Sexual Abuse: A-to-Z Guide from Diagnosis to Treatment to Prevention

 Introduction to sexual abuse:

Some of the most poignant episodes of my pediatric training were long visits with children victimized by sexual abuse. I vividly remember sitting with tears streaming down my face after hearing how children had been scarred by those they trusted.
How sad that this is such an important subject to discuss.

What is it?

Sexual abuse includes any activity with a child for the sexual gratification of an adult or significantly older child (generally more than 4 years older). Children’s intense need for affection and nurturance from older figures makes them vulnerable. Adults and older children hold a position of tremendous power in their lives. It is the abuse of this power (and the abuse of children’s trust) that is so damaging to children.

Sexual abuse falls into three different categories:

1. Molestation — Defined as the touching or fondling of the genitals of a child, or asking a child to touch or fondle an adult’s genitals, or using a child to enhance pleasure from sexual acts or pornography
2. Sexual intercourse — Includes vaginal, oral, or rectal penetration
3. Rape

Who gets sexually abused?

The most common perpetrator of sexual abuse is either a family member or a close friend of the family. Sexual abuse by a stranger is quite uncommon.

Unfortunately no age is exempt from sexual abuse. About one third of cases occur in kids younger than six years of age, about one third in children ages six to twelve, and one third in children ages twelve to eighteen.

What are the symptoms?

The most common way that sexual abuse comes to light is through the child’s disclosing sexual contact to a trusted adult. Historically, a child’s word was not taken seriously. During the last twenty years the pendulum swung to the opposite extreme — if a child described sexual contact it was considered a fact, and the volunteering of such information was considered very strong legal evidence. Recently, the pendulum has returned to a more balanced position: Take it very seriously whenever a child mentions sexual contact, but understand that not everything said necessarily mirrors physical reality.

Children who have actually been abused will often recant their initial statement because they are afraid of their abuser or because their abuser convinces them that this is “their little secret.” Several clues are associated with sexual abuse (but many children give no clues except what they say):

• Genital infections, redness, or discharge
• Burning with urination
• Urinary tract infection
• New onset of either bedwetting or stool problems
• Suddenly increased sexuality with peers, animals, or objects
• Seductive behavior
• Age-inappropriate sexual knowledge
• Regression
• Other dramatic behavior changes

Is sexual abuse contagious?

No

How long does sexual abuse last?

Most abuse begins with innocent physical contact. A needy adult then makes this a routine. Once a routine, it is not uncommon to progress to intercourse.

How is sexual abuse diagnosed?

The best way to clarify a situation is to have your child examined by a specialist in the area of sexual abuse. Most children’s hospitals have a sexual abuse team, or will be able to refer you to a specialist in the area.

A sexual abuse examination is comprised of two basic elements. First, and perhaps most important, a child would be interviewed by an expert who very gently elicits information about what might have happened. The interviewer will let the child set the pace and will use pictures or dolls to draw him or her out, without suggesting what might have occurred. This is generally followed by a physical examination of the external genitals, checking for any sign of trauma, laxity, or discharge.

Sometimes this will be done with magnification, using an instrument called a colposcope. In at least half of the cases of child abuse that are confessed by the abuser, there are no findings on physical exam.

How is sexual abuse treated?

Abuse should be treated by a supportive team of experts.

How can sexual abuse be prevented?

Parents need to be careful about who spends time alone with their children – where and when.

We must prepare our children to prevent sexual abuse. Begin by teaching them the proper names and significance of their private parts as soon as they are able to understand (about age 3). Then they will be ready to understand the three key messages:

1. Say no if somebody tries to touch your nipples, rectum, or genitals.
2. Tell a trusted adult if someone tries to touch you.
3. Don’t keep secrets — If somebody tells you to keep a secret, let your parents know right away.