Going to the doctor

Why Does My Child Need To See A Doctor ?
What Sort Of Doctor Will My Child See ?
What Happens In The Examination ?
Will The Examination Hurt ?
What Genital (and/or Anal) Injuries Are Likely ?
Can There Be Any Permanent Problems ?
Can I Ask Questions And Discuss Worries ?
Who Will Be Given Information About The Examination ?
If It Is Necessary For The Offender To Be Apprehended...

Information for families and children on the medical care and assessment of sexual abuse and assault.

As part of any investigation into the sexual abuse or rape of a child or adolescent, a doctor's examination is required.
Parents, children and adolescents all have their own questions and concerns about the procedures involved. This pamphlet will answer some of them.
If you, or your child, or teenager have other questions, make sure they are answered too.
Ask either the person who arranges the appointment or the doctor who carries out the examination.
This pamphlet is written for the parents of a dependent child. Mature adolescents may prefer to read it for themselves. They may also prefer to be alone for the examination, or have a support person from outside the immediate family. Again, this can be discussed with the doctor.

Why does my child need to see a doctor?

The most important reason for a doctor's examination is to protect the child. A doctor can make sure that your child has no injury, infection or other physical problem that may require treatment. Usually, there are no such problems, but it is very important that the child is reassured about that.

If there are physical signs of abuse, consistent with the child's history, the examination will also be used to support the child's evidence if the person who abused the child should ever be prosecuted.

back to top^

What sort of doctor will my child see?

Doctors who examine children who have been abused require special training. There are skills involved in making a child feel comfortable and secure, and in examining for any infection, injury, or emotional problem. If you feel uncomfortable or unsure about this medical care, there are people you can talk to about this - for example, the social worker, or your own family doctor - or you can seek the help of DSAC, which is a group of doctors specialising in sexual abuse care.

back to top^

What happens in the examination?

First, there must be time to talk. The doctor will want to know about any medical problems or illnesses your child may have, and about your child's world of family, pre-school or school.

The doctor will also discuss what has happened to your child. It may be necessary
for some discussion to take place without you. This is done to help a child talk about anything that may make the child feel confused, embarrassed, or to-blame. It is important for the doctor and child to share this special information as it will help the child feel comfortable and trust the doctor during the examination.

The doctor must learn enough of the child's history to know what to look for, and also to help the child realise that examination will include looking at the genital and anal areas - the "pnvate parts".

back to top^

Will the examination hurt?

No. However, there may be some discomfort if the child is really anxious. You can help avoid this by supporting your child during the examination. In the case of an older child or adolescent, relaxation and understanding of the procedures involved will avoid discomfort.

As in a normal medical examination, the doctor will examine the "whole" child.
Height, weight and blood pressure may be taken, ears and mouth examined, and heart and lungs listened to. Much of this, including examination of the anal and genital areas, requires "looking only".
A blood test may be requested, for infection screening. Infection screening may also require samples from the throat, genital areas' and anus, and if so, these are taken with special moistened cotton buds.
An adolescent girl may need to provide a urine sample if there is any possibility of pregnancy.
It is not always easy to see, during a visual examination, whether findings are normal or not. Sometimes, it is necessary to magnify the genital and anal areas to make sure. If so, you and your child will be told about these procedures before the examination, so that you can give your consent and understand why they need to be done. A special instrument allows photographs to be taken so that the findings are recorded.
One of the advantages for the child is that the examination does not need to be repeated. Photographs provide an accurate record, as an x-ray does.
For girls, an internal examination is very rarely necessary unless puberty has been reached. If it is necessary, the doctor will explain why. The instrument used is a speculum - the same instrument as that used to open the vagina to take a smear test. It is important that the speculum is the right size for the patient - small sizes are available if required, so there should be no real discomfort.

If your child is seen within 72 hours of a sexual assault or rape, a special medical examinaton kit may be used. The doctor will explain each section of this. It is merely a way of making sure that all possible laboratory evidence of the offence is collected, and retained in an environment which will preserve it in case of some future prosecution.

The examinations described should not hurt. Swab taking and the use of a speculum may be uncomfortable, but your reassurance and the child's trust in the doctor can prevent even this.

back to top^

What genital (or anal) injuries are likely?

Most children have no physical injuries at all. Some will have very minor findings, only recognisable to a doctor trained in dealing with child sexual abuse. These will not affect the child, and will disappear quickly.

Only in an acute and forceful situation, are there likely to be cuts and bruises. Occasionally if these are very painful, they require careful examination under a general anaesthetic.
Very rarely, they may require stitching.

The important thing to realise is that any injury can heal to normal.
No child should worry that damage will be permanent or remain to show others what has happened. Even if infection is present, prompt treatment may prevent later troubles from sexually transmitted diseases. On occasion there may be fear that AIDS has been passed on to the child. This can be tested for, and followed up.

back to top^

Can there be any permanent problems?

The most damaging effects are emotional. Without help, they can go on to affect the child in later life. For this reason, counselling and support for ~the child is extremely important. The examining doctor will make sure this is available. The Accident Compensation Corporation (ACC) will pay for this therapy at a doctor's request.

Your child has been through a crisis. First there was the abuse/assault itself. Then there was the inevitable trauma that disclosure' sure and investigation brings in its 'wake. Counselling is really important.'

Often, parents and other family members need help, too. It is difficult for everybody close to the child to cope with their own feelings about what has happened. Please tell the doctor who sees your child, or your own doctor, about this so that your needs are met too.

back to top^

Can I ask questions and discuss worries?

It is absolutely necessary that you do this. Questions and worries are expected in this situation. An older child or adolescent may need time to tell the doctor his or her own concerns alone. Please don't resent this. It is normal.
Parents are often confused, hurt, or angry and children often feel guilty, particularly if they did not tell what was happening to them at the time. Child and adult have a quite different response to overwhelming threat.

Some examples:

Boys often worry that they may become homosexual as a result of abuse. This is not a realistic fear, but it doesn't stop them worrying unless they have good counselling. In the same way, girls (and their parents) may worry about a loss of 'virginity', the possibility of pregnancy, or infection and later implications.

These worries need to be voiced. The examining doctor will be used to such questions, and is experienced in discussing issues of sex and the feeling and reactions that children and parents may have a' a result of their experience. The most appropriate counselling for the child an/or the family can then be arranged.

back to top^

Who will be given information about the examination?

Where no prosecution is involved the information about the examination is entirely confidential.

With your consent, a claim to the ACC which enables you to receive help and counselling, can be completed. The doctor completes the forms, which do not require the disclosure of private details, and will discuss this with you.

With your consent, the examining doctor, will advise your family doctor. We believe this is important because he/she is responsible for continuing care in the future. However, this is entirely your decision.

back to top^

If it is necessary for the offender to be apprehended the results of the examination will be passed on to a member of a specially trained team from the police and 'Department of Social Welfare (DSW) - the Sexual Abuse Team (SAT). They will treat the information with strict confidentiality.
You may have already seen a member of the team. If not, a SAT member trained to interview children will be responsible for taking a history from your child, yourself, and if necessary, other family members.

It is important that the Sexual Abuse Team is involved. Working in this way, the investigation, including the medical examination, is completed with the least distress to the child and family. In addition, ,the DSW has statutory powers which, if needed, can be used to, protect the child, while the police have the statutory powers to apprehend and interview the offender.

No family can deal with these responsibilities alone.


You have been through a very traumatic experience.
As doctors, we may not have shared that experience, but we do recognise its impact.
Please feel free to discuss or question any aspect of the treatment we can offer.

Office Location: Unit 5/4 Warnock Street
Grey Lynn Auckland Postal Address: PO Box 90 723 Auckland

Telephone: (+64 9) 376 1422
Facsimile: (+64 9) 376 0790
Email: dsac@ihug.co.nz