Lesson of the week Child sexual abuse enquiries and unrecognised vulval lichen sclerosus et atrophicus

Abstract

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 misdiagnosis 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. ### Case 1 A 6 year old girl was admitted to hospital as an emergency under the care of the paediatricians. There was a history of a suspected accidental fall, after which the girl's mother noticed blood staining on her daughter's underwear The girl lived with her mother and her mother's partner and visited her natural father once a week. The local social services department had already been involved about six months previously because of a history of suspected, unexplained perineal trauma. At that time, after a visit to her father, the girl had complained of soreness around the vulva, and a brown discharge had been noticed on her underwear. The girl's mother had described continuing vaginal ulceration which did not heal completely. The symptoms had persisted despite antibiotic treatment, acyclovir for suspected genital herpes simplex infection (which prompted further investigation because of the association with child sexual abuse), and reassurance. …