Examination techniques

1
Examination techniques

• Dr Jacqueline Mok
• Consultant Paediatrician
• Royal Hospital for Sick Children, Edinburgh

2
CSA examination

• Behaviour,demeanour, emotional state
• Appropriate for age?
• State of clothing
• Sexual development
• Superficial injuries - head and neck, mouth,
  breasts, arms, inner thighs, buttocks, perineum,
  genitalia, anus
• Detailed exam using colposcope

3
Examination techniques

• Supine frog-leg
• On examination couch, alone or lying against
  mother
• Inspection
• Labial separation
• Labial traction

4
Examination techniques

• Supine frog-leg
• Defining the anatomy of a fimbriated hymen
• Floating with saline
• Teasing with cotton bud
• Foley catheter

5
Examination techniques

• Supine knee-chest
• For anal examination
• Left lateral
• For anal examination
• Prone knee-chest
• For clarification of doubtful findings on hymen

6
Comparison of techniques

• Supine labial separation - good view of labia,
  vestibule and posterior fourchette
• Supine labial traction - largest transverse
  diameter
• Prone knee-chest - largest vertical diameter

McCann,1990,Pediatr
7
Hymenal diameter depends on

• age / stage of puberty
• position during examination
• degree of traction applied
• degree of relaxation of child
• examination under GA
• hymenal morphology
• time between abuse and exam

8
Documentation of visual evidence

• Written notes not always legible
• Drawings - subjective, difficult to challenge
• Photographs / slides - objective, dependent on
  examiners choice
• Videotapes / CDs - dynamic variability of the
  entire examination

9
Video-colposcopy

• Immediate viewing on monitor
• Dynamic 3-D procedure recorded on tape / CD
• Playback for review
• Images captured on photographs or slides
• Digitalised for computer analysis

10
Relate findings to

• Time of examination in relation to assault
• Examination position and state of child
• Examination technique abnormality must be
  demonstrated in gt1 position or gt1 method
• Duration of examination (eg venous pooling
  appearing after 1 minute)
• Relevant medical history