Sex Abuse Hysteria - The Physicians¹

Richard A. Gardner*

We in the medical profession are part of the network of people involved in the sex abuse hysteria.  Psychiatrists, like the author, have become involved as evaluators (we do not call ourselves "validators") and as therapists.  Unfortunately, there are psychiatrists whose level of evaluation is no better than the validators described in Chapter Six.  Unfortunately, as well, there are psychiatrists who "treat" the children who have been diagnosed as having been sexually abused.  Such psychiatrists accept these people as "experts" and then "treat" the child.  It would be an error for the reader to assume that I have any less scorn for these medical colleagues than I do for those in other professions who treat children for sex abuse when there is little if any evidence that such abuse took place.

A recent development in the field of psychotherapeutic psychiatry is the "uncovering" of early sex abuse that the patient never realized took place.  This has been very much in vogue during the last few years.  Sometimes, the process starts with the psychiatrist "suspecting" sex abuse on the basis of allegedly derivative statements and symptoms that are "suggestive" of early childhood sex abuse.  When the patient expresses puzzlement and even disbelief, he (she) is encouraged to enter into a more meaningful and deeper (sometimes on the couch) therapy in order to "uncover" these lost memories.

Human beings, suggestible and gullible animals that we are, are likely to comply with the psychiatrist's prediction and provide the psychiatrist with the "lost" material.  Such patients, then, go around the rest of their lives proudly telling others how they learned in their treatment how they were sexually abused as children and that this revelation not only served as an important advance in their treatment but brought about other changes that would not have been possible without the revelation.  Some even believe that it was the sex abuse that was at the root of many (if not most) of their problems and that now that it has been brought into conscious awareness the symptoms that derive from it have been reduced significantly, if not evaporated entirely.

Such a statement is testimony to the credulity of the human being.  It is patently preposterous if the sex abuse never took place (a likely possibility).  However, even if there was sex abuse, it is extremely unlikely that most of the patient's problems were derived from this experience (or even experiences).  No symptom is caused by one event or one type of event.  Symptoms are multi-determined.  Furthermore, insight is only one small part of the therapeutic process.  Such scenarios may make good movies and novels, and may make the author a lot of money, but they have nothing to do with real therapy as it takes place in the real world.

Interestingly, an even more recent development is the suspicion by patients — arising within themselves — that they may have been sexually abused and were not aware of it.  Here, it was not the therapist who suggested this possibility, but the patient.  Like all phenomena, this phenomenon has multiple determinants, which vary with each individual.  Perhaps some of the people actually were sexually abused and the therapeutic inquiry is warranted.  Others, I am certain, were never abused but may be looking for a simple answer to explain their problems and, by implication, a magical solution to their difficulties.  Others, I am certain, are just keeping with the Joneses and have been affected by the mass hysteria phenomenon.

Physicians in other branches of medicine have also become deeply involved.  This is especially the case for pediatricians, pediatric gynecologists, and people from other branches of medicine (such as internal medicine and family practice) who have become experts" on sex abuse in recent years.  Those who diagnose sex abuse in the vast majority of cases presented to them are generally attractive to prosecutors who can rely upon them to provide the "definitive medical evidence" that is the "proof" that sex abuse took place.  Those who rarely find sex abuse are likely to be engaged by defense attorneys in order for them to testify that the child is "normal" and that there was "no evidence for sex abuse."  Although there are people who claim that they are completely neutral, my experience has been that most people who are doing this king of work have a reputation (whether warranted or not) for being in either of the two camps.

There are doctors (even pediatricians) who claim that any inflammation of a little girl's vulva is a manifestation of sex abuse.  Most, however, claim that this is an extremely common finding and can result from sweat, tight pants, certain kinds of soap, and the occasional mild rubbing (and masturbatory) activity of the normal girl.  There are some who hold that the normal hymen is a perfect circle (or close to it) without any irregularities.  It follows, then that if any irregularities are found these must have been artificially created by the insertion of something else (like a crayon or pencil).  There are others who claim that the normal hymen is most often not a circle and there are irregularities, tags, and bumps.  Others hold that these irregularities (referred to as a serrated hymenal orifice) are within the normal range of hymenal variation (I am in agreement with this group).  Some claim that a three-year-old girl's vagina can accommodate an adult's fingers and even penis without necessarily showing signs of physical trauma — other than the production of the aforementioned irregularities, tags, and bumps.  Others claim that the insertion of an adult male penis in a three-year-old girl's vagina will produce severe pain, significant bleeding, and deep lacerations and that the insertion of crayons and pencils at that age is extremely rare because of the pain and trauma that such insertion will produce (again, I am in agreement with this group).

There are significant differences of opinion regarding what is the normal size of the hymenal opening and this, of course, bears directly on the question of abuse.  Most agree that there have not been large studies of many children at different ages with regard to what the normal hymen looks like, its size, and whether or not it is indeed circular.  Furthermore, all do agree that the older the child the greater the likelihood the vaginal opening will accommodate a penis without significant trauma and so that by the age of nine or ten one does not get the same degree of trauma that one may get at younger ages.  Most agree, as well, that children of nine and ten, whose vaginal orifices are still small, could still be brought to the point of intercourse with an adult by gradual stretching of the vagina in the course of repeated experiences in which progressively larger objects (fingers, and ultimately a penis) are inserted.  There are some who hold that a certain type of dilatation ("winking") of the anal mucosa is pathognomic of penile penetration into the anus.  There are others who claim that such dilatation is normal (again, I am with the group that holds that the puckering described here is most often normal and is not a manifestation of sex abuse).

The net result of this is that there are sharply divided opinions among physicians regarding whether or not a particular child has been sexually abused.  However, this does not stop each side from bringing in a parade of its own physicians who will predictably provide the "proof" or "no proof' findings that are requested.  Another result is that many doctors are making a lot of money, especially because providing court testimony can be quite remunerative.  Wakefield and Underwager (1988 & 1989) provide a comprehensive review bf the literature on the present status of medical findings in sex abuse evaluations.

(Editor's note: Also see Lee Coleman, Medical Examination for Sexual Abuse: Have We Been Misled?, Issues in Child Abuse Accusations, 1989, Volume 1, Number 3).