SPECIALIZED COURSE FOR WOMEN

AND CHILDREN PROTECTION DESK

(WCPD) OFFICERS

WCPC
WCPC
To understand the purpose of the medico-legal
examination
To understand the meaning of the medical findings
To be aware that there are many ways of abusing
children without resulting in medical findings and
therefore, proceed with the investigation and filing of
cases on the basis of a child’s statement.

WCPC
 For diagnosis and treatment
 To identify and document evidence
of abuse
 To assess the child’s safety
 To reassure the child and family
 To obtain counseling if indicated
 To provide expert witness testimony

WCPC
 Developmentally appropriate interview
 Complete examination to include growth,
development, social, and emotional state
 Directed genital examination for specific signs or
physical indicators
 Laboratory evaluation, cultures for STD’s, as
indicated by history or physical

WCPC
1. Evaluate Medical Problems
2. Gather Evidence
3. Aid Transition Into Therapy

 by providing a supportive and
protective environment

 by giving feedback to the patient that
her body is OK, despite the abuse

WCPC
1. Acute Evidentiary Exam (less than
72 hours)

2. Non-acute Exam (more than 72

hours)

WCPC
Immediate Examinations are required
for:
1. History of sexual assault within
preceding 72 hours.
2. History of genital or anal bleeding
3. Symptomatic Sexually Transmitted
Infections (STIs)

WCPC
1. MEDICAL EVIDENCE
 Physical
 findings
 Forensics


2. CONVINCING DISCLOSURE BY CHILD

3. BEHAVIOR
 developmentally
 unusual sexual behavior
knowledge or symptoms
 Depression, post-traumatic stress

disorder
4. EVIDENCE THAT CORROBORATES
THE ABUSE
WCPC
ANO-GENITAL FINDINGS
 Laceration of the hymen
 Bruising of the hymen
 Perianal lacerations deep to the external
anal sphincter
 Healed hymenal transection
 Absence of hymenal tissue

WCPC
 Finding of sperm or seminal fluid on the
child’s body
 Pregnancy
 Confirmed cultures of N. gonorrhea
 Evidence of syphilis acquired after delivery
 Cases where photographs or videotape
show a child being abused
 HIV infection (not due to other causes like
blood transfusion, etc.)

WCPC
1. Type of abuse
2. Deliberate avoidance to hurt child
3. Difference in child and adult view
of “penetration”
4. Elasticity of hymen and anal
sphincter

WCPC
5. Post-assault activities
6. Delay in disclosure / examination
7. Limitation of equipment / technique
8. Limitation of examiner

WCPC
CONTACT:
• Touching, fondling or oral
contact
• Insertion of fingers or objects
into vulva or anus
• Masturbation
• Intercourse
• Other genital contact
• Prostitution
WCPC
NON- CONTACT:
•
• Exhibitionism (flashing)
• Pornography
• of many kinds;
photographing sexual acts or anatomy
• Showing
• pornographic photographs,
films,video.

WCPC
 Skillful Perpetrator

avoid hurting
child

Genital Trauma when

assaulted by stranger (25%)
vs. known assailant (12%)
WCPC
Young
 children naïve about sexual
practices, will usually does not know
that something can penetrate deep into
the vagina.

Their
 definition of “inside” may not turn
out to actually mean deep or even any
penetration

WCPC
Normal Genital Anatomy
“Hymen Tissue is “ELASTIC”
It
 can stretch to allow penetration, even
in the pre-pubertal child.
“full penetration…particularly in an older

child, may cause no visible trauma…”

(Bays
(Bays && Chadwick,
Chadwick, 1993;
1993; Huffman,
Huffman, Dewhurst &
Capraro,
Capraro, 1981;
1981; Mahran
Mahran &
& Saleh,
Saleh, 1964;
1964; Pokorny,
Pokorny,
1987;
1987; Teixeira,
Teixeira, 1981)
1981)

WCPC
Size of child
Size of penetrating object
Amount of hymen tissue
Amount of force

WCPC
Urination

Defecation

Genital wipe /wash

Bath / shower

Brushing of teeth

Oral gargle / swish

Change of clothing


WCPC
History of Penetration

 36% had genital trauma when

examined within 24 hours

 to 13% after 24 hours

WCPC
 Colposcope


 Examining
 methods/positions
 Examining technique


WCPC
 Lack of Special Training
 Personal biases

WCPC
Exactly what object caused injury
When it occurred (once injury has
healed)
How many times it happened
Who did it

WCPC
Majority of children with history of SA
have normal examinations
Children’s injuries heal amazingly well

WCPC
WCPC
1. Nothing happened.
2. Something happened which did not
cause injury.
3. Something happened which may have
caused an injury which has healed since
the event occurred.

WCPC
1. “Intact Hymen”
2. “Virgin State”
3. Size of Hymenal Opening

WCPC
“ The use of this term is to be
discouraged due to its non-specificity.”

American Professional Society on the Abuse

of Children (APSAC),1999

WCPC
Hymenal Diameter is affected by:
• Patient
• relaxation
• Position
•
• Examining technique
•
• Age of patient
•

In and of itself, measurement of the

hymenal opening is NOT a reliable
indicator of abuse

WCPC
“Most hymenal measurements lack adequate
sensitivity or specificity to be used to
confirm previous penetration”

-- Abby
Abby Berenson,
Berenson, et
et al,
al, Pediatrics
Pediatrics Vol
Vol .109
.109 No
No 2
2 Feb.2002
Feb.2002

WCPC
1. Color is NOT reliable in aging bruises (Maguire
et.al.-Archives of Disease in Childhood, 2005)
 Contrary to common belief, the exact time
a bruise was inflicted cannot be
determined accurately based on
appearance
 Different colors may appear at any time
from within 1 hour of infliction to
resolution
 Bruises of identical age and cause on same
patient may vary in appearance and
change colors at different rates
2. It’s Normal to be Normal!! (Adams,
et.al. 1994)
 Normal or non-specific findings in a
victim do not necessarily imply that
no abuse occurred
 77% of victims in the study had normal
or non-specific genital findings
 People v Llanita (364 SCRA 505):
“absence of hymenal lacerations does
not disprove sexual abuse”
3. Digital Photographs are admissible in
court for civil cases!!! (R.A. 8792 or
Electronic Commerce Act of 2000)
 Digital images or photographs may
be used in court as evidence as
stated in Sec.12, “In any legal
proceedings, nothing in the
application of the rules on evidence
shall deny the admissibility of an
electronic data message or
electronic document in evidence
1. What types of sexual abuse are
consistent with normal examinations?
 Oral, fondling, rubbing, vaginal
penetration after puberty, rectal &
partial or attempted vaginal
penetration, and penetration that had
time to heal
2. Child describes penetration but
examination is normal
 May have been only partial or
attempted penetration but child is
not able to differentiate
 Pubertal adolescent
 Hymenal opening has sufficient
elasticity
 Rectal penetration with lubricant use
  In general, injury is more likely if the
victim was young, physical force was
applied, penetration was deep, victim
was uncooperative, no lubricant was
used, object used was large, and
repeated penetration applied
3. Can the number of abuse episodes be
determined?
 Not usually. Vaginal injuries do not
reliably differentiate between single
or multiple abuse episodes.
4. When did injury occur?
 If injuries are acute (redness,
swelling, fresh abrasions or
lacerations), examiner may reliably
identify it as relatively recent
 Timing injuries within specific hours
or days is not possible
Can a child get an STI by merely
sharing the same bed, toilet seat , or
towel with an infected individual?

NO
 Except for infections acquired
perinatally , presence of an STI in
a child implies that it was
transmitted by sexual contact

WCPC
Can biking or horseback-riding cause
hymenal injuries?
NO
How about dancing or doing the split?
NO

There is no evidence of anal

or genital injuries associated
with or resulting from the above
vigorous physical activities.
WCPC
Can masturbation cause hymenal
injuries?
NO
Normal masturbation in girls
involves clitoral or labial
stimulation.These do not cause
hymenal injury.

(Hobbs & Wynne 1987; Huffman, Dewhurst &

Capraro, 1981; Tipton , 1989; Woodling &
Kossoris, 1981)
WCPC
Can masturbation cause hymenal
injuries?

NO
Study of self-injurious behavior in
97 mentally retarded individuals:
No genital or anal injuries were
reported

(Hyman, Fisher, Mercugliano

WCPC
& Cataldo, 1990)
Statement of Child
Police Investigation to
Corroborate Story
 > collateral interviews

> gather evidence at the site

WCPC
 Reasons for the Absence of Physical
Findings
 Elasticity of Hymen and Anal Sphincter.
 Terms that were no longer used in Child
Sexual Abuse Evaluation
 Interpretations of Normal Findings in
Child Sexual Abuse

WCPC
WCPC