PHYSICAL EXAMINATION: Reassuring the Child/Adolescent and Parent/Caregiver
The physical examination, particularly the genital examination, may trigger recall of the abusive event. As a result, a child/adolescent may spontaneously ask questions about what has happened. Answer these questions in addition to providing reassurance using the following suggestions:
Avoid using medical jargon and words like "scarred" or "damaged."
When appropriate, discuss good touches and bad touches.
Take the time to explain any abnormal or significant physical findings. Drawings or colposcopy images can make the explanation easier to understand.
When possible, preface descriptions of tears and lacerations with words like "healing." That is, tears are "healing" tears.
When appropriate, reassure the child/adolescent that the injuries are not permanent, will not cause permanent problems, and will heal, often with no residua.
Use age-appropriate language to explain the implications of any findings.
Utilize appropriate resources, such as sign language interpreters, to assist with reassuring children with disabilities.
When the examination is normal, explain why it may be normal despite the incident of abuse. Convey that you believe the child/adolescent even though there is a lack of physical findings. Reasons for lack of findings include:
Fondling rarely causes physical damage
The vaginal opening is very elastic, even in prepubertal girls
The anal area may dilate, therefore reducing the chance of injury
Healing of genital areas, including the anus, can be very rapid