Child Sexual Abuse; a Medico-Legal Analysis

Background: Child sexual abuse is frequently discussed in Sri Lanka. The type of abuse, hymenal injuries and their association with penetrative intercourse are important facts in the management of child sexual abuse. Methods: Out of 7257 Medico-legal examinations, 78 child sexual abuse cases reported to a tertiary care hospital in Colombo, Sri Lanka, from January 2011 to December 2013 were studied. Results: Females 85% and 59% were 11-15 years. Sixty nine percent during day time, 91% by known persons and 64% at outside place. Vaginal intercourse was alleged by 15% of below the age of 10 years and 62% of above 10 years (P < 0.01) and committed was by 73% of ‘boyfriends’ and 33% of non-boyfriends (P < 0.01). Hymenal tears were in 15% of fimbriated and 45% of non-fimbriated hymen (P < 0.05). Hymenal tears at 5-7 O’clock position in 40% of alleged vaginal intercourse and 3% of not alleged (P < 0.01). Hymenal orifice diameter greater than 2 fingers was in 69% of alleged vaginal intercourse and 3% of not alleged (P < 0.01). Anal intercourse was in 6% of females and 58% of males (P < 0.01). Conclusion: Child sexual abuse is common among children above 10 years, during day time, by a known person at an outside place. Vaginal intercourse is common among girls above 10 years by ‘boyfriends’ with a tear at 5-7 O’clock position. Taut annular and crescentic hymen have a higher chance of getting torn than lax fimbriated hymen. Anal intercourse is committed on male than female children. Findings will be useful for medico-legal and holistic management, and evidence based prevention of child sexual abuse.