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 is/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, ecchymoses or petechiae, 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 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 trauma, bleeding, irritation or discharge, dysuria, frequent urinary tract infections, encopresis, enuresis (especially after continence has been acheived), pregnancy, diagnosis of a sexually transmitted disease (STD) and oral trauma.
Children may present with somatic 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.
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.
Hope it helps!
