Use of the colposcope in childhood sexual abuse examinations

The addition of the colposcope to the armamentarium of the medical investigator of childhood sexual abuse has many advantages. The ability to accurately record anatomic findings has implications for the medical community, the judicial system, the accused, the victim, and the family. Through the use of the photographs produced by this instrument, examiners can inspect physical findings without the time constraints imposed by the short attention span of the young child. If necessary, colleagues can be consulted and interpretations discussed. The availability of these photographs to the courts has reduced the need to re-examine the child for another opinion. The colposcopic photograph has also proved to be an excellent teaching and research tool. As an aid to teaching, the photographs and slides produced by this instrument help the instructor demonstrate anatomic findings while allowing the student time to ask questions. As a research tool, this instrument has opened up a myriad of possibilities for medical examiners. It has facilitated the collection of clinical data, it has allowed the standardization of examination techniques, and with the help of computers it has made possible the sophisticated analysis of the information collected. The colposcope has limitations. Aside from its cost, it is a difficult instrument to use in the examination of the young child. The time required for an examination can increase substantially as the examiner attempts to maneuver the scope into a proper position. During this procedure, the maintenance of the child in a suitable state of relaxation, while avoiding further emotional trauma, can be a challenge. The reality that the photograph is two dimensional and represents only the findings at that moment will always be a limiting factor in its use as a means of assessing a child's anatomy. Even the multimethod approach employed to offset this problem may compound the situation by further increasing the length of the examination. Most of these and other dilemmas encountered in the use of the colposcope can be solved by additional experience with this instrument. Despite the improvements brought about by the introduction of the colposcope, more advanced technology may be needed to help solve some of the problems currently plaguing medical examiners. The use of video tape could provide a solution to the documentation of the changes that occur in the soft tissues as the child moves or becomes more or less relaxed. The potential of the computer appears unlimited, and its application to the problem of the interpretation of findings could make a significant contribution to the field.(ABSTRACT TRUNCATED AT 250 WORDS)