National Guidelines on Management of Sexual Violence in Kenya

The following pieces of information are essential for medical history:
• When do you say this happened?
• When is the first time you remember this happening?
• Threats that were made?
• What area of your body did you say was touched or hurt?
• Do you have any pain in your bottom or genital area?
• Is there any blood in your panties or in the toilet?
• Any difficulty or pain with voiding or defecating?
• First menstrual period and date of last menstrual period (girls only)?
• Details of prior sexual activity (explain why you need to ask about this).
• History of washing/bathing since assault.
3.2.2 Head to Toe Examination for Children
The physical examination of children can be conducted according to the procedures
outlined for adults in section 3.1.1 (Head to toe examination for adults). When
performing the head-to-toe examination of children, the following points are important:
• Record the height and weight of the child;
• In the mouth/pharynx, note petechiae of the palate or posterior pharynx, and
look for any tears to the frenulum;
• Record the child’s sexual development and check the breasts for signs of injury.
3.2.3 The Genito-Anal Examination for Girls
Remember that in most cases, a speculum exam is not indicated. It is only indicated
when the child may have internal bleeding arising from a vaginal injury as a result of
penetration.
• In this case, a speculum examination should be done under general anaesthesia;
• Examine the anus. Look for bruises, tears or discharge. Help the child lie on
her back or on her side;
• The child may need to be referred to a higher level health facility for this
procedure;
• For small girls, a paediatric speculum is recommended.
Whenever possible do not conduct a speculum exam on girls who have not reached
puberty. It might be very painful and cause additional trauma.
3.2.4 The Genito-Anal Examination for Boys
• Check for injuries to the skin that connects the foreskin to the penis;
• Check for discharge at the urethral meatus (tip of penis);
• In an older child, the foreskin should be gently pulled back to examine the
penis. Do not force it since doing so can cause trauma, especially in a young
child;
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