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  • Most sexual abuse examinations in children are normal even with known sexual abuse.
  • The history is usually the most important piece of evidence in cases of suspected sexual abuse in children.
  • All 50 states require reporting suspected child abuse including sexual abuse to a proper investigatory agency (child protective services and/or law enforcement).
  • Sexually transmitted diseases are extremely rare in cases of pediatric sexual abuse.
  • Screening for and empiric treatment of sexually transmitted diseases is not routinely recommended in cases of pediatric sexual abuse.
  • Forensic evaluation is recommended by the American Academy of Pediatrics (AAP) when the abuse occurred within the previous 72 hours.
  • Speculum examinations are not indicated in preadolescent female sexual abuse patients. A thorough external genital examination is sufficient.


The National Center on Child Abuse and Neglect defines child sexual abuse as “contact or interaction between a child and an adult when a child is being used for the sexual stimulation of that adult or another person. Sexual abuse may also be committed by another minor when that person is either significantly older than the victim or when the abuser is in a position of power or control over that child.” Contact forms of child sexual abuse include fondling the child's genitals, getting the child to fondle an adult's genitals, mouth to genital contact, rubbing an adult's genitals on the child, or actually penetrating the child's vagina or anus. Noncontact forms of child sexual abuse include showing an adult's genitals to a child, showing the child pornographic material, or using the child as a model to make pornographic material.


Sexual abuse of children is a very real problem in our society. Children are most often abused by adults or older children who are known to them and who can exert power over them. The victim knows the offender in 8 out of 10 reported cases.1 The offender can be a family member or a nonfamily member and is more frequently male.2 The offender is frequently someone that the child trusts and will often persuade the child with bribes, tricks, or coercion to engage in sex or sexual acts. This can be followed by threats to the child if he or she tells.


Increased risk for sexual abuse of children is not related to socioeconomic status or race.3 Family risk factors associated retrospectively with child sexual abuse include poor parent–child relationships, poor relationships between parents, absence of a protective parent, and presence of a nonbiologically related male in the house.3


Sexual abuse affects approximately 100,000 children each year in the United States.4 Most abuse goes unreported during childhood. However, it is estimated that 20% of girls and 9% of boys are the victims of sexual abuse during childhood.1,3 Children of all ages are the victims of sexual abuse, but are most likely to be abused sexually during preadolescence, that is, from ages 8 to 12 ...

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