Diagnostic accuracy of colposcopic photographs in child sexual abuse evaluations

Study Objective: To evaluate the utility of colposcopic photographs in child sexual abuse evaluations and to assess whether such photographs can be reliably used for peer review, second opinion, and court testimony. Methods: A prospective review of colposcopic photographs at the Pediatric and Adolescent Gynecology Clinic in Louisville, Kentucky. Participants were 189 girls who were referred for evaluation for possible sexual abuse. Interventions used included gynecologic evaluation, colposcopic photographs, and review of photographs. The main outcome measure was the degree of agreement between the examining physician and the reviewers. Results: The reviewersʹ accuracy for the entire set of 189 cases is uniformly high (93%–95%). Accuracy rates are significantly lower for pubertal girls (83%–90%) and for girls with signs of abuse (58%–88%). Conclusions: The diagnostic accuracy of the colposcopic photographs is sufficiently high to warrant continued use of medical photography for documentation and peer review. One should anticipate some disagreements between the examining physician and the reviewers, and contradictory opinions are more likely to occur with girls exhibiting physical signs of abuse and with pubertal girls.