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Child Sexual Abuse (From Child Abuse and Neglect: Guidelines for Identification, Assessment, and Case Management, P 82-90, 2003, Marilyn Strachan Peterson and Michael Durfee, eds. -- See NCJ-200932)

NCJ Number
Angela Rosas M.D.
Date Published
9 pages
This chapter describes procedures for the medical screening and diagnosis of child sexual abuse, including a description of the California protocol for the examination of sexual assault and child sexual abuse victims.
Data from studies on the epidemiology of child sexual abuse indicate that approximately 1 percent of children experience some form of sexual abuse each year, resulting in the sexual victimization of 12-25 percent of girls and 8-10 percent of boys by age 18. For various reasons some of these victims are brought to the attention of the health care system. In addition to the victim's disclosure of sexual abuse, other signs and symptoms of sexual abuse are acute anogenital injuries without clear accidental cause; rectal or genital bleeding; genital discharge or infection; anal or genital pain, itching, swelling, or bruising; sexually transmitted disease; or sexually obsessive, aggressive, or coercive behavior. Stressors that may indicate sexual abuse are sleep disturbances, sudden drop in school grades, chronic abdominal pain, enuresis, encopresis, or phobias. The chapter describes two types of forensic medical examinations, i.e., acute medical forensic examinations and nonacute medical forensic examinations. The acute examination is conducted when the victim reports that sexual abuse has occurred within the past 72 hours; a complete forensic examination looks for signs of abuse-related injuries. The focus of the nonacute medical forensic examination involves signs of healed injury, irregularities in the genital structures due to chronic sexual abuse, and sexually transmitted disease. The California protocol for the examination of sexual assault and child sexual abuse victims, which was developed in 1987 to standardize the performance of such examinations, involves detailed procedures for the performance and documentation of acute and nonacute child sexual abuse medical forensic examinations. This chapter also describes the use of the colposcope in these examinations. This instrument enables pediatric examiners to detect subtle injury and/or healed changes in the genital or rectal area. In addition, the chapter discusses the importance of the multi-method approach in examining prepubertal adolescent females, considerations in the evaluation of children, and the classification of examination findings. In discussing prognosis, the chapter advises that the psychological effects of child sexual abuse or sexual assault require counseling to address acute and long-term issues related to posttraumatic stress disorder. It further advises that children in foster care should receive comprehensive medical examinations during the first 30 days of placement, including a screening assessment of the anogenital area. The chapter presents a relevant case vignette with follow-up questions. 2 tables and 5 resources