August 1991

Anal Fissure Produced by Examination for Sexual Abuse-Reply

Author Affiliations

Emanuel Hospital & Health Center 2801 N Gantenbein Ave Portland, OR 97227; Kempe National Center 1205 Oneida St Denver, CO 80220

Am J Dis Child. 1991;145(8):849. doi:10.1001/archpedi.1991.02160080022011

In Reply.—The case described by Baker is unfortunate. It is intrusive and even abusive for a child to be taken to multiple examiners for repetitive genital examinations. Herman-Giddens and Berson1 have described parents who focus excessively on their child's genitalia, including parents who performed genital inspections or took the child for multiple examinations or procedures by professionals. Many physicians have not been trained to perform detailed genital examinations,2 and further confusion arises if the examiner is unsure or mistaken in interpreting physical findings. It is unfortunate that the mother in the case described by Baker, and apparently the child protective authorities, "remained convinced that abuse had occurred" even after being informed that the "bruise" was a venous plexus.

Regardless of whether a child is being molested, unresolved allegations of sexual abuse in the context of a divorce or custody dispute create additional stress for the child. These

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