Children's Understanding of Genital Anatomy and Its Relationship with Children's Use of the Word “inside” during Questioning about Possible Sexual Abuse

Background and purpose: Research exploring the relationship between children’s comprehension of genital anatomy and their response to questions about genital touch during a sexual abuse investigation is sparse.  When female children engage in normal hygiene after urination it is assumed they touch their genital area and that this touching involves penetration of the labia, but not the vagina. This act of wiping after urination presented an opportunity to explore how children use language to report an experience of genital contact.  The purpose of the current study was to investigate the relationship between children’s knowledge of genital anatomy and whether they responded to the question, “When you wipe after you pee, does it feel like you are wiping on the inside or the outside of your private part (or name provided by child) or both?” with the words “inside,” “outside,” “both,” or “I don’t know.”

Methods: This study involved a secondary data analysis of 674 records of female children who presented to a sexual abuse clinic. Data were analyzed using multinomial logistic regression analysis.  Missing data were handled using multiple imputation methods.  The dependent variable was their word choice in response to the question about wiping after urination, while the independent variables were age, minority status, prior history of sexual abuse, acuity of referral, and understanding of genital anatomy.

Results: The overall results of the multinomial logistic regression were statistically significant, χ²(18) = 76.8, p < .0001.  The relationship between words used and age, χ²(3) = 14.33, p < .02, and knowledge of genital anatomy, χ²(3) = 19.5, p < .001, were statistically significant. The Pearson goodness-of-fit value, χ²(334) = 340.4, p > .05, and Deviance value, χ²(334) = 369.1, p> .05, were consistent with a good fitting model.   Results suggested the odds a child with an accurate understanding of genital anatomy used the word “outside” were about 2.5 times greater than the odds she used word “inside” in response to the question about wiping after urination.  Results also suggested the odds a child with an accurate understanding of her genital anatomy responding with “outside” to the question about wiping were about 4 times as great as the odds she answered with, “I don’t know”. 

Conclusions and implications: The results of the current study suggested younger girls, and those with less accurate understanding of genital anatomy, appeared more likely to use the word “inside” to describe labial penetration; and older girls, and those with better understanding of genital anatomy, appeared more likely to use the word “outside” to describe labial penetration and reserve the word “inside” to describe vaginal penetration.  Younger girls, and those less knowledgeable about genital anatomy, may use the word “inside” to describe genital contact that involves only penetration of the labia or genital opening, whereas older girls, and those more knowledgeable about genital anatomy may limit their use of the word “inside” to penetration of the vagina. These findings have implications for social workers who conduct sexual abuse investigations.