Child sexual abuse: the impact of medical evidence on the legal outcome of criminal cases

INTRODUCTION: CSA represents a public health problem with a global lifetime prevalence of sexual abused children aged <18 years in 2011 of 7.6% (for male) and 18% (for female). The evidence of the conviction procedure has been hypothesized to depend on many factors as physical findings and quality of the child’s disclosures and testimonies. Nevertheless, most sexually abused children will not have signs of genital or anal injury, especially when examined non-acutely. The objective of this review is to investigate the impact of medical evidence (i.e. bodily and/or anogenital injuries) found during medical examination on the outcome of criminal proceedings for CSA, in order to understand the contribution of the healthcare providers. EVIDENCE ACQUISITION: This review was conducted in adherence to the guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). After the screening phase, 13 publications were assessed as eligible for full-text assessment. Finally, four articles were added though backward search (analyzing the cited references in the selected articles), resulting in 17 articles included in the conceptual review. EVIDENCE SYNTHESIS: Overall, four studies found a positive association between medical evidence and the legal resolution of cases, six studies found no association, and seven studies showed that medical findings are only relevant for the initial stages of the legal process or in the final stages of the process if associated with other variables. CONCLUSIONS: This review revealed contrasting results concerning the influence of medical examination findings on the judicial outcome of criminal cases of child sexual abuse, highlighting the complexity of the issue. Health professionals and all criminal justice system personnel need to be better informed about how to interpret the presence or absence of injuries and other medical findings. Anyway, it is crucial that medical documentation follows rigorous forensic standards and provides a detailed description of the evidence for investigative and judicial authorities.