II. Epidemiology
- Perpetrators are known to child or child's family in 90% of cases
-
Incidence of sexual buse during childhood in U.S.
- One in four girls
- One in thirteen boys
III. Symptoms: Sexual Abuse Indicators
- Behavior change
- Unwilling to participate in activities
- Aggression
- School problems
- Sleep problems
- Eating disturbance
- Regression to Thumb Sucking or security blanket
- Bizarre, sophisticated behavior or knowledge
- Beyond age appropriate behavior
- Sexual acting out
- Child may report sexual abuse (believe them)
- May be most important piece of information
IV. Findings: Sexual Abuse Indicators
- Difficult walking or standing
- Torn, stained or bloody undergarments
- Genital pain or Pruritus
- Genital Bruising or bleeding
- Frequent Urinary Tract Infections
- Encopresis
- Enuresis
- Recurrent Abdominal Pain
- Chronic Headaches
- Pregnancy or Sexually Transmitted Disease
V. History: Medical Interview Technique
- Perform alone with open ended questions
- Use neutral tone
- Avoid leading questions
- Record answers exactly as spoken
VI. Exam: Technique
- Perform full medical exam (including for other signs of injury)
- See Child Abuse
- Forensic evidence with Rape Kit if within 72 hours
- Typically performed by Sexual Assualt Nurse Examiner (SANE)
- Consider adjunctive examination equipment
- Colposcope
- Otoscope
- Examination points
- Examination of mouth for forced oral penetration
- Palatal Ecchymosis or Petechiae
- Trauma to frenulum of Tongue
- Genital exam in Girls
- Pubertal girls
- Speculum Exam in lithotomy position
- Prepubertal girls
- Examine in frog-leg position in caretakers lap
- Prone with knee-chest position exam
- Internal exam is typically performed by specialist in operating room under sedation
- Endoscope
- Speculum exam for unexplained bleeding
- Moistened cotton swab for hymenal exam
- Foley Catheter in vagina behind hymenal ring
- Pubertal girls
- Genital exam in Boys
- Examine penis, Testicles, perineum, and anus
- Examination of mouth for forced oral penetration
VII. Exam: Red Flags
- Findings suggestive of abuse
- Posterior hymenal ring deep notches or clefts
- Condyloma in children over age 2 years
- Significant anal dilatation or scarring
- Findings diagnostic of Penetrating Trauma
- Hymenal Laceration or Ecchymosis
- Posterior hymenal ring tissue defect or cleft
- Anal Laceration
VIII. Management
- Consult Sexual Assualt Nurse Examiner (SANE) for evidence based exam
- Indicated if sexual act within last 72 hours
- See Rape Management
- Includes testing and empiric treatment for Sexually Transmitted Infection
- Consult Child Abuse specialists
- Evaluate safety of home environment
- Report all cases of suspected abuse
- Evaluate patient's physical and mental health
- Anticipatory guidance for non-perpetrator parents
- Support and believe your children
- Respond in a protective and calm manner
- Reassure children that this is not their fault
- Ensure close medical and mental health follow-up
IX. References
- Claudius and Willner in Herbert (2019) EM:Rap 19(1): 2-4
- (1999) Pediatrics 103:186-91 [PubMed]
- Adams (2004) J Pediatr Adolesc Gynecol 17:191-7 [PubMed]
- Bays (1993) Child Abuse Negl 17:91-110 [PubMed]
- Hymel (1996) Pediatr Rev 17:236-50 [PubMed]
- Lahoti (2001) Am Fam Physician 63(5):883-92 [PubMed]
- Suniega (2022) Am Fam Physician 105(5): 521-8 [PubMed]
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| Definition (MEDLINEPLUS) |
Sexual abuse is one form of child abuse. It includes a wide range of actions between a child and an adult or older child. Often these involve body contact, but not always. Exposing one's genitals to children or pressuring them for sex is sexual abuse. Using a child for pornography is also sexual abuse. Most sexual abusers know the child they abuse. They may be family friends, neighbors or babysitters. About one-third of abusers are related to the child. Most abusers are men. If you think a child may have been abused, it's important to report it. |
| Definition (MSH) | Sexual maltreatment of the child or minor. |
| Concepts | Mental or Behavioral Dysfunction (T048) |
| MSH | D002650 |
| ICD9 | 995.53 |
| SnomedCT | 154906006, 95922009 |
| DSM4 | V61.21 |
| English | Abuse, Child Sexual, Child Abuse, Sexual, Child Molestation, Sexual, Molestation, Sexual Child, Molestation, Sexual, Child, Sexual Abuse, Child, Sexual Child Abuse, Sexual Child Molestation, Sexual Abuse of Child, Child molesting, Sexual abuse of child, Child sexual abuse, child sexual abuse, child abuse sexual, of child sexual abuse, sexual abuse child, abuse child sexual, of sexual child abuse, sexual child abuse, Sexual Abuse of Children, Sexual abuse of child (disorder), CSA - Child sexual abuse, Child Sexual Abuse |
| Swedish | Sexuella övergrepp mot barn |
| Spanish | Abuso sexual de un niño, Abuso Sexual de Niños, Abuso Sexual del Niño, Abuso Sexual Infantil, Acoso Sexual Infantil, Vejamen Sexual Infantil |
| French | Abus sexuel d'enfants, Sévice sexuel chez l'enfant, Maltraitance sexuelle chez l'enfant, Violence sexuelle chez l'enfant, Exploitation sexuelle d'enfants |
| Dutch | seksueel kindermisbruik, Misbruik van kinderen, seksueel, Molestatie van kinderen, seksuele, Molestatie, seksueel, kinderen, Seksueel misbruik van kinderen, Seksueel misbruik, kinderen |
| Portuguese | Abuso sexual de criança, Abuso Sexual do Adolescente, Maus-Tratos Sexuais de Menor, Abuso Sexual na Infância, Abuso Sexual Infantil, Violação Sexual de Menor, Violação Sexual Infantil, Abuso Sexual de Adolescente, Abuso Sexual de Menor, Abuso Sexual de Crianças e Adolescentes, Maus-Tratos Sexuais Infantis, Abuso Sexual de Menores, Maus-Tratos Sexuais da Criança, Abuso Sexual da Criança, Molestamento Sexual da Criança |
| German | sexueller Missbrauch eines Kindes, Belästigung, sexuelle, von Kindern, Kindesmißbrauch, sexueller, Sexuelle Belästigung des Kindes, Sexueller Mißbrauch des Kindes, Sexueller Mißbrauch, Kind |
| Italian | Abuso sessuale su bambino, Molestia sessuale su minori, Violenza sessuale su minori |
| Japanese | 幼児への性的虐待, ﾖｳｼﾞﾍﾉｾｲﾃｷｷﾞｬｸﾀｲ, 性的児童虐待, いたずら-性的-小児, 児童虐待-性的, 小児性的いたずら, 幼児性的虐待, 児童性的虐待, 小児のいたずら-性的, 小児虐待-性的, 性的いたずら-小児, 性的虐待-幼児, 虐待-児童-性的 |
| Finnish | Lasten sukupuolinen hyväksikäyttö |
| Russian | RASTLENIE MALOLETNIKH, DETI, RASTLENIE, DETEI RASTLENIE, ДЕТЕЙ РАСТЛЕНИЕ, ДЕТИ, РАСТЛЕНИЕ, РАСТЛЕНИЕ МАЛОЛЕТНИХ |
| Czech | Sexuální zneužití dítěte, sexuální obtěžování dítěte, sexuální zneužívání dítěte, dítě - zneužití sexuální, sexuální obtěžování dětí, sexuální zneužívání dětí |
| Croatian | DIJETE, SPOLNO ZLOSTAVLJANJE |
| Polish | Nadużycia seksualne w stosunku do dziecka, Seksualne wykorzystywanie dziecka, Wykorzystywanie seksualne dziecka, Molestowanie seksualne dziecka |
| Hungarian | Gyermekkori szexuális visszaélés |
| Norwegian | Seksuelle overgrep mot barn, Barnemishandling, seksuelt misbruk |
