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Chances of rape in prepubertal girl with VAGINAL ATRESIA.

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Hello. My name is Katie, is there a Pediatrician Specialist I could speak to? My family and I really need answers. A family member of mine has been diagnosed with hemophilia, vaginal atresia and is prepubertal. She claims she had been raped numerous times between the ages of 9 and 15, anally and vaginally, by another family member who did some time for the claim. All we're needing is for a Doctor/Specialist to explain the medical, physical impossibilities, in order for our family to except the fact that it was in fact a false claim and get back to being a family again. If a doctor would be able to give a little explanation/ professional opinion about any one or more of these following bullet points, it would be greatly appreciated.

* The hardships of being hemophilic and the proper procedures it would take to attend to a 9 year old raped hemophilic victim
* How attending to a 9 year old rape victim would have required a legally mandated report of abuse from the doctor to the state
* The consequences of a hemophilic child being raped and not being attended to by a doctor immediately to stop the bleeding
* The impossibilities of having full penile/vaginal intercourse with a prepubertal, unestrogenized, 9 year old with vaginal atresia
* The medical/physical consequences of having anal sex (scarring, tearing, lesions, stretch marks etc.) and the impossibilities of having anal sex without leaving some form of inner rectal scarring.
I did recieve answers from an OBGYN but I would like multiple responses from different specialists to further prove my points to my family. Please may I speak to a pediatrician.

Category: Pediatrician

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Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
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Expert:  Dr. Saptharishi L G
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Dear Katie,
Thank you for your query at DoctorSpring.com
Thank you for giving me time to understand the aforementioned problems and break them down into distinct medical and psychosocial entities. While going through this particular case of yours, I have realized that there are some loose ends that I need to clarify in order to be able to understand the situation in totality. This may involve certain personal or intimate questions, but without these information, I would not be able to help you out.
1. When was this 9 year old diagnosed as hemophiliac? Was she symptomatic in the form of recurrent bleeds or joint swellings? Does anyone else in your family have hemophilia? You need to provide me all relevant details regarding who made the diagnosis of hemophilia and on what basis?
2. When was she diagnosed as vaginal atresia? Isolated vaginal atresia is very rare. It usually exists because of hormonal, gonadal or genetic abnormalities. It is usually associated with hypoplasia (poor development) of all mullerian structures such as uterus, fallopian tubes, etc (MRKH syndrome). They may also have associated skeletal abnormalities. All of them require karyotyping as some of these girls are actually boys (46 XY) with androgen insensitivity syndrome. So this, in itself is a complex entity. Many a times, an imperforate hymen is misdiagnosed as vaginal atresia. So it is also important to understand how she was diagnosed, when and who made the diagnosis.
3. Regarding the possibility that the child has been abused sexually by a person. What is the age of this person? How is his professional and family life? Does he suffer from any psychiatric illnesses? Does he have any history of deviant behavior in the past? Does he engage in substance or alcohol abuse? Does he have any other subtle clues such as special attention to young girls, volunteers to baby sit them, buys them frequent gifts, always makes them sit on his lap, etc.. Some of these behaviors may be excessive and may point to a tendency towards paedophilia. Remember in a case of child abuse, the onus is always on the perpetrator to prove his innocence as medically and legally, the child's words are taken at face value and it is not expected that a 9 year old would report any person as having abused her vaginally and anally otherwise.
4. Assuming for a moment that the allegations are false, how were the allegations made? Who confirmed it? Who performed the medical examination of the child and the perpetrator? Your statement that it is the duty of the pediatrician to report the issue to the social services as well as the police is mandatory by law, is correct. We do not expect any pediatrician to do otherwise. There are so many ways to report the suspicion.
5. Now combining these medical and psychosocial problems. Achieving penile penetration in a child with vaginal atresia is very difficult due to poor development of the vaginal tract. Having said that, the degree of hypoplasia determines if it is possible or not. In milder variants, a reasonable length of vagina may be preserved. Penetration in a hemophiliac with vaginal atresia is something that I have come across for the first time. Though theoretcially there is very high risk of bleeding with both vaginal and anal penetration, no one can be absolutely sure that they would bleed and would require medical attention. But, it is definitive that there would marks of injury (some of the things that you have already mentioned and many more other tell-tale signs of forced penetration) in the vulva and perennial region. The absence of any such injury marks is really suspicious.
It is absolutely surprising that this case has not been reported to the law enforcement authorities and social services yet. That would be the basic requirement in any such case. I would appreciate if you can answer some of those questions and also relate the sequence of events impartially for us to understand this case better.
Regards
Dr. Saptharishi L G


Patient replied :

Hello.

First off, the alleged rape victim was actually the product of her mothers rape occurrence. The hemophilia is hereditary. The state had a vested interest in finding who that dad was because the mother was on welfare. There were many blood tests taken and never found out who the father was, however we do know she was born with hemophilia.

When the alleged rape victim was just 8 months old, her mother married a man named Justin. The alleged rape victim grew up knowing Justin as her father. She was a very happy child prior to these false allegations. Her parents and siblings had just about everything. They had money, lake side home, lots of friends not to mention they were a huge part of the community thus bolstering their popularity.

The alleged rape victim was a busy body. She was apart of sports in school (softball, gymnastics) along with snowmobiling/ motorcycling on a daily basis (depending on the season). She also went to friends houses weekly, or had friends over to play on trampolines, go swimming, jet ski, tubing behind a boat, and she rode bicycle on a daily basis to get to these locations (at lease a mile a day)

The girl first experienced her period when she was 13 years old. Due to her hemophilia, she was an excessive bleeder. The doctor then put her on birth control to help control the bleeding.

Later on in life, when the alleged rape victim was about 15 years old, her parents were having some troubles which led to divorce, breaking up the family and the kids’ hearts. After the parents separated, the kids didn’t see their father much if at all. Therefore, with a little influence from other angry family members, you can imagine it wasn’t hard for the kids to believe it was all daddy’s fault. The alleged victim lost all her toys, friends and basically her future, and had to move to a tiny apartment, and lost most luxuries. Dwelling on this anger, she managed to put together a story that would punish her father. Court T.V and life time television influenced her immensely, She practiced a sex allegation on a school coach which cost the man his job for a temporary period of time. After finding out it was a false allegation, he returned to coaching. She also accused a high school “enemy” of fooling around online with her father. This was also disproven and found malicious. These prior false allegations were also withheld from the jury.

At the age of 15, the alleged rape victim went in for a rape kit exam, claiming that just 4 days prior she experienced the final rape. This is when she was diagnosed with vaginal atresia (In the doctors words) “Absent vagina”. The doctor also stated she was a Tanner V and that there were no tears, lesions, stretch marks, scarring or abrasions etc. Even with her “absent vagina” the doctor however was still able to perform a pap smear. Therefore she must have had a vagina, and by absent vagina he meant to the degree of mere closure.


Later on in court, the prosecutor stated she had but a dimple for an opening, and that just the head of his penis touching the dimple was penetration by law Yet the alleged rape victim claims she had been full on forcefully penetrated/ raped anally and vaginally by the alleged rapists 8” long x 5 ¾ “circumference x 2 ½” wide penis 4-7 times a day for 6-7 years (9-15 years old)

What if her atresia/absent vagina wasn’t as severe as the prosecutor said, (considering the doc was able to perform a pap smear) She was still prepubescent, unestrogenized, no mucus membrane, and the vaginal opening couldn’t have been more than 10cm? So to forcefully full on penetrate a prepubescent vagina that size with a very well endowed penis (8” x 5 ¾” x 2 ½”) would still cause tearing, lesions, scaring, pain etc? Given she had no time to heal between the alleged rape incidents, would cases of fissures and/or fistulas be a possibility? What would the consequences be if left unattended to? Wouldn’t experiencing this cause debilitating pain?

During investigation, there wasn’t any OBGYN exam because they knew this couldn’t have happened. The rape kit exam proved there were no lesions, tears scarring etc, to show there was ever any form of sexual activity. Her medical history showed no legally mandated reports of abuse, no suspicions of anything in the notes and no treatments of hemophilia. They had questioned all of the family and the child’s mom and everyone stated that same thing. “This could not, did not happen.”

However the prosecutor and the sheriff investigator wanted this case bad, and went on ignoring the fact that Child Protective Services found no maltreatment. They withheld all the medical evidence knowing they could just put her on the stand, cue her when to shed tears in front of a jury, told that in MN there is no evidence needed, all you have to do is believe the alleged victim to find guilt for conviction. The jury was then threatened to be held until midnight and be sequestered over the weekend unless they were to come up with a unanimous vote. Just so they could get back to their lives the jury decided guilty at 9pm on a Friday night when they were told they would be able to leave at 5pm. Several of them called the defendant’s lawyer stating that they knew there was probably medical evidence to set the alleged rapist free, but were refused to see it when they asked for it. There are a lot of constitutional errors in this trial.

There were many pieces of evidence in this case, proving that the alleged rapes did in fact not occur, and that she was lying. All of this went unseen by the jury. Not one stitch of evidence was used. Only her word put away this man.

The alleged rapist is 20 years older than the alleged victim. He is a man of the community, helping where he can, hosting celebrations/gatherings open to the public. He is a business owner. He volunteered services to local fire departments, and helped his local communities with parades, street dances, car shows, fundraisers, and was apart of miscellaneous boards and memberships. He owned a bar and an auto restoration shop, both located on the same in town property as his house. There were always several employees, friends and family members freely roaming the property 24/7. There was never a chance for sexual intercourse for this man (Partial reason for his wife’s divorce) let alone 4-7 times a day with a busy body child who had friends and family at the house randomly through out her day as well.
I hope this infromation clears up some of your questions. I eagerly await your response. Thanks again.


Expert:  Dr. Saptharishi L G
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Dear Katie,
At the outset, Thank you for sharing all these vital information with me. It has definitely helped me understand the whole case much better.
I must clarify that any opinion that I provide would not hold any value in a court of law and any points discussed herewith cannot be used against anyone.
Having clarified that... A couple of things are pretty clear. If the child's claim is true (that the child was sexually abused so frequently every day for so many years), there are definitely going to be tell-tale signs on medical examination. There may not be traumatic signs as they are going to be present during the acute phase ( the first few instances of abuse). In chronic abuse, there is significant dilatation of the vagina with not many signs of forceful penetration. But, biologically, vaginal atresia is incompatible with this story. Definitely incompatible.
Obviously, as pointed out by you, there are multiple loopholes in the conviction. For a child's benefit, the law is obviously in favour of the kids. The person who is accused of sexual abuse and the defence team have all the onus on themselves to prove the perpetrator's innocence. Unfortunately, this inherent legal bias favouring children seems to have been misused.
Your understanding of the medical components of the case is accurate. But, our understanding cannot change anything. It is the jury that needs to be convinced of these medical implications.
Regards.


Patient replied :

Hello again,
Just to clarify, I am not asking for any legal information, help or advice. All legal matter has been taken care of.
The childs claim is not true. And as i stated in my previous message, she had plenty of motive to make such a claim and there were many wrong doings when the law was dealing with this case. There were absolutely no signs of any forms of abuse. They simply put an innocent man away by the word of her mouth.
As the doctor stated, "the childs vagina is absent". The procecutors later stated there was mearly a dimple. Unfortunately that is enough for law to convict. However her "Dimple does not match up with her claim of "forced full vaginal penitration" approximately 4 times a day. Could you please give a little explaination on this subject?
Aside from her hemophilia and atresia, could you explain that even a normal 9 year old girl would still show many types of scars, lesions tearing, stretch marks etc after enduring thousands of rapes, 7300 of them being prior to puberty. As well as what hardships she would endure considering she was a busy body. With my under standing, riding bike, motorcycles, playing sports etc would be nearly impossible to normally participate in, let alone go unnotice that she would not be able to preform to her full potential do to alleged sercumstances. Would you agree with these statements? And could you give a little explaination regarding the statements. Also, through out her childhood, her parents, as I stated previously, were definately financially stable. Her parents took well care of her including frequent check ups, physicals etc with her main doctor. She had physicals at least 4 times a year, and her doctor never once suspected nor reported any forms of abuse. These doctors were very good doctors and well trusted to this day. This abuse simply didnt happen and I would appreciate you explaining this so my family can become a family again.
Thank you again for your professional opinions.


Expert:  Dr. Saptharishi L G
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Dear Katie,
I agree that there is a mismatch between presence of just a dimple/ absent vagina and child's claim of full vaginal penetration.. But without physically examining the patient personally, I would not be able to give any further explanation. Yes, it appears very unlikely if the medical examination findings are accurate.
Secondly, I think you are assuming a bit too much here. When it happens for the first few times, it may be rape, but thereon it assumes a consensual form as the child abuse victim also starts recognizing it as a routine. Just because someone has been engaging in various degrees of sexual activities, it does not mean that the child cannot go around living her life normally in front of the external world. The fact that she is a busy body does not mean that she could not have been abused. You need to understand that we cannot typecast all child abuse victims into one group and assume that they will all behave exactly the same way. What do you mean by performing to her full potential? There are no standards for such comparisons. A child may be depressed for a few weeks when the abuse began. Once the child understands or assumes that abuse is inevitable, they may go about living their lives normally. They may even enjoy the physical intimacy with a power figure. It is after they attain the age of puberty and gradually start understanding what it all actually means, they feel outraged.
How often do doctors during the routine physicals strip a child naked and examine the vulval region and anal region?? It is the most commonly missed problem. If she had indeed been examined that well, your pediatrician would have diagnosed her vaginal atresia long ago. The truth is.. It is just not possible for a physician to examine the genital area without causing discomfort to a pre-adolescent girl. Hence, it is done only if there are complaints or suggestive symptoms.
Lastly, it appears that you have a strong personal bias favoring Mr. Justin's innocence in this case. It is simply not possible to be so sure.


Patient replied :

I am so sure of Justin's innocence because I've gone through the case myself. Transcripts, notes, legal statements, letters etc. We all know he is innocent, but our family needs a better understanding of the medical/physical impossibilities of this. Second I was not talking about psychological/social interaction of the alleged rape victim. I was stating that a 9 year old child partaking in any form of sex with a 8"x5.5"x2.5" penis 4 times a day every day would not be able to ride a bike, snowmobile, participate in sports etc and preform to her full potential without showing some form/physical signs of pain. (Walking funny, sitting awkwardly etc) I researched and found that many full grown women (including myself) find that having sexual intercourse with a man who is not even as well endowed as Justin endure pain afterwords. Unable to sit properly, walk irregularly, wince in pain etc. Certainly if a grown estrogenized women endures such things, I can't imagine what a 9 year old girl would experience. Not to mention to further my research, some women have to "train" their vaginas to be able to recieve full penitration from their well endowed partner. And this process takes weeks. There was no "training" involved in the alleged rape occurrences. This would result in severe pain. She claims at 9 years old he, with out warning, brought her into the house, tore her clothes off, and fully and forcefully penetrated her anally and vaginally. We've read many federal cases where a prepubescent girl is forcefully penetrated only once and she undergoes a year of surgery. In an underdeveloped child, there is simply no room for a full grown penis to be inserted. Causing fistures etc. As for her doctor visits, it sounds like youre saying that you would have an underdeveloped child in your care and not notice she is partaking in sexual activity 4 times a day for many years. Not even a suspicion or anything worthy of putting into documentation?


Expert:  Dr. Saptharishi L G
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Dear Katie,
Having read through the case files, legal transcripts, letters, etc you say that you are sure of Justin's innocence. I respect your judgement. Obviously, without having physically examined the child and going through all vital documents, it is absolutely beyond any physician to come to any reasonable conclusion. You are well within your rights to believe anything that you want.
In life as well as in medicine, it is not all black and white. There are many grey zones. There are thousands of reports of sexual abuse having been missed in minor children for years, until they come out with it themselves. The law as well as medicine do not expect the child to know what a full vaginal or anal penetration involves. It is possible that she had not been penetrated at all and the child had assumed them to be penetration.
You seem to be asking me about my office practice- If I would not notice that an underdeveloped child is partaking in sexual activity four times a day and not notice it. That question is inappropriate, in the context of this discussion. I most definitely know what I would do. But I cannot guarantee that the same has been done in this particular case. I respect the pediatrician colleagues who have cared for the alleged victim during her childhood. But, nobody except the pediatricians who have actually cared for her, give any assurance regarding their having complied with it.
It is easy to get drawn into one aspect and forget the bigger picture.. For a moment assume that the child does not know what a full penetration entails. For a moment assume that it was not a penetration at all. Then is there any loose end in this whole sequence of events? I do not think so.. But, yeah. we may agree to disagree. After all, if all our opinions were to be the same, we would not be discussing these details in a consult.
I respect your opinion. That's all I want to say.
Regards.

Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
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