The Case

A healthy 14-year-old female presents to the emergency department with her parents, who suspect she had sexual intercourse with an older male. They brought her to the emergency department, requesting she be checked to see if she has had sex and is not a virgin. If so, they will pursue criminal charges. The patient says she has never had sex with anyone, let alone an older male, and she adamantly refuses a pelvic examination, despite her parents’ demands and threats to you to perform the exam. Her vital signs are normal, and her general physical examination is totally unremarkable. How should you proceed?

Discussion

This is an interesting but infrequent case seen in the emergency department. When evaluating how to proceed, there are several concepts that need to be considered. The first and ultimately most important: If the parents have a concern, what is your obligation related to reporting this to law enforcement? In our last column, we discussed rape-reporting laws and obligations.¹ This case has the added complicating factor that the patient is a minor. Even if she reports having consensual sexual contact with an adult, it would likely be classified as statutory rape. In general, statutory rape is nonforcible sexual activity between two persons, one of whom is under the age of legal consent. The age of legal consent for sexual activity is usually 16 to 18 years. The laws also often specify how many years of difference are required between the individuals (usually three to four years). For example, in Pennsylvania, the law states that teens between 13 and 15 years of age cannot consent to sexual activity with someone who is four or more years older.

Although the patient denies sexual activity, her parents have a concern—and in most jurisdictions, under mandated reporter requirements, that is enough. A mandated reporter is a person who, because of their profession, is legally required to report any suspicion of child abuse or neglect to the relevant authorities.² Therefore, you should contact law enforcement. The patient and even her parents have a right to decline to speak with the police. However, your requirement to report must be fulfilled.

Also, depending on who they suspect the adult male may be, you may also have an obligation to report the case to child protective services (CPS). If this adult male has regular contact with the patient in a supervisory role, such as a coach, teacher, family member, household member, babysitter, etc., a CPS report should be made by the emergency department clinician. If in doubt, it is safer to report.