What to expect at a doctor's exam after molestation

Karen Kay Imagawa, MD, shares advice for parents on what to expect at a doctor's exam after your child has been molested and how to support your child during the exam
What To Expect At Your Child's Doctor's Exam After Molestation
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What to expect at a doctor's exam after molestation

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With respect to actual examination, if the child is required to have a true forensic evaluation for a child molestation, part of it depends on the time frame. So, if the molestation happened within 96 hours, most of the laws in different states is within 96 hours, there may be a need to do a rape kit. And this requires a lot of different forensic evidence. Really looking for DNA, for sperm samples for anything that might be able to help identify who the perpetrator is. If it's outside of that 96 hours, the rape kit is not necessarily to be done. But, we are still looking for any signs of molestation. Any old scars. Any old injuries or anything that might be more acute or recent. And in doing this kind of evaluation, it takes a special machine that's called a colposcope. And, it's basically just a magnifying lens. It looks externally, at external genitalia, as well as the anus. It does not go inside the child, it's strictly external type of exam. Most colposcopes can magnify somewhere between 5 times to maybe 15 times normal. So that we can look for any small signs of any injury, any kind of old tears, any kind of old scars. The only time where an internal type of evaluation would need to be done is if the child has really a significant laceration, or is bleeding, and physicians can't figure out where they're bleeding from. But, in a prepubertal child, so a child that has not yet started their period, their menstrual cycles, we would take them to the operating room. Put them under sedation, and examine them under sedation. For an older child, an adolescent who maybe already sexually active, we would do just like when you go to your gynecologist with a specular exam, and looking a little bit more internally. So, it's variable on what the concerns are, how old the child is, what types of injuries we are evaluating. So, the type of evaluation varies. Depending on the age of the child. The type of injuries. The concerns that we have. Whether or not we need to do more of a intensive evaluation or whether or not we can do of a more superficial evaluation.

Karen Kay Imagawa, MD, shares advice for parents on what to expect at a doctor's exam after your child has been molested and how to support your child during the exam

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Karen Kay Imagawa, MD

Director of the Audrey Hepburn CARES Center, Children's Hospital Los Angeles

Karen Kay Imagawa, MD: Director, Audrey Hepburn CARES Center, Director, Developmental-Behavioral Pediatrics Program, Division of General Pediatrics; Children's Hospital Los Angeles. Karen Kay Imagawa, MD, is also the Assistant Professor of Pediatrics at USC’s Keck School of Medicine and is a full-time attending within the Department of Pediatrics, Division of General Pediatrics, at Children’s Hospital Los Angeles (CHLA). She received her medical degree at the University of California, Los Angeles, and is board certified in General Pediatrics, Developmental-Behavioral Pediatrics, and Child Abuse Pediatrics.  Dr. Imagawa has made significant contributions to program development at CHLA: She is currently the Director of the Joint General Pediatrics – USC University Center for Excellence in Developmental Disabilities (UCEDD) Developmental-Behavioral Pediatrics Program ,expanding the program to its current position with the largest number of board-certified developmental-behavioral pediatricians (7) in a Southern California program, and was integral in establishing the ACGME accredited Developmental-Behavioral Pediatrics Fellowship program at CHLA . Dr. Imagawa is also one of the founders and the Director of the Audrey Hepburn CARES Center at CHLA, a multifaceted interdisciplinary child protection center involving evaluation, treatment, prevention, education and research in the field of child maltreatment.  Dr. Imagawa is a court appointed expert (730 paneled expert in both Criminal and Dependency Court) in the field of child abuse, and was actively involved in the development of the Foster Care Hub at CHLA, one of seven designated Hubs in Los Angeles County that were initially established to provide forensic, medical, and mental health screenings for newly detained children entering the foster care system.  She previously served on the advisory group for The California Medical Training Centers formulating standardized training in child abuse, and collaborated on a task force to develop standards at the state level for mental health care for child victims of trauma. She is a medical consultant for the Inter-agency Council on Child Abuse and Neglect (ICAN – the official county agency which coordinates the development of services for the prevention, identification and treatment of child abuse and neglect), having participated in various medical task forces establishing protocols and best practice standards for the evaluation and treatment of suspected victims of child abuse, included those with developmental disabilities. Dr. Imagawa’s strength as a clinical educator is also seen in her dedication to education and training. She has been invited to participate in numerous speaking engagements, as well as requests from the media and entertainment industry, involving a variety of topics in the fields of child abuse and/or developmental-behavioral pediatrics. 

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Transcription: 
With respect to actual examination, if the child is required to have a true forensic evaluation for a child molestation, part of it depends on the time frame. So, if the molestation happened within 96 hours, most of the laws in different states is within 96 hours, there may be a need to do a rape kit. And this requires a lot of different forensic evidence. Really looking for DNA, for sperm samples for anything that might be able to help identify who the perpetrator is. If it's outside of that 96 hours, the rape kit is not necessarily to be done. But, we are still looking for any signs of molestation. Any old scars. Any old injuries or anything that might be more acute or recent. And in doing this kind of evaluation, it takes a special machine that's called a colposcope. And, it's basically just a magnifying lens. It looks externally, at external genitalia, as well as the anus. It does not go inside the child, it's strictly external type of exam. Most colposcopes can magnify somewhere between 5 times to maybe 15 times normal. So that we can look for any small signs of any injury, any kind of old tears, any kind of old scars. The only time where an internal type of evaluation would need to be done is if the child has really a significant laceration, or is bleeding, and physicians can't figure out where they're bleeding from. But, in a prepubertal child, so a child that has not yet started their period, their menstrual cycles, we would take them to the operating room. Put them under sedation, and examine them under sedation. For an older child, an adolescent who maybe already sexually active, we would do just like when you go to your gynecologist with a specular exam, and looking a little bit more internally. So, it's variable on what the concerns are, how old the child is, what types of injuries we are evaluating. So, the type of evaluation varies. Depending on the age of the child. The type of injuries. The concerns that we have. Whether or not we need to do more of a intensive evaluation or whether or not we can do of a more superficial evaluation.