Focus on Pediatrics: Colposcope documents child sexual abuse exam

But doesn’t always provide evidence

A February on-line article by Reuters Health touted the use of the colposcope in the examination of sexually abused children, a new technique for German physicians who find its use less invasive. They also hope that this instrument, which is normally used by gynecologists to examine the cervixes of adult women, will reduce the need for children to testify in court.

While the German court system may be different than that in the United States, the use of the colposcope in examinations of sexually abused children does not change the need for the victim’s testimony in the United States, says Cindy Christian, MD, chair of Child Abuse and Neglect Prevention at the Children’s Hospital of Philadelphia and a frequent expert witness in child sexual abuse cases. In the United States, the instrument has been used at many centers that have seen sexually abused children since the 1980s.

The colposcope is a good lighting source, allows for some magnification, and for photographs to be taken. "It is a piece of equipment that can be used for good documentation of examinations," says Christian. Some practitioners use a video colposcope as well, she says.

However, the equipment doesn’t add a lot of information in terms of proving whether a child was sexually abused or not or identifying findings that are specific for injury related to sexual abuse. That’s because much of the examination focuses on things that can be seen by the naked eye, says Christian.

Also, most children who have been sexually abused have norSmal genital exams. Unlike adult rape, child sexual abuse is not frequently violent. Therefore, it does not usually injure the genitals. Often there is a lapse in time between the actual abuse and the disclosure. "By the time kids disclose their sexual abuse and get to a doctor’s office for an examination, their minor injuries will have likely healed. For those two basic reasons, it is a minority of young children who have been sexually abused who have abnormal genital exams," says Christian.

It is unnecessary to bring a photo of a child’s genitals to court as evidence, she says. "If there is injury, it is usually easy enough to simply draw it or discuss it or describe it," she says. Also, because jurists have never looked at these types of photographs, they don’t have a context for them. That makes it difficult for them to interpret the evidence.

In the United States, the most credible evidence has been the verbal history and disclosure by the child, says Christian. It is true that the colposcope can prevent children from having to have a number of different exams if someone requests it, but most just need one examination, she says.