O3189: Clinical and laboratory findings when male child sexual assault survivors present to the pediatric emergency room

Background: Fifty years ago the sexual abuse of children was dubbed “a hidden problem”. Child sexual abuse (CSA) is under-reported and under-recognized, delaying the care and recovery for male and female survivors alike. Intervening decades have begun to better characterize reasonable expectations of the potential physical exam and laboratory findings after a child makes an outcry, yet boys who have suffered CSA remain comparatively overlooked. This study aims to describe the presentation of boys and young men who seek emergency room care for a chief complaint of sexual abuse or assault.

Methods: This was a retrospective chart review of male patients presenting from October 2019 to March 2024 to a large urban tertiary care children’s hospital emergency room. Ninety-four encounters for male children aged 0 to18 years who provided a history of sexual abuse or assault themselves, or due to expressed concerns by a caregiver, were included when the clinician ordered studies/procedures indicating high level of concern for recent sexual contact. These interventions included a microscopic wet preparation sample collected off mucosa stained to identify spermatozoa, and/or a forensic evidence collection kit. One investigator (MDK) with 18 years of experience in sexual assault exams reviewed all photodocumentation of patients with anogenital injuries.

Results: Mean age of patients was 11.9 years and median age was 12.9 years (IQR 7.8) The ages were weighted heavily toward school-aged children and adolescents; only seven boys (7.4%) were aged 5 or younger. Psychiatric comorbidities were common. (Table 1) Anogenital injury was rare, diagnosed in only 11.9% of boys who allowed exam (n=84), and primarily found to affect the anus. (Table 2). Sexually transmitted infections were not found in any prepubertal boys, and were rarely present in adolescents; one case of syphilis was detected in an eighteen-year-old, and two seventeen-year-olds had urine polymers chain reaction testing positive for N. gonorrhea.

Conclusion:

Conclusions: In this study we demonstrate that boys presenting acutely for care related to sexual abuse or assault most often have normal exams, much like their female counterparts. When found, injury is most often to the anus. Sexually transmitted infections are uncommon. Consistent with previously published literature on predominantly female CSA survivors, this cohort of boys also shows that ‘it is normal to have a normal exam’, even after a recent abusive event.