From the Bonita Papers:
In August, the Boulder police department contacted Dr. John McCann, one of the nation’s leading experts on child sexual abuse. McCann had agreed to assist the police department in determining if JonBenet had been a victim of sexual abuse during or before her murder. McCann was sent the autopsy report and photos. According to McCann, examination findings that indicate chronic sexual abuse include the thickness of the rim of the hymen, irregularity of the edge of the hymen, the width or narrowness of the wall of the hymen, and exposure of structures of the vagina normally covered by the hymen. His report stated that there was evidence of prior hymeneal trauma as all of these criteria were seen in the post mortem examination of JonBenet.
There was a three dimensional thickening from inside to outside on the inferior hymeneal rim with a bruise apparent on the external surface of the hymen and a narrowing of the hymeneal rim from the edge of the hymen to where it attaches to the muscular portion of the vaginal openings. At the narrowing area, there appeared to be very little if any hymen present. There was also exposure of the vaginal rugae, a structure of the vagina which is normally covered by an intact hymen. The hymeneal orifice measured one centimeter which is abnormal or unusual for this particular age group and is further evidence of prior sexual abuse with a more recent injury as shown by the bruised area on the inferior hymeneal rim. A generalized increase in redness of the tissues of the vestibule was apparent, and small red flecks of blood were visible around the perineum and the external surface of the genitalia. It was his opinion that the injury appeared to have been caused by a relatively small, very firm object which, due to the area of bruising, had made very forceful contact not only with the hymen, but also with the tissues surrounding the hymen. McCann believed that the object was forcefully jabbed in – not just shoved in. Although the bruised area would indicate something about the size of a finger nail, he did not believe it was a finger, because of the well demarcated edges of the bruise indicating an object much firmer than a finger. McCann was not able to see any fresh tears of the hymen which he thought might be due to the lack of detail in the photographs. It was unclear where the blood on the perineum originated, since there were no lacerations visible in these photos. McCann also noted that in children of this age group the labia, or vaginal lips, remain closed until literally manually separated. In order for there to be an injury to the hymen without injuring the labia, the labia would have to be manually separated before the object was inserted. The examination also indicated that the assault was done while the child was still alive because of the redness in the surrounding tissue and blood in the area.
McCann stated that this injury would have been very painful because the area of the injury as indicated by the bruise was at the base of the hymen were most of the nerve endings are located. Such an injury would have caused a six year old child to scream or yell. The doctor also stated that he assumed the object did not have jagged edges because there were no evidence of tears in the bruised area.
McCann also noted that there appeared to be a bruise on the inner right thigh which he though might represent a thumb imprint from forcing the legs apart.
Dr. McCann explained the term "chronic abuse" meant only that it was "repeated", but that the number of incidents could not be determined. In the case of JonBenet, the doctor could only say that there was evidence of “prior abuse". The examination results were evidence that there was at least one prior penetration of the vagina through the hymeneal membrane. The change in the hymeneal structure is due to healing from a prior penetration. However, it was not possible to determine the number of incidents nor over what period of time. Because the prior injury had healed, any other incidents of abuse probably were more than 10 days prior.
In discussing perpetrators of sexual abuse on children, McCann stated that the majority of children this age are molested by someone with whom they have close contact most commonly family members. He explained that if the molester is a stranger or someone else with whom the child is not close, the child will usually tell someone or psychological problems appear which create behavior changes observed by their parents. Common symptoms would be eating disorders, nightmares or a variety of behaviors indicating that something is bothering them. Commencement or increased bedwetting is also commonly seen in sexually abused children. When asked about JonBenet's sexualized behavior during her pageant performances, McCann said that this was not necessarily a sign of abuse, since this was taught behavior for the pageants. Also, with children's exposure to sexually explicit television programs, sexualized behavior is no longer considered to be an indication of possible sexual abuse.
Dr. Andrew Sirotnack from Children’s Hospital in Denver was also asked to review the medical findings and autopsy photographs. He confirmed McCann's determination of acute vaginal trauma during the assault on JonBenet, but he had not yet concluded that there was chronic abuse. Sirotnack had examined over 2,500 abused children during his career at Children's Hospital and had testified in approximately 50 - 100 criminal trials regarding sexual abuse on children.
In September 1997, the police department held a meeting with McCann and three other child sexual abuse experts to go over their opinions based on their review of the autopsy results. Dr. Virginia Rau of Dade County, Florida stated that she observed fresh hymeneal trauma on JonBenet and chronic inflammation that was not related to any urination issues. Dr. Rau said, “In my heart, this is chronic abuse,” but feared that a defense argument would be made that this was only evidence of masturbation.
Also agreeing with the findings of both McCann and Rau was Dr. Jim Monteleone of St. Louis. Dr. Richard Krugman, Dean of the University of Colorado Medical School, an expert first contacted for assistance in the Ramsey case by the D.A.’s office, was the most adamant supporter of the finding of chronic sexual abuse. He felt that in considering the past and present injuries to the hymen that the bedwetting/soiling took on enormous significance. He believed that this homicide was an indecent of “toilet rage” and subsequent cover up. He told the group of experts and detectives about another Colorado case where both parents had been at home and both were charged. “The JonBenet case is a text book example of toileting abuse rage," Krugman stated.
All of the experts agreed that there was no way any of the recent or chronic abuse damage to the genitalia of the child was the result of masturbation.
And later:
Dr. Bernhard felt there needed to be more follow-up with Burke in the discussion of sexual contact. The only show of emotion by Burke, other than the irritation with the questions about the actual crime, was when Dr. Bernhard began to ask about uncomfortable touching. Burke picked up a board game and put it on his head an action indicating anxiety or discomfort with these types of questions and that there was more that he was not telling her. Dr. Bernhard asked Burke if he had any secrets, and he said, “probably, if I did, I wouldn't tell you, because then it wouldn’t be a secret."
