Understanding distress in child sexual abuse exams: A systematic review

BACKGROUND: The purpose of the ano-genital examination in the context of possible sexual abuse/assault, is to reassure the caregiver and child/adolescent that he or she is physically well, to test for sexually transmitted... [ view full abstract ]

BACKGROUND: The purpose of the ano-genital examination in the context of possible sexual abuse/assault, is to reassure the caregiver and child/adolescent that he or she is physically well, to test for sexually transmitted infections, and to document abnormal examination findings, if they are present. Although this examination typically involves inspection of the external genital structures and is fairly non-invasive, there are concerns that the ano-genital examination may cause anxiety and/or distress for some victims and their caregivers, resulting in emotional harm.
OBJECTIVES: The primary objective of this systematic review is to provide a summary and evaluation of the current literature on the anxiety and distress experienced by patients during sexual abuse examinations, and to offer practical applications for patient practice.
METHOD and RESULTS: Searches were conducted by a medical librarian in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, Cinahl and Web of Science. Twenty articles that focused on the issue of anxiety and distress during sexual abuse medical exams were identified and reviewed by a research team. Themes were established and strategies to address each of these themes were identified.
CONCLUSION: Ano-genital examinations may create anxiety and distress for some children/adolescents and their caregivers following sexual abuse/assault. Implications for practice, including preparation for the child/adolescent and the caregiver, strategies during the examination and the overall approach to the examination, will be discussed. Recommendations for future research will be addressed.