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Kentucky Child Sexual
Abuse Medical Protocol
and Resources

Below are up-to-date reference materials for medical providers who are treating children for concerns of abuse.

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Kentucky Medical Protocol for Child Sexual Assault/Abuse Evaluation

This protocol offers comprehensive recommendations for medical providers caring for children who present with concerns of sexual abuse or assault.

Kentucky Medical Protocol for Child/Adolescent Sexual Assault/Abuse Evaluation Flow Chart

This chart provides a clinical decision tool for evaluating pediatric/adolescent sexual assault/abuse.

Appendices for the Kentucky Medical Protocol for Child Sexual Assault/Abuse Evaluations

Appendix A - Tanner Stages Chart 

Provides a chart of the Tanner stages of development (prepubertal to adult).

Appendix B - Strangulation References

Designed by the Training Institute on Strangulation Prevention, these illustrations depicts signs and symptoms of strangulation in both pediatric and teen patients.

The Strangulation Quick Reference Guide

The Strangulation Quick Reference Guide from Alliance for Hope and the Training Institute on Strangulation Prevention provides guidance regarding questions to ask patients and documentation of injuries specific to strangulation.

Appendix C - Illustrations of Exam Positions and Techniques

This document, from the National Protocol for Sexual Abuse Medical Forensic Examinations – Pediatric, illustrates exam positions and techniques.

This document, illustrating clinical photography of genital findings techniques, was created by the KASAP Medical Protocol Work Group.

Appendix D - Diagrams of Genital Anatomy

Diagrams of pediatric male and female genital anatomy are from the National Protocol for Sexual Abuse Medical Forensic Examinations – Pediatric.

Appendix E - Types of hymens

This diagram, illustrating types of normal hymens, was created by the KASAP Medical Protocol Work Group.

Links to the references/resources discussed in the Medical Protocol

Statistics regarding child sexual abuse in Kentucky

The Children’s Bureau of the U.S. Department of Health and Human Services publishes statistics annually on child abuse reports by state.

National Protocol for Pediatric Sexual Medical Forensic Examinations

This National Protocol for Sexual Abuse Medical Forensic – Pediatric is intended to be a guide for health care providers who conduct sexual abuse medical forensic examinations of prepubescent children, as well as other professionals and agencies/facilities involved in an initial community response to child sexual abuse.

Map of local advocacy agencies

Kentucky is served by regional sexual assault programs. Each program provides advocates to respond to victims at hospitals. This map includes contact information for each program.

Physical Examination and Evidence Collection Resources

TEN-4 Bruising and TEN-4-FACESp Mnemonics

The TEN-4 Bruising and TEN-4-FACESp Mnemonics assist in identifying bruising that is suspicious for child abuse in infants and preschoolers/young children.

Interpretation of Medical Findings in Suspected Child Sexual Abuse Reference Article:

This peer-reviewed article discusses the interpretation of medical findings in suspected child sexual abuse.

Substances tested for by the KY state crime lab when a toxicology kit is submitted can be found here

HIV Nonoccupational exposure and nonoccupational exposure prophylaxis (nPEP) information

Medical Protocol HIV nPEP Chart

This chart, created by the Kentucky Medical Protocol Subcommittee of the Sexual Assault Advisory Committee, provides a clinical decision tool for evaluation pediatric/ adolescent sexual assault/abuse patients with potential HIV exposure.

The probability of acquiring HIV from an infected source, by exposure act is discussed on this CDC website:

Detailed information and training about risk factors for HIV acquisition and nPEP can be found at this website:

Resources for providers of HIV nPEP can be found at this website (CDC):

HIV information from the National Clinician Consultation Center can be found here.

Assistance with PEP-related decisions can be obtained by calling the National Clinician's Post Exposure Prophylaxis Hotline (PEP Line 888-448-4911).

Non-Occupational Post-Exposure Prophylaxis (nPEP) Toolkit

AIDS Education and Training Center Program website resources provide step-by-step instructions for the medical care of persons following possible sexual HIV exposure. (Includes nPEP information, medication assistance postcard.)

HIV nPEP Vouchers

Vouchers may be available to assist with the cost of nPEP through the Kentucky Office of Claims and Appeals website (kycc.ky.gov) Sexual Assault Exam Program.

STI Information

CDC’s Sexually Transmitted Infections (STI) Treatment Guidelines, 2021
provides current evidence-based prevention, diagnostic and treatment recommendations.

Discharge Planning

Contact information for board certified child abuse pediatric specialists in Kentucky

Statewide Coverage Map of Children’s Advocacy Centers

Kentucky is served by a network of 15 regional children’s advocacy centers, providing coordinated care for abused children. Find the contact information for each CAC here.

Sample Discharge Form

This is a sample discharge form providing a non-offending caregiver with information about the exam and any anticipated follow-up needs or services.

Ampersand Sexual Assault Survivors Resource Guide

Provides survivors with information about their rights and resources, with some resources focused on the central Kentucky area.

Comprehensive Bibliography

This document provides the references used in development of the medical protocol.