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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Child abuse - sexual

Sexual abuse - children

Last reviewed: September 17, 2012.

Child sexual abuse is the deliberate exposure of minor children to sexual activity. This means a child is forced or talked into sex or sexual activities by another person. Such abuse includes:

  • Oral sex
  • Pornography
  • Sexual intercourse
  • Touching (fondling)

Causes, incidence, and risk factors

Society was reluctant to deal with child sexual abuse a few decades ago. Today, it is considered a serious issue.

It is difficult to determine how often child sexual abuse occurs, because it is more secret than physical abuse. Children are often scared to tell anyone about the abuse. Many cases of abuse are not reported.

Abusers are usually men. They tend to know the person they are abusing. The abuser violates the trust of the younger person, which makes the sexual abuse even more devastating.

Child sexual abuse occurs in all social and economic classes of people. It has the same type of risk factors as physical child abuse, including:

  • Alcohol and drug abuse
  • Family troubles
  • Poverty

Abusers sometimes have a history of physical or sexual abuse themselves.

A small group of repeated abusers have the psychiatric disorder, pedophilia. Their preferred sexual contact is with children.

Symptoms

Symptoms of sexual abuse in chlildren are similar to those of depression or severe anxiety and nervousness. They can include:

Children who are abused may:

  • Display disruptive behaviors such as using alcohol and street drugs or engaging in high-risk sexual behaviors
  • Do poorly in school
  • Have excessive fears
  • Withdraw from normal activities

Signs and tests

If you suspect a child has been sexually abused, the child should be examined as soon as possible by a trained health care professional. Most pediatricians, many family medicine doctors, and most emergency room (ER) doctors have been trained to examine cases involving sexual abuse.

Do not delay a doctor's exam for any reason. Many signs of injury related to sexual abuse are temporary. The exam should be done within 72 hours of the event or discovery.

A complete physical exam must always be performed, so that the examiner can look for any signs of physical and sexual abuse. The two forms of abuse may exist together.

Affected areas may include the mouth, throat, penis, anus, and vagina, including the hymen. The hymen is a thin piece of tissue covering the opening of the vagina. It can be affected by abuse.

Your doctor may also order blood tests to check for sexually transmitted diseases, such as syphilis and HIV, and pregnancy in females. These tests can help determine treatment.

Photographs of injuries may help establish what happened. It is extremely important to write down symptoms due to any form of child abuse.

An exam will automatically be scheduled when suspected child sexual abuse is reported to police or child protection agencies. A second exam with an expert abuse examiner should be scheduled after the first exam. A doctor or nurse specialist can be found through child protective services programs anywhere in the United States.

Treatment

Treatment for the physical signs of sexual abuse is the same as for any types of cuts, bruises, or scrapes. The patient may need medicines to prevent or treat sexually transmitted diseases. Older females may receive medicines to prevent pregnancy.

All children who have been sexually abused or traumatized in any way should receive mental health counseling.

Any suspicion of child sexual abuse must be reported to child protective services and the police. Medical professionals, teachers, and child care professionals are required by law to make a report.

Once a case is reported, child protection agencies and the police must investigate. If the report is considered true, the child must be protected from further abuse. The child may be placed with a non-abusing parent, another relative, or a foster home.

Support Groups

Support groups for abused children, their parents, and caretakers are available and strongly recommended. The following organizations may provide more information:

Child Help USA - www.childhelpusa.org

Prevent Child Abuse America - www.childabuse.org

Rape, Abuse & Incest National Network - www.rainn.org

Expectations (prognosis)

The biggest issue is the child's mental health. The outcome depends on:

  • Family and social support
  • The child's personality
  • The length of time the child was abused and the type of abuse
  • Therapy

Complications

Calling your health care provider

If you suspect child abuse in any form, immediately call your health care provider, Child Protective Services, or police.

Prevention

Prevention involves teaching children never to keep secrets and the difference between "good" and "bad" touches. Parents need to begin this work at home. Most schools now have programs to teach young school-aged children about sexual abuse and its prevention.

Teenagers also need to be taught how to avoid rape and date rape.

Constant supervision and vigilance by adults is essential to preventing all forms of child abuse.

References

  1. Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 36.

Review Date: 9/17/2012.

Reviewed by: A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine (1/24/2011).

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • School‐based programmes for preventing child sex abuse may improve knowledge and self‐protective behaviours but also increase anxiety; further research is neededSchool‐based programmes for preventing child sex abuse may improve knowledge and self‐protective behaviours but also increase anxiety; further research is needed
    Childhood sexual abuse is a serious problem for school aged children worldwide. There is no consistent definition of sexual abuse. Some studies restrict sexual abuse to instances of sexual body contact with the child, while others define sexual abuse as any sexual behaviour in a child's presence. Whatever its form, childhood sexual abuse can have a very negative impact on a child. The United Nations' Convention on the Rights of the Child states that "children have the right to be protected from being hurt and mistreated, physically or mentally" and the international community needs to investigate ways this can be done effectively. One widespread method used is to teach school aged children, using school‐based programs, about child sexual abuse and how to protect themselves from it. It is important to know if this approach works, for how long it works and if it causes any unintended harm to children and adolescents. This is the purpose of this systematic review.
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