Genital Lichen sclerosus mistaken for child sexual abuse and genital mutilation

Abstract

Child sexual abuse is a severe and widespread problem across the globe. The sexual exploitation of children is incomparable whose dynamics are very unusual to that of adult sexual abuse and hence should be handled and investigated differently. Failure to misdiagnose sexual abuse can expose the children to the risk of further abuse and may lead to serious consequences.  This case report describes the forensic examination of a 17-year-old girl who primarily presented to the obstetrics and gynecology department with complaints of episodic acute urinary retention and difficulty in passing urine. While evaluating her, the primary physicians observed complete adhesion and fusion of labia majora. This unusual presentation made the examining physicians suspicious of genital mutilation and child sexual abuse. The examination revealed that the labia majora was less appreciable and was fused like parchment-like skin with no visualization of labia minora, clitoris, hymen and vaginal opening.  There were no fresh signs of injuries to the anogenital region and no evidence of any surgical procedure done in the recent past suspected to be of genital mutilation. The local examination findings and absence of signs of trauma or surgical scar marks disproved the suspicion of genital mutilation and sexual abuse. The patient's condition was diagnosed with lichen sclerosus et atrophicus, causing genital labial sclerosus. The attending physicians often mistake such conditions as signs of suspected sexual abuse and if not correctly identified, may invite unwarranted child abuse inquiry by law enforcement authorities.