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Book Reviews and Other Media |

Medical Evaluation of Child Sexual Abuse: A Practical Guide, 2nd ed

Lori Frasier, MD, Reviewer
Arch Pediatr Adolesc Med. 2002;156(6):627. doi:10.1001/archpedi.156.6.627.
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The title of this text implies that it is a brief, yet practical, review of the approach to a child who alleges sexual abuse. However, Medical Evaluation of Child Sexual Abuse is much more. It is a comprehensive, multidisciplinary reference that provides a well-designed, thoughtful compendium of the subject. The editors have chosen authors who are well respected in their fields and employ a clear, well-focused, research-supported approach. The first 2 chapters, entitled "The Problem" and "The Evaluation," authored by the coeditors, lay the framework for the rest of the book. "The Problem" defines what child sexual abuse is, differentiates it from adult sexual abuse, and discusses some of the more commonly accepted psychobiological models. Dr Finkel's chapter, "The Evaluation," is a handbook in and of itself. Without taking too much of a "cookbook" approach, this chapter is really an introductory course in child sexual abuse for the medical practitioner; it outlines the "medical model" approach to such evaluations. Behavioral, physical, and emotional indicators are discussed at length, as is appropriate timing of the examination. Dilemmas that confront a family physician are handled well, with recommendations to consult specially trained community teams to assist in the evaluation. Chapter 3 carefully describes anatomy, physiology, and development in one of the clearest and most concise sections of any textbook. These subjects are rarely taught in a professional curriculum. Excellent illustrations and descriptions of how to position a child during the evaluation are also helpful. The illustrations accompanied by descriptions of types of genital contact are a unique aspect of this book, and the cross-sectional anatomy is superior to any verbal description. These unique illustrations explain why findings from genital examinations are often normal after such contact and, therefore, why children may misperceive and miscommunicate the actual nature of the abuse. An example of this from the book describes how children disclosing genital penetration may actually have been subjected to vulvar coitus, or contact between the labia majora.

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