Rare cases of aberrant genital hygiene practices in young girls have been reported in the North American medical literature (37,38). They involve three classes of behavior. The first is a ritualistic focus by the parent on invasive and sometimes painful inspection and washing of the child's genitalia. This may be related to parental suspicion of sexual abuse. The second is a form of Munchausen syndrome by proxy, whereby the parent repeatedly solicits medical intervention for perceived or fabricated genital problems in the child. The third is an overt form of abuse, usually by a male, involving the application of creams or ointments to the child's genitalia for the purpose of the perpetrator's sexual gratification. All three classes are forms of abuse requiring intervention, which may include referral of the child and the caregiver for treatment and, when appropriate, reporting to child protective services.
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