TABLE 127.1 CONDITIONS MISTAKEN FOR SEXUAL ABUSE TRAUMA Variants of normal anatomy Nonabusive trauma Vestibular bands (periurethral, hymenal); hymenal skin tags, septa, clefts; median raphe; linea vestibularis (hymen, posterior fourchette); perianal erythema; anal dilation; failure of midline fusion Straddle injuries; impalement to anogenital structures; zipper injuries; suction drain injury; toilet seat injury Dermatologic Lichen sclerosus; seborrheic, atopic, or contact dermatitis; psoriasis; hemangioma, pseudoverrucous perianal papules Infectious Staphylococcus aureus (impetigo); Group A streptococcus (balanitis, vaginitis, anal); shigella or salmonella (infectious diarrhea); human papillomavirus (perinatal and horizontal transmission); molluscum contagiosum; autoinoculation of oral HSV infection or herpetic whitlow; scabies; diaper candidiasis; parasitic (pinworms) Inflammatory/allergic Crohn disease; Kawasaki disease; Behỗet syndrome; erythema multiforme; Stevens– Johnson syndrome, milk-protein allergy Miscellaneous Idiopathic thrombocytopenic purpura; prolapse (urethral, rectal); labial fusion; hair tourniquet; retained foreign body Clinical Recognition While many patients will present to the ED with a chief complaint of assault or abuse, the ED clinician should consider the potential for sexual assault in patients with injuries that not match the provided history Triage