Child sexual abuse enquiries and unrecognised vulval lichen sclerosus et atrophicus
P L Wood and T Bevan Find that unrecognised vulval dystrophy in young girls may wrongly suggest childhood sexual abuse
Lichen sclerosus et atrophicus in young girls can present as haemorrhagic areas on the vulva. Failure to consider this diagnosis and to treat the condition appropriately may lead to a mis diagnosis of child sexual abuse, resulting in a lengthy and distressing investigation for all concerned, particularly the parents. There was extensive publicity surrounding these issues in the United Kingdom after events in Cleveland in 1987. We present three patients with lichen sclerosis et atrophicus. In each case, investigations into child sexual abuse had been instigated before an appropriate referral and correct diagnosis were made.
The symptoms of itching and soreness can be troublesome, and a young child may try various ways of obtaining relief, some of which may be mistakenly interpreted as masturbatory behaviour.4 Masturbation is not uncommon in children,5 but rubbing may lead to concerns over possible sexual abuse if it is perceived as inappropriate childhood behaviour.