Sage Publications Description: This manual is intended to serve as a reference guide for health care
professionals whose job includes evaluating children where there is an
allegation of sexual abuse. It is intended for several professional groups, not
just medical professionals, although the evaluation primarily described
is a medical examination of children's genitalia. There are eight
chapters, an index, and a description of the authors in
152 pages. After defining the problem in Chapter 1 and offering general
guidelines for evaluations in chapter 2, a brief and elementary description of
the process of interviewing children forms Chapter 3. Chapters 4 and 5 present a
set of basic instructions on how to do a physical examination and make a
differential diagnosis. These chapters are greatly assisted by many large and
clear photographs of child genitalia to show what is being described. Chapter 6
gives summary information on some of the sexually transmitted diseases while
Chapter 7 offers a short discussion of a mental health assessment. The final
chapter is a brief statement about the importance of keeping accurate records
and documentation. Discussion: Although clearly written, this book is so elementary and basic that it seems likely to be useful only to nonmedical professionals who have no real sophistication about medical practice. However, the authors report a study of pediatricians which found a surprising level of ignorance about children's genitals. Among other surprising findings are that only 59% of pediatricians could correctly label the hymen. It may be that the elementary level of this book is what is needed for pediatricians also. The manual can be quite helpful to the nonmedically trained professional who has to understand or use the results of a medical evaluation of a child suspected of being a victim of sexual abuse. However, the book does not quite present the full range of caution that must be exercised in dealing with medical evaluations. To benefit from reading this book, its conclusions, procedures, and recommendations must be viewed cautiously; particularly given recent research data on the genitalia of normal, nonabused children and the bias of many physicians who do sexual abuse evaluations. Accepting its generalizations without limits and qualifications would increase the error in the direction of false positives. As an example, the authors do not even list McCann's research on genital findings in their bibliography although they refer to his article on examination positions and anal findings. A careful reading of McCann's data leads to some questions about the meaning and interpretation of physical observations made by these authors. Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.
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