A 3 YEAR OLD GIRL WAS

BROUGHT TO GYNAECOLOGIC
CLINIC WITH BRUISES ON THE
VULVA HAVING BEEN SEXUALLY
ASSAULTED BY A 35YEAR OLD
MAN.
DISCUSS HER MANAGEMENT.
PRESENTER: DR UMAR H.S
MODERATOR: DR ONWUHAFUA O.
 INTRODUCTION
• The diagnosis is sexual assault with the girl as the survivor and the
man as the assailant
• Sexual assault is any sexual act performed by one person on
another without the person’s consent
• Could result from force, threat, or inability to give appropriate
consent
• Could be regarded as “corruption of a minor”, “child sexual abuse’’
• 90% of sexual abusers of children are adult males

• Has medico-legal consequences

– Apprehensive parents
– Forensic evidences

• rate 1:4 for girls and 1:6 for boys (WHO)

• The child is exposed to injuries and infections
• Injuries: physical, mental, emotional and social
• Infection: gonorrhea, Chlamydia, and HIV
• complications
-Early
-Late
• Hence parental apprehension and need for
forensic evidence
 Clinical Management
• Collection of forensic evidence
• Evaluation of STI
• Treatment of injuries
• Psychological support

• This management is achieved by…….

 HISTORY
• Establish rapport
• Presence of somebody comforting
• information from parent or guardian
• history about : duration of assault? how it
was discovered? whom she has been with
recently ? where she goes to? anyone
close wt STI? Does she know the
assailant?
Extent of injury? Is there bleeding? Difficulty
walking? Previous incidences? Pre-
existing morbid conditions? Vaccination
status with dates? Had she been bathed?
Or clothes changed? Had she eaten? Or
drank anything after the assault?
• NOTE the initial triage may reveal severe
medical conditions that need to be treated
as emergency :active vaginal bleeding
,vomiting, and pains
 Examination
• She is made comfortable by sitting or lying
on a couch for the examination
• No force or restrain on the child
• Examination steps could be demonstrated
on a doll
• Could be commenced by holding her hand
• Physical signs: temperature, pallor, noted
• Emotional and mental status noted:
frightened? drowsy?
• Signs consistent with the story of the
assault searched for
 Systemic examination
• CVS: pulse rate blood pressure, heart
sounds
• Respiratory: rate, chest wall expansion,
bruises,
• Abdomen: movement, bruises,
tenderness, palpation of internal organs
 Pelvic examination
• The victim here presented with vulval
bruises: color, size, shape, foreign bodies,
• Check for vulval swellings, active bleeding
• Examine the hymen: tears; fresh or
healed? amount left
• Check the vagina: orifice, mucosa for
tears, active bleeding from internal
tissues?
• NOTE: no speculum nor digital
examination unless indicated as in EUA
vaginoscopy could be done
• Check perineum for bruises, tears,
bleeding, faeces
• Other systems: mss, cns
 Forensic evidence collection
• To confirm sexual assault
• To identify assailant
• To show proof of force or coercion
• Forensic sample: victim’s torn clothes, or
bloodstains, foreign bodies
• Assailant hair, sperm, seminal fluid
• NOTE: THE ABOVE SAMPLES COULD
BE SENT FOR DNA ANALYSIS
• OTHER SAMPLES INCLUDE:
• VAGINAL SWAB or pipette specimen; for
sperms, acid –phosphates ,STI detection:
gonorrhea, Chlamydia, HIV screening
• Blood samples: FBC,E/ U/ CR, toxicology,
STI screening.
• Abdomino-pelvic ultrasound: internal
organs injuries
• X-rays: fractures, septic arthritis
 treatment
• Resuscitation :IVF, transfusion, sedatives,
arrest bleeding .

• Antibiotics: suspected STI;

EXAMPLE:CEFTRIAXONE,METRONIDA
ZOLE AND DOXYCYCLINE
• Prophylaxis: tetanus, hepatitis B, HIV
– HIV—PEP…
 Psychosocial support
• By trained counselors
• To address the present and future
emotional consequences of the trauma
• To rehabilitate the child back into the
society : school and home
• Follow-up: for counseling and re-
assessment of STI
 Prognosis
• The prognosis for complete recovery is
improved if health care professionals have
a supportive, non judgmental approach
and a well developed understanding and
competent treatment of the emotional as
well as the physical consequences of the
sexual assault
 Conclusion
• Sexual assault is a serious health problem
that profoundly affect the physical,
emotional, mental and social well being of
the individual hence the need for complete
compassionate and competent handling
 THANK YOU
• THANK YOU