According to the World Health Organization (WHO), child sexual abuse is defined as “the involvement of a child in sexual activity that he or she Sexual Abuse in Children – know all the factsdoes not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws of social taboos of society.”
There are different types of child sexual abuse and a few include:
- Engaging in sexual activities with a child.
- Indecent exposure of the child’s genitals, female nipples, etc.
- Child grooming such as child prostitution.
- Using a child to produce child pornography.
Child sexual abuse takes place in a variety of settings, for example, in the homes, school, or work (where child labor is common). Child marriage is known as one of the main forms of child sexual abuse.
In child sexual abuse, physical force or violence is rarely used, as the perpetrator would try to manipulate the child’s trust and hide the abuse. The perpetrator is usually a trusted caregiver and the sexual abuse often occurs over many weeks or even years.
WHAT INCREASES RISK OF SEXUAL ABUSE IN CHILDREN
A few of the factors that put a child at risk of sexual abuse are listed below:
- Female sex, however, in some developing countries, the male child constitutes a large number of the victims
- Children in foster care, adopted children, stepchildren
- Physically or mentally handicapped children
- History of past abuse
- Psychological or cognitive vulnerability
- Single parent homes or broken homes
- Social isolation
- Parents with mental illness or alcohol or drug dependency
WHAT INDICATES THAT A CHILD HAS BEEN SEXUALLY ABUSED?
There are a few physical and behavioural changes that would indicate that a child is being sexually abused and a few are listed below.
More often than not, clear physical findings of sexual abuse are seldom seen in children. This is because very little or no force is used. However in some cases, there may be evidence of force and harm and other physical changes would be seen in the child.
- Unexplained genital injury
- Recurrent vulvovaginitis – this is an inflammation or infection of the vulva and vagina that results in discharge, itching and pain
- Vaginal or penile discharge
- Bedwetting and fecal soiling beyond the usual age
- Anal pain, bleeding or fissures
- Painful urination
- Sexually transmitted infections
- Presence of sperm
- Regression in behavior and attaining developmental milestones – the child tends to return to younger behaviors
- Regression in school performance
- The child becomes withdrawn or very clingy
- The child becomes unusually secretive
- Outbursts of anger
- Depression, self-harm, personality changes, mood swings and becoming insecure
- The child has an unaccountable fear of particular places or people
- Eating disorders
- Sleep disturbances
- Inappropriate sexualized behaviors – there are developmentally appropriate sexualized behaviors such as kissing, fondling, masturbation and rhythmic pelvic thrusting, however these become inappropriate when, for example, a little boy is frequently playing with his penis in public or a girl masturbating repeatedly in school.
HEALTH PROBLEMS RELATED TO SEXUAL ABUSE
Child sexual abuse can result in a number of health problems and a few are listed below.
- Gastrointestinal disorders – chronic abdominal pain, non-ulcer dyspepsia, irritable bowel syndrome, etc.
- Gynecological disorders – chronic pelvic pain, dysmenorrhea, menstrual irregularities, etc.
- Psychological effects – somatization, depression, post-traumatic stress disorder, eating disorders, anxiety, sleep disturbances, poor self-esteem, etc.
DIAGNOSIS AND MANAGEMENT
Most children who are being sexually abused would not disclose this immediately. This reluctance to disclose is usually due to fear of the perpetrator who probably told them, they would die or a family member would die if they disclosed it. Some children also feel helpless because no one would believe them if they were to speak up.
Sometimes, a child may not disclose to their mother because usually she is being abused by the same perpetrator. In this case, disclosure would be to a close friend, peer or teacher.
When a child discloses abuse or abuse is identified, it must be reported as soon as possible and the child must be taken to see a healthcare professional.
A thorough assessment and examination of the child would be done. To gain information, a medical history is taken and an interview conducted. A head-to-toe physical examination is also done.
A number of diagnostic tests and specimen collection would be done based on prior assessment.
A child may be tested for some sexually transmitted infections (STI). The decision to test for STIs is made based on the following:
- If the child presents with symptoms of an STI e.g. vaginal discharge, genital ulcers.
- If the perpetrator is known to have an STI or is at high risk of contracting STIs.
- If there is a high prevalence of STIs in the community.
- If anyone in the household is showing symptoms of an STI.
- If the patient or parent requests for testing.
Pregnancy testing may also be done.
After a thorough assessment, the child would be treated based on findings.
Counselling and social support is highly recommended.