生殖器硬皮病被误认为是儿童性虐待和生殖器切割

Amit Patil, Mukta Agarwal, Prabhat Kumar, H. Narang, Shashank Ranjan
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摘要

儿童性虐待是全球普遍存在的严重问题。对儿童的性剥削是无法比拟的,其动态与成人性虐待非常不同,因此应区别对待和调查。对性虐待的误诊会使儿童面临进一步受虐待的风险,并可能导致严重后果。 本病例报告描述了对一名 17 岁女孩的法医检查,该女孩主要因主诉阵发性急性尿潴留和排尿困难而到妇产科就诊。在对她进行评估时,主治医生观察到大阴唇完全粘连和融合。这种不寻常的表现让主治医生怀疑是切割生殖器和儿童性虐待。检查发现,大阴唇不明显,像羊皮纸一样融合在一起,看不到小阴唇、阴蒂、处女膜和阴道口。 肛门生殖器区域没有新的受伤痕迹,也没有迹象表明近期做过任何疑似切割生殖器的手术。局部检查结果以及没有外伤或手术疤痕的迹象推翻了切割生殖器和性虐待的怀疑。患者的病症被诊断为硬化性苔藓和萎缩性苔藓,导致生殖器阴唇硬化。主治医生常常误认为这种病症是疑似性虐待的征兆,如果不能正确识别,可能会招致执法部门不必要的虐童调查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Genital Lichen sclerosus mistaken for child sexual abuse and genital mutilation
Child sexual abuse is a severe and widespread problem across the globe. The sexual exploitation of children is incomparable whose dynamics are very unusual to that of adult sexual abuse and hence should be handled and investigated differently. Failure to misdiagnose sexual abuse can expose the children to the risk of further abuse and may lead to serious consequences.  This case report describes the forensic examination of a 17-year-old girl who primarily presented to the obstetrics and gynecology department with complaints of episodic acute urinary retention and difficulty in passing urine. While evaluating her, the primary physicians observed complete adhesion and fusion of labia majora. This unusual presentation made the examining physicians suspicious of genital mutilation and child sexual abuse. The examination revealed that the labia majora was less appreciable and was fused like parchment-like skin with no visualization of labia minora, clitoris, hymen and vaginal opening.  There were no fresh signs of injuries to the anogenital region and no evidence of any surgical procedure done in the recent past suspected to be of genital mutilation. The local examination findings and absence of signs of trauma or surgical scar marks disproved the suspicion of genital mutilation and sexual abuse. The patient's condition was diagnosed with lichen sclerosus et atrophicus, causing genital labial sclerosus. The attending physicians often mistake such conditions as signs of suspected sexual abuse and if not correctly identified, may invite unwarranted child abuse inquiry by law enforcement authorities.
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