Sexual abuse

Definition
• CHILD – all those aged below 18 years
• A child is abused sexually if the child takes
part, either as participants or observers, in any
sexual activity for any purpose or sexual
exploitation by any to satisfy the sexual
desires of that person or another person.
- Child Act 2001
• Sexual abuse defined as any sexual behavior or
action toward a child that is unwanted or
exploitative

• Sexual abuse does not have to involve direct

touching or contact by the perpetrator.

• Showing pornography to a child, filming or

photographing a child in sexually explicit poses,
and encouraging or forcing one child to
perform sex acts on another also constitute
 Epidemiology
• 80% of victims are girls
• Most child abuse goes unreported
• Majority of child sexual abuse perpetrators
were mainly from persons known to the
victims

• Perpetrators are more often male than female

• All perpetrators strive to keep the child from

disclosing the abuse and often do so with
coercion or threats.
• Children commonly delay disclosure for many
weeks, months, or years after their abuse,
especially if the perpetrator has ongoing
access to the child.
 Presentation
• Children exhibit sexually explicit behaviour
(outside the norm for a child’s age and
developmental level)
• Child may tell someone about the abuse
 Presentation
• Behavioural symptoms
– Social withdrawal
– ↑ fearfulness
– Distractibility
– Learning difficulty
– Poor school performance
– New onset of bedwetting
– Self-harm
– Aggressive
– Depression
– Running away from home
 Presentation
• Physical symptoms
– Vaginal bleeding, itching, discharge
– Rectal bleeding.
 Presentation
• Pregnancy
• Sexual transmitted disease with no clear
explanation
 Hx
• History obtain from child
• Interview should conduct with child separate
from family member
• Ask open ended & non leading question
 Special questions
• Identity of alleged perpetrator/relationship to
child
• Time of last possible contact
• Method of disclosure
• Specific types of sexual contact included in the
abuse
• Previous official reports of the abuse
 Special questions
• In all cases, the child should be questioned
about medical issues related to the abuse,
such as timing of the assault and symptoms
(bleeding, discharge, or genital pain)
• Review of systems including genital pain,
bleeding, dysuria, constipation, painful bowel
movements, and behavioural changes