National Guidelines on Management of Sexual Violence in Kenya
National Guidelines on Management of Sexual Violence in Kenya
National Guidelines on Management of Sexual Violence in Kenya
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• Take a swab <strong>of</strong> the external genitalia before attempt<strong>in</strong>g any digital explorati<strong>on</strong><br />
or speculum exam<strong>in</strong>ati<strong>on</strong> Gently stretch the posterior fourchette area to<br />
reveal abrasi<strong>on</strong>s that are otherwise difficult to see.<br />
• If any bright blood is present, gently swab <strong>in</strong> order to establish its orig<strong>in</strong>, i.e.<br />
whether it is vulval or vag<strong>in</strong>al.<br />
• Warm the speculum prior to use by immers<strong>in</strong>g it <strong>in</strong> warm water.<br />
• Insert the speculum al<strong>on</strong>g the l<strong>on</strong>gitud<strong>in</strong>al plane <strong>of</strong> the vulval tissues and then<br />
rotate it <strong>in</strong>to its f<strong>in</strong>al positi<strong>on</strong> <strong>on</strong>ce the <strong>in</strong>itial muscle resistance has relaxed.<br />
• Inspect the vag<strong>in</strong>al walls for signs <strong>of</strong> <strong>in</strong>jury, <strong>in</strong>clud<strong>in</strong>g abrasi<strong>on</strong>s, lacerati<strong>on</strong>s and<br />
bruis<strong>in</strong>g. Collect any trace evidence, such as foreign bodies and hairs if found.<br />
• Suture any tears if <strong>in</strong>dicated.<br />
• Before remov<strong>in</strong>g the speculum, do a warm sal<strong>in</strong>e vag<strong>in</strong>al wash.<br />
3.2 History Tak<strong>in</strong>g and Exam<strong>in</strong>ati<strong>on</strong> for Children<br />
General approach:<br />
• Always ensure patients privacy;<br />
• Approach all children with extreme sensitivity and recognize their<br />
vulnerability;<br />
• Try to establish a neutral envir<strong>on</strong>ment and rapport with the child<br />
before beg<strong>in</strong>n<strong>in</strong>g the <strong>in</strong>terview;<br />
• Try to establish the child’s developmental level <strong>in</strong> order to understand<br />
any limitati<strong>on</strong>s as well as appropriate <strong>in</strong>teracti<strong>on</strong>s. It is important to<br />
realize that young children have little or no c<strong>on</strong>cept <strong>of</strong> numbers<br />
or time and that they may use term<strong>in</strong>ology differently from adults<br />
mak<strong>in</strong>g <strong>in</strong>terpretati<strong>on</strong> <strong>of</strong> questi<strong>on</strong>s and answers a sensitive matter;<br />
• Stop the exam<strong>in</strong>ati<strong>on</strong> if the child <strong>in</strong>dicates discomfort or withdraws<br />
permissi<strong>on</strong> to c<strong>on</strong>t<strong>in</strong>ue;<br />
• Always prepare the child by expla<strong>in</strong><strong>in</strong>g the exam<strong>in</strong>ati<strong>on</strong> and show<strong>in</strong>g<br />
equipment; this has been shown to dim<strong>in</strong>ish fears and anxiety;<br />
• Encourage the child to ask questi<strong>on</strong>s about the exam<strong>in</strong>ati<strong>on</strong>;<br />
• If the child is old enough, and it is deemed appropriate, ask whom<br />
they would like <strong>in</strong> the room for support dur<strong>in</strong>g the exam<strong>in</strong>ati<strong>on</strong>.<br />
Some older children may choose a trusted adult to be present;<br />
• Always identify yourself as a help<strong>in</strong>g pers<strong>on</strong>;<br />
• Ask the child if s/he knows why s/he has come to see you;<br />
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