Medical Examination for Sexual Abuse: Have We Been Misled?
ABSTRACT: There are serious difficulties in
diagnosing sexual abuse on the basis of an ano/genital examination.
Nevertheless, medical conclusions are often used in court to provide
evidence for abuse. The support for the alleged physical indicators of
abuse has been based on opinions and claims unsupported by research
data. Recent research by John McCann on the ano/genital anatomy in
nonabused children has established that findings often attributed to
sexual abuse are found in many normal children. McCann's findings were
applied to 158 children who had been medically examined in cases of
alleged sexual abuse. Nearly all the findings attributed to sexual
abuse were present in McCann's sample of nonabused children. More
baseline studies are needed, including those comparing nonabused
children to children where there is convincing evidence of abuse. In the
meantime, the courts need to modify their current practices concerning
evidence from ano/genital examinations.
The growing recognition of sexual exploitation of
children has brought special problems in determining whether an alleged
abuse has in fact taken place. Unlike other crimes, the victim may not
complain immediately. The victim may be inarticulate, or feel
intimidated by the perpetrator. There may be no obvious physical
evidence of abuse.
Equally difficult, the "victim" may in
truth have been led to believe he or she was abused, through the use of
leading and suggestive questioning. In such cases, false accusations are
not necessarily lies because improper questioning may lead a child to
sincere but incorrect beliefs (Coleman, 1986).
Faced with such problems, police and child protection
workers naturally hope for a way to resolve these special difficulties
which may protect the child molester in one case and falsely accuse an
innocent person in another.
Not for the first time and undoubtedly for the last,
we have turned to doctors to relieve us of the
uncertainty. And so great has been our desire for resolution, for
"science" to come to the rescue, that we have been only too
happy to accept whatever the doctors have offered. With few exceptions
(Nathan, 1989; Paul, 1977; Paul, 1986; Woodling & Heger, 1986;
Zeitlin, 1987) little thought has been given to whether the doctors'
offerings are legitimate medical evidence, or mere speculation.
A good beginning is a recognition that sexual abuse
is not a "diagnosis" but an event. Even highly suspicious
findings, such as the presence of a disease normally transmitted through
sexual contact, do not automatically mean sexual abuse. While medical
findings may be important in supporting or negating alleged events, a
finding of sexual molest is a legal and not a medical conclusion.
The confusion becomes acute when the methods normally
used to reach a diagnosis in a nonadversarial, clinical situation are
carelessly adopted in a legal investigation. Take, for example, the
"history." In medicine, statements made by patients and/or
family are generally taken at face value. Allegations of criminal
conduct, on the other hand, should be investigated rather than assumed
If a doctor hears an allegation and writes it down as
"history," he or she has not made a "finding" but
merely repeated the allegation. This might seem obvious, yet it is
common for doctors to make a "diagnosis" of sexual abuse,
relying heavily on what they call the "history," as given by
an accusing adult or by an investigator.
Likewise, it might seem obvious that a normal ano/genital examination is no help in establishing molest.
examinations are, nonetheless, frequently termed "consistent
with" sexual abuse. Rarely is this followed by a statement
indicating that a normal examination is equally consistent with no
abuse. Take, for example, the case in which the doctor wrote, "The normal size of her vagina is
not an uncommon finding in girls who have been fondled although not
deeply penetrated into the vagina. This finding is still consistent with
someone attempting to stick their finger into the vagina."
Given that with many victims of molestation the
medical examination will be normal, it follows that every child's
anatomy is "consistent with" molest because normal anatomy is
also consistent with nontraumatic molest.
The confusion deepens when these two non-findings — "history of molest" and "physical examination
consistent with molest" — are combined. Investigators learn that
medical examiners have made a "diagnosis" of sexual abuse,
based on the "history" and on a medical examination said to be
"consistent with the history." With their suspicions
confirmed, these investigators are hardly likely to continue with a
vigorous and unbiased investigation.
Next, it should be remembered that "normal"
always means a range. Parts of the body vary in detail from person to
person. Whether examiners may safely equate physical findings with prior
trauma will depend on whether controlled studies have documented the
range of normal anatomy.
Finally, a note on "experience." Experience, like consensus, is not enough to move from conjecture to
science. Feedback, i.e. controlled testing of ideas through research, is
necessary to be sure that one's experience is not filled with incorrect
notions that go unrecognized. Thousands of women, for example, underwent
radical mastectomy because highly experienced surgeons, and doctors in
general, believed it was the best way to save lives. Only subsequent
research demonstrated that simple mastectomy saved as many lives.
The situation is even worse when the doctor's opinion
will itself influence the ultimate findings of the justice system.
If Doctor X opines that a child has been molested, based on findings which
in truth do not prove molest, a court will frequently rubber-stamp such
an opinion. This judicial finding then becomes the confirmation which
makes the doctor feel he can rely on his "experience." Such
"confirmation" is, of course, scientifically meaningless.
History of Sexual Abuse Examinations
Medical examinations for sexual abuse of children,
done long after the alleged fact, are a new phenomenon. All but a
handful of the articles on this subject are from the 1980s.
An early but influential article was that of Woodling
and Kossoris (1981). A collaboration of a family practitioner and a district attorney, this
article listed findings which the authors claimed were indicative of
abuse. These included a number of findings which are either extremely
nonspecific or open to subjective interpretation by the examining
physician, such as perihymenal erythema (redness), tightness (too much
or too little) of pubic or anal muscles, anal fissures, and hymenal
irregularities interpreted as either "transections" or
evidence of scarring.
In support of these alleged indicators of prior
sexual contact, Woodling offered only his "experience," which
he wrote "suggests that only forced penile penetration causes
actual transection of the hymen or perihymenal injuries. Chronic
molestation or repeated coitus will result in multiple hymenal
transections which eventually heal and leave multiple rounded remnants
present between 3 and 9 o'clock ..."
When a growing number of physicians and nurses began
to take a special interest in forensic ano/genital examinations of
suspected child sexual abuse victims, these new specialists eagerly
absorbed such ideas, despite the lack of any research corroboration.
Take, for example, Woodling's Training Syllabus: Medical Examination of
the Sexually Abused Child (1985). To the above list of supposed
indicators of molest he added "rounded scars called
synechiae," which "when magnified may show neovascularization."
Another unsupported claim: "the rectal sphincter may manifest
laxity or may reflexively relax when stimulated by direct contact with
an examining finger, perianal stroking with a cotton bud (perianal wink
reflex) or by lateral traction of the buttocks."
As trainees went back to their communities, and in
turn became the trainers, these uncorroborated claims became the
conventional wisdom of the "experts." This second generation
wrote more articles which passed along the same alleged
"indicators" of molest, articles which were conspicuous in
their absence of any controlled data (Berkowitz, Elvik, & Logan,
1986; Cantwell, 1983; Cantwell, 1987; Chadwick, undated; DeJong, 1985;
Elvik, Berkowitz & Smith-Greenberg, 1986; Enos, Conrath, & Byer,
1986; Grant, 1984; Hammerschlag, Cummings, Doraiswamy, Cox, &
McCormack, 1985; Heger, 1985; Herbert, 1987; Herman-Giddens &
Frothingham, 1987; Hobbs & Wynne, 1986; Hobbs & Wynne, 1987; Jones,
1982; Kerns, 1981; Khan & Sexton, 1983; Levitt, 1986; Levitt,
undated; McCann, Voris, & Simon, 1988; McCauley, Gorman, &
Guzinski, 1986; Muram, 1988; Pascoe & Duterte, 1981; Ricci, 1966;
Seidel, Zonana, & Totten, 1979; Seidel, Elvik, Berkowitz, & Day,
1986; Spencer & Dunklee, 1986; Tilelli, Turek, & Jaffe, 1980).
Pediatricians and other qualified physicians refused
to do such examinations, deferring to those few who claimed to be
"specialists." Law enforcement and child protection workers quickly learned which examiners
were likely to make findings supportive of an allegation of molest.
often these examiners were attached to a "sex abuse team."
I have had the opportunity to read the reports and
testimony of these examiners in cases involving 158 children suspected
to have been molested. The confidence expressed, to the effect that
findings like those mentioned above are reliable indicators of molest,
is usually very high. Rounded hymenal edges and anal relaxation, to
mention just two examples, are seen as signs of molest, and only molest.
Behind the scenes, however, doubts were being
expressed. Perhaps far fewer doubts than scientific caution dictated,
but nonetheless more doubts than law enforcement officials, judges, or
juries were hearing. Take, for example, a meeting in April, 1985, during
which physicians and nurses came to learn how to examine children who
might have been molested.
Dr. Woodling acknowledged that "there is a
significant variation in hymenal types ... we need to realize that
hymens are like people's faces, there are lots of variations ... there
are often times cuts or transections but they're not traumatic, they're
just clefts that the child was born with ... and can in fact
appear to the untrained eye as an old transection .. " (Woodling
& Heger, 1985).
I have seen countless cases in which exactly these
findings were said to be unequivocal evidence of molest. Likewise, to
take another example, vaginal size may be cited as evidence of molest.
paper by Cantwell (1983) is still cited as support for the proposition
that a vaginal opening size above four millimeters is supportive of
molest. Woodling nonetheless acknowledged that this had "not held
true in our experience" (Woodling & Heger, 1985).
Countless trials have had expert testimony that anal
sphincter relaxation was a definite sign of sodomy, but Woodling
admitted, "This is not a hard test, that means in fact that you
have sexual abuse ..." (Woodling & Heger, 1985).
At the same meeting, the remarks of another
specialist, Dr. Astrid Heger, also showed greater willingness to
acknowledge uncertainty than I have seen in court trials. "...
I think diagnosing sexual abuse on the hymenal
diameter alone is a very dangerous thing to do ... the same kid (may
have) two different diameters, depending on how you were looking at
her" (Woodling & Heger, 1985).
What emerges from these meetings is the fact that
these "specialists" have seen a lot of children, and opined on
which ones were molest victims, but they have no way of checking the
accuracy of their conclusions. Even if they agree on how to interpret
a particular finding, this doesn't mean they are correct. Only
controlled research will allow them to decide whether a particular
finding is indicative of molest.
Dr. Robert ten Bensel, a physician long involved in
the effort to increase awareness of child abuse, has commented on the
difference between consensus and true scientific evidence. In response
to a 1985 Los Angeles conference at which there was an attempt to reach
consensus of positive findings among doctors doing these examinations,
ten Bensel wrote, "I am not comfortable with the reported 'consensus
of positive findings.' This is not the procedure of science; rather, it
is simply an agreement among a select group of physicians invited ..." (1985).
Consensus, in other words, is no substitute for
In Search of Research
The heightened interest in medical detection of
sexual abuse of children has produced lots of articles, but little
research. Before discussing what little research exists, let me
illustrate how today's "experts" seem to ignore the difference
between naked claims and true evidence.
A nurse examiner routinely consulted by law
enforcement officials in Northern California county described "a
healed V-shaped laceration at the 12 o'clock position in the rectum ...
the tip of the V is pointed toward the inside, this indicates
penetration from the outside." This nurse was faithfully passing on
what she had learned in workshops like those mentioned above. No
supportive evidence was cited.
Asked to evaluate these claims, I commented on the
lack of data to support such an allegation. In response, lawyers
supporting the allegation called on a pediatrician specializing in such
examinations. She backed the nurse's findings by citing several articles
which made the same claims. None of the articles, however, contained
reference to any research. Once again, unsupported claims were being
passed 6ff as medical evidence.
Dr. David Paul, one of the most experienced examiners
for sexual abuse, has written "... even the most careful examination of a
fissure — healed or fresh — by magnifying glass or colposcope, cannot
differentiate between a "natural" fissure caused by
constipation and one that was caused by anal penetration" (1986).
Clearly, there is a need to get beyond these
differences of opinion, into the world of research findings.
remarkable, considering the attention paid to sexual abuse of children
in recent years, how little the doctors examining the children and
giving opinions which may send a person to prison for life, have done
to validate the claims they so readily make in our courts.
We are not totally without research findings,
however. What we do have directly contradicts the claims made in recent
years by the small number of examiners so regularly consulted by law
enforcement and child protection investigators.
Emans, Woods, Flagg, and Freeman (1987) attempted to
compare three groups of girls; abused (group 1), normal girls with no
genital complaints (group 2), and girls with other genital complaints
(group 3). The study has serious flaws. The examiners were not blind to
which category each girl belonged; no information is given on how
certain it was that alleged molest victims were true victims; and
examiners were not randomly assigned. Instead the lead author was the
exclusive examiner of girls assumed to be molested.
Nonetheless, the authors deserve credit for
addressing what has been ignored by so many others. They concluded from
their literature search, just as I have from my own, that "no
previous study has reported the incidence of various genital findings in
Presence or absence of twenty genital findings were
recorded on each child. These included hymenal clefts, hymenal bumps,
synechiae (tissue bands), labial adhesions, increased vascularity and
erythema (redness), scarring, friability (easy bleeding), rounding of
hymenal border, abrasions, anal tags, anal fissures, and condyloma
accuminata (venereal warts). These are the kinds of findings which are
being attributed to sexual abuse in courts across the land, despite
there having been "no previous study ..."
Their findings: "The genital findings in groups
1 and 3 were remarkably similar ... There was no difference between
groups 1 and 3 in the occurrence of friability, scars, attenuation of
the hymen, rounding of the hymen, bumps, clefts, or synechiae to the
vagina." These findings, in other words, are not specific to
Emans et al. do claim that only the sexually abused
group showed hymenal tears and synechiae (tissue bands) inside the
vagina. Doubts about this, however, are raised by the results of the
only other research effort done so far. It is not yet in print, but lead
investigator, Dr. John McCann, has recently been presenting his team's
data before professional audiences.
McCann and his colleagues are the only ones so far to
take on the very necessary task of trying to establish the range of ano/genital
anatomy in normal children. Without such data, the "findings"
so regularly attributed to molest are essentially meaningless. That there are as yet no published data on this is
itself highly significant.
At a meeting in San Diego in January, 1988, sponsored
by the Center for Child Protection of the San Diego Children's Hospital,
McCann reported on this research. Three hundred prepubertal children,
carefully screened to rule out prior molest, were examined, and it was
found that many of the things currently being attributed to molest are
present in normal children. Here are some conclusions:
· Vaginal opening size varies widely in the same
child, depending on how much traction is applied and the position of the
child while being examined. Knee-chest position (Emans, 1980) leads to
different results from frog position.
· Fifty percent of the girls had what McCann calls
bands around the urethra. He has heard these described as scars
indicative of molest.
· Fifty percent of the girls had small (less than 2
mm) labial adhesions when examined with magnification (colposcope).
Twenty-five percent had larger adhesions visible with the naked eye.
· Only 25 percent of hymens are smooth in contour. Half are redundant, and a high percentage are irregular.
· What are often called clefts in the hymen, and
attributed to molest, were present in 50 percent of the girls. Commenting on his team's mistaken assumptions at the outset of their
study, McCann said, "We were struck with the fact that we couldn't
find a normal (hymen). It took us three years before we found a normal of
what we had in our minds as a preconceived normal ... you see a lot of
variation in this area just like any other part of the body ... We need a
lot more information about kids ... we found a wide variety ...
" (my emphasis).
·"... in the literature, they talk about ...
intravaginal synechiae and it turns out that ... we saw them everywhere
... We couldn't find one that we couldn't find those
· "When does normal (hymenal) asymmetry become
a cleft? I don't know."
McCann's anal examination were equally revealing of a
good deal more variation among normal children than the
"experts" have so far been recognizing:
· Thirty-five percent of children had perianal
· Forty percent had perianal redness. The younger
the age group, the more likely this finding.
· One third of the children showed anal dilation
less than 30 seconds after being positioned for the examination.
· Intermittent dilation, said by Hobbs and Wynne (1986)
to be clear evidence of molest, was found in two thirds of the children.
Recall that Emans found that while abused (by
"history" at least) girls were remarkably similar to nonabused
but symptomatic girls (infections, rashes, etc.), hymenal tears and
intravaginal synechiae were said to be found only in the abused group.
We now see that McCann's findings contradict both these alleged
differences between molested and nonmolested children. McCann saw no way
to distinguish between a healed hymenal tear and "normal
asymmetry." He also routinely saw "intravaginal
synechiae" in his population of normal girls.
What little research exists, then, shows that a small
group of self-appointed "experts" has been given undeserved
credibility by an all-too-eager law enforcement and child protection
bureaucracy. This has misled the courts, falsely diagnosed sexual abuse,
and damaged the lives of countless nonabused children and falsely
The Debacle in England
To illustrate that such an assessment is not an
overstatement, let us briefly review what happened in the English town
of Cleveland, where two pediatricians relied on their certainty that
anal relaxation meant "buggery" (sodomy)
Hobbs and Wynne (1986) had reported in the British
medical journal Lancet that "Dilation and/or reflex dilatation of
the anal canal" were not seen in normal children, and indicated
sodomy. They added that, "In addition to reflex dilatation, we have
also seen alternate contradiction and relaxation of the anal sphincter
or 'twitchiness' without dilatation. In our experience this also
Despite the fact that Hobbs and Wynne (like Woodling)
presented no controlled data, relying instead on their
"experience," their claims were accepted as uncritically in
Britain as similar ones are here. This is how Her Majesty's Report of
the Inquiry into Child Abuse in Cleveland 1987 (Butler-Sloss, 1988)
described what then started to unfold:
"Dr. Higgs had, in the summer of 1986 ...
suspected sexual abuse and on examination saw for the first time the
phenomenon of what has been termed 'reflex relaxation and anal
dilatation.' She had recently learned from Dr. Wynne ... that this sign
is found in children subject to anal abuse ..."
Higgs and a colleague (Wyatt) soon were diagnosing
children right and left as victims of sodomy. So sure were they of their
conclusions that when the finding disappeared and then returned, and the alleged
perpetrator had no contact prior to the reappearance, they presumed a
second sodomy by a different person! In one case, by the time of the
fourth reappearance of the anal relaxation, the grandfather, father and
finally the foster parents had all been accused of sodomizing the child.
Before this farce played itself out, Higgs and Wyatt
had "diagnosed" sexual abuse in 121 children from 57 families,
over a period of 5 months. In the typical case, the child would be
removed from the parents and then subjected to regular "disclosure
Eventually, outraged parents were able to arrange
second examinations and British courts gradually came to their senses
and returned most of the children. Interestingly, these second
examinations by highly experienced doctors often differed from the
initial examinations. As Her Majesty's investigators wrote, "The
signs recorded by Dr. Higgs and Dr. Wyatt were in the main confirmed by
Dr. Wynne in those children she examined, but not by Dr. Irvine, Dr.
Paul, Dr. Roberts and others in the children they saw."
This should be enough to give readers a sense of the
pseudoscience which is presently passing as medical evidence in these
A Review of 158 Examinations
I have as of this writing reviewed 221 cases of
alleged child sexual abuse. Some cases have included dozens of children,
so the total number of children is much higher. In these cases, 158
children have been examined medically. In all but a handful, only one
examiner was permitted to examine the child, a practice which surely
needs revising in light of the current state of the art.
Of the 158 children examined, 49 were boys and 109 girls. They ranged in age from one year, 10
months to 13 years old. The age distribution is shown in Tables 1 and 2.
Age Distribution of Boys
Once again, we should first make use of the only study of normal
children available, McCann's, to evaluate these findings. Both
hyperpigmentation and anal relaxation were found in many unmolested
children. Venous congestion was very common, as was thickening of anal
folds. This leaves "scars" and "fissures" as the major
finding said to indicate anal abuse in the cases I have studied.
Several factors raise serious questions about whether these findings
are reliable. First, it is not uncommon for the scars described to be so
small (one or two millimeters) as to be visible only with the use of the colposcope.
(I am unable to present here a tabulation of the sizes of the
scars in the the cases reviewed, for most often no pictures are taken and
no measurement is taken.)
Also, we have no data on how frequently these findings will be found if
normal children are examined in this way, particularly if the examiner is
not told ahead of time that the child is to be examined is brought in for
a sexual abuse examination. Specks of one or two millimeters (about
one-sixteenth of an inch) may be easily called "scars" but are
hardly reliable indicators of prior trauma.
Paul (1986) has commented forcefully on overinterpretation of such
"scars." He writes, "... there is no evidential value in
the finding of these tiny areas of scar tissue, for they are certainly not
indicative of any form of sexual abuse. To honour them as being indicative
of sexual abuse is to dishonour the administration of justice."
Clayden (1987), Hey, Buchan, Littlewood and Hall (1987) and Roberts (1986)
comment in a similar vein.
Are "fissures" any more reliable as an indicator
of molest? Just as in other parts of the body, (take chapped lips, for
example) fissures may occur from many causes (Mazier, DeMoraes & Dignan,
1978). Infection and secondary scratching are certainly a prime example.
fissures are too nonspecific to reliably indicate anal abuse.
In those cases I have reviewed where a second examination took place, it was common for the one examiner
to describe fissures and/or scars while the next examiner saw none. This was
particularly true if the second examiner had not had a chance to see the first
Confusion in the Laboratory
Overinterpretation of data is not, unfortunately, confined
to the physical examination of the child. Laboratory data are frequently being
interpreted in ways which are not medically justified.
Gonorrhea of the throat, for example, is easily confused
with other organisms which occur normally (Mazier et al., 1978; Whittington,
Rice, Biddle, & Knapp, 1988). Even genital gonorrhea, which obviously
should lead to the most searching investigation of possible sexual contact, is
not inevitably caused by adult sexual contact (Folland, Burke, Hinman, &
Schaffner, 1977; Frau & Alexander, 1985; Frewen & Bannatyne, 1979;
Gilbaugh & Fuchs, 1979; Gunby, 1980; Lipsitt & Parmet, 1984; Low, Cho,
& Dudding, 1977; Neinstein, Goldenring & Carpenter, 1984; Potterat,
Markewich, King, & Merecicky, 1986; Shore & Winkelstein, 1971).
Condyloma acuminata (so-called venereal warts) in children
do not necessarily prove molest, despite frequent court testimony to the
contrary (Bender, 1986; DeJong, 1982; Rock, Naghashfar, Barnett, Buscema,
Woodruff, & Shah, 1986; Seidel et al., 1979; Shelton, Jerkins, & Noe,
1986; Stringel, 1985). Chlamydia false-positives are a risk with antigen
screening tests, yet many persons have been accused on this basis (Fuster
& Neinstein, 1987; Hammerschlag, Rettig, & Shields, 1988). Other
organisms, such as Gardenella may infect the genitals of children, but
insufficient data exist to automatically assume molest (Bargman, 1986;
Bartley, Morgan, & Rimsza, 1987; Kaplan, Fleisher, Paradise, &
The medical community should first speak out forcefully,
alerting the community to the fact that unwarranted conclusions are being
drawn by a small group of practitioners.
Research which generates controlled data is long overdue. Studies like that of McCann et al. must be replicated for all age groups, so
that standards of normal ano/genital anatomy are established. Examiners should
not be limited to those with a "special interest" in sexual abuse,
for they have already demonstrated a profound bias.
Beyond such studies to establish the range of normal
anatomy, we need studies which compare molested with nonmolested children.
Those studies which have claimed to do this have in fact simply relied on the
judgment of the referring agency as to which children were molest victims
(Cantwell, 1983; Cantwell, 1987; Emans et al., 1987; Enos et al., 1986; Grant,
1984; Hammerschlag et al., 1985; Herbert, 1987; Hobbs & Wynne, 1986; Khan
& Sexton, 1983; McCann et al., 1988; McCauley et al., 1986; Muram, 1988;
Seidel et al., 1986; Spencer & Dunklee, 1986; Tilelli et al., 1980).
ignores, of course, the well established fact that false accusations of molest
are a major problem.
Studies which compare molested children with normals must
limit themselves to children demonstrated convincingly to have been molested.
This will be difficult, for court findings are not necessarily accurate.
however, this difficulty is ignored, and an unknown number of children
examined and assumed to be molested have in fact not been molested, the data
will continue to be as meaningless as they are now.
Meanwhile, the courts need to modify their current
practice. The current assumption that a second examination is unnecessary must
be reevaluated. Opinions not accompanied by photographs should be viewed with
suspicion. Serious consideration should be given to the claim that
interpretations being currently offered are not yet recognized by the general
medical community. Finally, our Appeals Courts should recognize that
convictions which relied on these premature medical claims are now suspect.
Physical examiners should not interview the child to get a
"history" of possible abuse. This may influence the child and bias
the examiner's subsequent findings and interpretations. Examiners should be
told only that a careful ano/genital examination is required. When findings
are conveyed to family members and/or law enforcement, overinterpretations must be
avoided. All parties should be careful to remember that sexual abuse is rarely
determined by physical examination alone. Thorough investigation is required.
Only when the medical community recognizes, and speaks out
against, the current perversion of medical science, will the Courts and law
enforcement respond. No sign of such an outcry from the doctors is on the
horizon. Their deep sleep will only end, it seems, when concerned citizens
take up the trumpet to awaken them.
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