One of the scariest types of cases to defend even in my experience, even over that of a death penalty case, is a case where actual penetration of an infant’s or near infant’s genitals is thought to have occurred.  These types of cases oftentimes involve someone who cannot speak or testify or is legally deemed incompetent to testify due to age.  Many times these cases have little or no meaningful forensic science, but rely strictly on the fact that there is damage to the perineal area.

As a result sometimes even seemly experienced physicians or pathologists can easily mistake or make a hasty decision that the damage to the perineal area or genital-urinary apparatus can only come from intentional sexual abuse.

There are many causes that may present consistent with what one may find in abuse but instead are congenital problems in the perineal area or genital-urinary apparatus such as periurethral bands, labial adhesion, vaginal ridges, urethral dilatation and erythema of the vestibule.  There are even many case reports reported in the medico-legal world that conclude that there is an accidental mechanism of cause for the injury.  These events include aggressive stretching during innocent play, motor vehicle accidents, falls from medium height, bicycle-related accidents (which were reported as “prevalent” in those under the age of 9 years old, playground-related equipment and even intentional child self-mutilation during “normal” exploration of themselves.

The forensic community relies heavily on the “investigation” of the circumstances and especially does so in the case of lack of physical evidence.  In the police science investigatory realm, the investigators are taught to closely question the caretaker or person of significant opportunity  to look for:  minimization of the injuries, minimization of the person’s caretaking role, reports of substance abuse by the caretaker, mental illness in the caretaker, other signs of neglect/malnourishment/other physical abuse in the child, attempts to minimize the nature or seriousness of the injury, not having vaccinations up-to-date and finally my favorite either a “lack of significant protest that there was abuse” or “too much concern that there may have been abuse while regularly protesting that they are the perpetrator.”

Also, they are tasked to examine a “change in the child’s behavior” such as sleeping, eating or social interaction (e.g., extreme withdrawal or aggressiveness or self-destruction, or inappropriate sex play or premature understanding of sex).

One of the most useful aspects that one who accepts the challenge of examining the Government’s accusation that there was in fact abuse is to understand very basic anatomy (the study of form and function, in plants, animals, and other organisms, or specifically in humans) and anthropometry (refers to the measurement of the human individual for the purposes of understanding human physical variation).  It basically asks:  Is this story even physically possible?

In girls under 6 years of age carnal penetration is impossible for anatomic reasons: the subpubic angle is still very acute and therefore creates a true bone barrier which obstructs penetration by the penis.  In girls between the ages of 6 and 11 years, because of the disproportion in size of the genital organs, carnal penetration causes serious tears with serious bleeding to the vulvo-vaginal walls, to the perineum, and to the rectal walls.  From 11 years of age until menarche there is hymenal laceration and minimal trauma to the genital and paragenital areas. In adult virgins, penetration can cause only hymenal alteration dependent on the anatomical variations of the membrane, unless there is particular violence used.

While no one can possibly condone child abuse and it is truly an abomination against humanity, we need to be diligent in our investigation to make sure that such a serious accusation is indeed supported by the scientific, anatomical and anthropometric reality of human beings.