Topic : 03/07 Dr. Phil Now: Sex Offenders Next Door

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. 

familywatchdog.us is the ONLY site I have ever found that does not charge a fee for the information. I think John Walsh is involved in it. I am thankful for it and I really appreciate the information I have found there.

Today as I was watching Dr. Phil, which I do most weekdays, I almost turned it off because I didn't think that it related to me.  My oldest children are 27 and 25, my youngest is 18 and away at college.  I thought the show would be about young children, grammar school, middle school, maybe even high school.  I was so far removed from that I didn't think I could learn anything.  To my shock the show focused on Brianna Denison, a college student who was abducted and murdered.  I was sick.  My 18 yr. old goes to a small junior college  in West Virginia.  That's a ways from where we are on Long Island in New York. Anyway,  after I watched the show I really felt the need to call her and remind her NEVER to walk alone.  I put the call off waiting for her to call me.  She called at 11pm. I was surprised because it was late. She informed me that she was accosted that night as she was entering her dorm by a man who was drunk and had no business being on campass.  Thankfully she wasn't hurt but somebody touched my child. I'm outraged and thankful. She goes to a small rural college, not a huge university. I asked her if she screamed and she said no.  She's not a screamer, so she says.  All I'm saying is that  if you saw the show heed the warning, if not maybe you should see it.  The man who grabbed my daughter was arrested.  He was out on probation.  Drinking seems to be his problem and he is being charged with batttery. I'm sick that this happened, don't let it happen to you.