impacting injury documentation after sexual assault: role of examiner experience and gender. Am J Obstet Gynecol. 2004 Jun;190(6):1739-43; discussion 1744-6.
  • Alexander RA. Medical advances in child sexual abuse. J Child Sex Abus. 2011 Sep;20(5):481-5.
  • Finkel MA, Alexander RA. Conducting the medical history. J Child Sex Abus. 2011 Sep;20(5):486-504.
  • Dansky BS, Roitzsch JC, Brady KT, Saladin ME. Posttraumatic stress disorder and substance abuse: use of research in a clinical setting. J Trauma Stress. 1997 Jan;10(1):141-8.
  • Christian CW, Lavelle JM, De Jong AR, Loiselle J, Brenner L, Joffe M. Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics. 2000 Jul;106(1 Pt 1):100-4.
  • Watkeys JM, Price LD, Upton PM, Maddocks A. The timing of medical examination following an allegation of sexual abuse: is this an emergency? Arch Dis Child. 2008 Oct;93(10):851-6. Epub 2008 May 2.
  • Adams JA. Medical evaluation of suspected child sexual abuse: 2011 update. J Child Sex Abus. 2011 Sep;20(5):588-605.
  • Christian CW. Timing of the medical examination. J Child Sex Abus 2011;20(5):505-20.
  • Gould F, Clarke J, Heim C, Harvey PD, Majer M, Nemeroff CB. The effects of child abuse and neglect on cognitive functioning in adulthood. J Psychiatr Res. 2012 Feb 13. [article in press]
  • Nesvold H, Friis S, Ormstad K. Sexual assault centers: attendance rates, and differences between early and late presenting cases. Acta Obstet Gynecol Scand. 2008;87(7):707-15.
  • http://hastaneler.erciyes.edu.tr/orta_haber/citem/citem.htm SET: 28.02.2012
  • http://www.dch.gov.tr/detay.php?cid=132&id=481 SET: 28.02.2012
  • http://www.hsyk.gov.tr/Mevzuat/Genelgeler/GENELGELER/10.pdf SET: 28.02.2012