Clinical and Laboratory Findings When Pediatric Male Sexual Assault Survivors Present to the Emergency Department

OBJECTIVE: The child sexual abuse (CSA) literature demonstrates that the majority of female pediatric survivors present with normal, uninjured, and uninfected anogenital examinations, yet the clinical presentation of male survivors remains underexplored. This study describes the history, clinical presentation, and medical examination findings of boys and male adolescents presenting to a large urban children's hospital emergency department (ED) seeking care for sexual assault. METHODS: A retrospective cross-sectional chart review was conducted for male patients aged 0-18 years who presented to an urban pediatric ED following a chief complaint of CSA or acute sexual assault between October 2019 and March 2024. Data extracted included patient demographics, history of the present illness, elapsed time to evaluation, and documented anogenital examination and laboratory findings. RESULTS: A total of 92 male patients with 93 system encounters met the inclusion criteria. The median age at presentation was 12.9 years. Like patterns for female counterparts, male sexual abuse survivors evaluated in the ED manifested only rare physical trauma or acute infection. Normal healthy anatomy was documented in 93% of patients who allowed physical examinations. Acute physical injury or positive laboratory findings were identified in only 7% and 3% of tested cases, respectively. CONCLUSIONS: Male pediatric CSA survivors evaluated in the ED rarely manifest anogenital trauma or acute infection upon medical examination. These findings align closely with established female pediatric cohorts and emphasize that a lack of physical or laboratory findings should be anticipated in both male and female pediatric patients disclosing sexual abuse in an acute care setting.