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HIGH-YIELD FACTS

  • 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 (STDs) are uncommon in cases of pediatric sexual abuse.

  • Empiric treatment of STDs is not routinely recommended in cases of pediatric sexual abuse, especially in prepubescent children. Case-by-case determinations should be made.

  • 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.

ETIOLOGY

The National Center on Child Abuse and Neglect defines child sexual abuse as “A type of maltreatment that refers to the involvement of the child in sexual activity to provide sexual gratification or financial benefit to the perpetrator, including contacts for sexual purposes, molestation, statutory rape, prostitution, pornography, exposure, incest, or other sexually exploitative activities.”1

Child sexual abuse includes 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. Showing an adult’s genitals to a child, showing the child pornographic material, or using the child as a model to make pornographic material are also forms of child sexual abuse.

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. The offender 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. There is often a period of “grooming” during which time the perpetrator gradually develops the child’s trust. This can be followed by threats to the child if he or she tells.

EPIDEMIOLOGY

While 57,300 cases were confirmed according to 2015 NCANDS (National Child Abuse and Neglect Data System) data, sexual abuse affects more than 100,000 children each year in the United States.3 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.1,4 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 years.4 Increased risk for sexual abuse of children is not related to socioeconomic status.4 While racial disparities have been found for other types ...

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