Probably one of the most disturbing facts about child sexual abuse and incest, is that in 80% of reported cases, the mother of the victim was aware of the sexual abuse inflicted on the child, yet did little or nothing about it. Just how responsible is a parent for failing to report or stop the sexual abuse of a child or family member?
If the sexual assault has occurred within 72 hours of a physical examination, forensic evidence collection should be conducted. A complete physical examination, including careful documentation of any lacerations (a torn or jagged wounds), ecchymoses (skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels) or petechiae (pinpoint size flat round red dots under the skin surface caused from hemorrage - bleeding into the skin), is critical. Physical examination of the oral cavity includes inspection of the hard and soft palate for bruising or petechiae, and inspection of the frenulum (the membrane that attaches the tongue to the floor of the mouth) for any lacerations that can result from forced oral penetration.
Rape evidence collection kits are available in the emergency department of most hospitals. Evaluation of acute sexual assault may be conducted in an emergency department setting or, if available, at a children's advocacy center. In nonacute cases, the office of the family physician has the benefit of being a familiar location for the patient. The physician should maintain a gentle and calm demeanor and be considerate of the apprehensive child. It is helpful to explain the examination beforehand to the patient and caretaker.
Medical problems include anogential (anal) trauma, bleeding, irritation or discharge, dysuria (painful or difficult urination), frequent urinary tract infections, encopresis (repeated passing of feces into places other than the toilet), enuresis (repeated passing of urine into places other than the toilet), pregnancy, diagnosis of a sexually transmitted disease (STD) and oral trauma.
Children may present with somatic (muscles and nerves) complaints such as recurrent agdominal pain or frequent headaches resulting from the psychologic stress. Sexual acting-out behavior is the most specific indicator of possible sexual abuse.
Child sexual abuse generally refers to sexual acts, sexually motivated behaviors, or sexual exploitation involving children. Child sexual abuse includes a wide range of behaviors, such as:
- Oral, anal, or genital penile penetration
- Anal or genital digital or other penetration
- Genital contact with no intrusion
- Fondling of a child's breasts or buttocks
- Indecent exposure
- Inadequate or inappropriate supervision of a child's voluntary sexual activities
- Use of a child in prostitution, pornography, Internet crimes, or other sexually exploitative activities
Sexual abuse includes both touching offenses (fondling or sexual intercourse) and nontouching offenses (exposing a child to pornographic materials) and can involve varying degrees of violence and emotional trauma.
The most commonly reported cases involve incest, or sexual abuse occurring among family members, including those in biological families, adoptive families, and stepfamilies. Incest most often occurs within a father-daughter relationship.
Mother-son, father-son, and sibling-sibling incest also occurs. Sexual abuse is also sometimes committed by other relatives or caretakers. In fifty percent of reported child sexual abuse within families the perpetrator was an older sibling.
Consider the possibility of sexual abuse when the child:
- Has difficulty walking or sitting
- Suddenly refuses to change for gym or to participate in physical activities
- Reports nightmares or bedwetting
- Experiences a sudden change in appetite
- Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
- Becomes pregnant or contracts a venereal disease, particularly if under age 14
- Runs away
- Reports sexual abuse by a parent or another adult caregiver
Consider the possibility of sexual abuse when the parent or other adult caregiver:
- Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex
- Is secretive and isolated
- Is jealous or controlling with family members
The presence of a single sign does not prove child abuse is occurring in a family; however, when these signs appear repeatedly or in combination you should take a closer look at the situation and consider the possibility of child sexual abuse.
CHILD SEXUAL ABUSE - DEFINED
Child sexual abuse (1 in 3 girls and 1 in 7 boys) occurs among all groups of the population. It happens to children in both rural and urban areas and in all socioeconomic and educational levels, and across all racial and cultural groups.
There is no rule governing the age range between a victim and a perpetrator. Generally, children are sexually abused by adults who are related to them or known by them or their families.
Sexual abuse is forced, tricked, or coerced sexual behavior between a young person and an older person.
Child sexual abuse may consist of any one of the following acts:
1. Nudity 2. Disrobing 3. Genital exposure 4. Inappropriate kissing or fondling 6. Masturbation 7. Oral-genital contact 8. Child pornography 9. Digital penetration 10. Vaginal or anal intercourse
Acquaintance perpetrators are the most common abusers, constituting approximately 70-90% of all reported perpetrators. In sexual abuse cases committed against females, approximately one third to one-half of all perpetrators were related to the victim. Only about one-tenth of the abusers were related to their male victims.
Hope it helps!
You've read the headlines, now watch the story about a crime so heinous some would rather see the suspect dead than in jail. The manhunt for the nation's most wanted alleged pedophile ended last night as fugitive Chester Stiles, accused in the videotaped molestation of a three-year-old girl, was arrested outside Las Vegas. Stiles had been wanted since October 5 on warrants issued for 21 felony charges in connection with acts seen on the videotape. Could you spot a child predator? Is your family at risk? Be there when Dr. Phil tells you the warning signs to watch for -- you'll be shocked! Plus, the reported victim's mother breaks her silence in an exclusive interview with Dr. Phil. Then, hear what Stiles' ex-girlfriend's son has to say, and what the victim remembers about the attack. If it's happening now, Dr. Phil is going to deal with it now! Don't miss this breaking news Dr. Phil Now. Join the discussion.
