Friday, March 27, 2015

9-year-old girl is brought into your office by her mother

A 9-year-old girl is brought into your office by her mother, who states that the daughter has been
losing weight and having difficulty at school. The mother discovered some yellow-colored discharge on  the child’s underwear.

On physical examination, you notice erythema to all parts of the patient’s vulva and to the vagina. There is some yellow discharge visible.

Which of the following is the most likely diagnosis?

a. Müllerian duct tumor
b. Wolffian duct tumor
c. Dermatitis
d. Sexual abuse
e. Straddle injury

The answer is D.  The majority of victims of sexual abuse have no physical examination
findings. Swelling and erythema of the vulvar tissue (genital trauma) should be a “red flag” for child abuse, especially if associated with bruising or a foul-smelling discharge. In addition to the anorectal and genitourinary problems, there can be significant behavioral changes, such as sexually provocative mannerisms, excessive masturbation, inappropriate sexual knowledge, enuresis, depression, social withdrawal, anxiety, school problems, and weight changes. A straddle injury, often from a bicycle seat, occurs over the symphysis pubis, whereas signs of sexual abuse are more posterior around the perineum.


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