A two-and-a-half-year-old girl of Asian origin came to the Primary Care clinic the day after the arrival of the Chinese orphanage in which she had been living, after having been adopted by a Spanish father.
She accompanies her adoptive mother, who requests a general assessment of her health status, awaiting being attended by the referral hospital established by the Community of Madrid in its International Adoption Protocol.
The inspection highlights the monoid racial phenotype, a good nutritional status and behavior.
On examination, it was found that there was a linear lesion in the perineum between the vulvar and the anus, with an incise, erythematous background, mucosal bleeding and no signs of infection.
The urethra, vagina, vulva and anus have a normal appearance.
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The first diagnostic suspicion was sexual assault, but an expectant attitude was chosen, due to the absence of active bleeding and pain, the normal appearance of the girl external genitalia and during rest of the exploration of the genitalia.
A normal renal and urinary tract ultrasound was requested.
After the first controls in the reference hospital mentioned above, the mother comes distressed to the health center, because in the hospital they suspect that in the family they are sexually abused by the child, and authorities have even denounced them.
In this interval, the opportune reading of an article related to the perineal groove3 provides the key to the definitive diagnosis, with the consequent relief of all those involved.
The microbiological study requested by the hospital to rule out sexually transmitted diseases was negative (lues, human immunodeficiency virus and hepatitis B, C and A, herpes and gonococci).
The child occasionally complains of mild pain in the vulva and has some tendency to constipation, although these discomforts do not interfere with their usual activity and there are no signs of local irritation.
