Definition Child sexual abuse is any experience during childhood or adolescence that involves inappropriate sexual attention by another person. This person is usually an adult, but can also be an older child, teenager, or even a person the same age. It can take place within the family, by a parent, stepparent, sibling, or other relative. It also can occur outside the family by a friend, neighbour, childcare person, teacher, or random molester. Broadbent and Bentley (1997) from the Australian Institute of Health and Welfare advise there were 4,862 substantiated cases of sexual abuse reported to state and territory organisations throughout Australia.
Sexual abuse can be classified into 3 types: non-touching sexual abuse, touching sexual abuse, and sexual exploitation.
Non-touching sexual abuse includes:
indecent exposure or exhibitionism
exposing a child to pornographic material
deliberately exposing a child to the act of sexual intercourse
masturbating in front of a child
Touching sexual abuse can include:
fondling
making a child touch an adult's sexual organs
any penetration of a child's vagina or anus by an object that doesn't have a medical purpose
Sexual exploitation can include:
engaging a child for the purposes of prostitution
using a child to film, photograph, or model pornography
What are the signs and symptoms of the injury? It is not always easy for an adult to recognise when sexual abuse has taken place. A child who has been sexually abused may:
wet or soil his or her bed
have nightmares
act seductively
be excessively curious about sex
have separation anxiety
have bruises or bleeding in the genital area
have pain or itching in the genital area
have frequent urinary tract infections
have poor self-esteem
lack confidence
have a premature understanding of sex
engage in inappropriate sex play
feel threatened by physical contact, closeness, or a certain person
What are the causes and risks of the injury? Sexual abuse happens to children of all religions, ethnic origins, and income levels. Often the abuser is someone the child knows, rather than a stranger. A person who was sexually abused as a child is more likely to become an abuser as an older child or adult.
Children who has been sexually abused usually develop low self-esteem, a feeling of worthlessness, and an abnormal perspective on sexuality. They may become withdrawn and mistrustful of adults, and attempt suicide. Some sexually abused children become child abusers or prostitutes in later years. They are more at risk to abuse alcohol or other drugs to dull the pain.
What can be done to prevent the injury? Parents need to warn children about possible risks. Children should be taught about good and bad touches. They need to be told that no one should touch their private areas. A child should be told that they should not keep secrets from their parents, even if someone has threatened to harm them or their parents.
How is the injury recognised? A abuser can make the child very fearful of telling anyone else. An adult should believe a child who says he or she has been sexually abused. Children rarely lie about sexual abuse.
When sexual abuse is suspected, the child should be taken to a doctor who is trained to deal with and recognise sexual abuse. He or she will ask the child to describe what happened. He or she also will look for injuries to the mouth, rectum, and vaginal area, if the child is a girl. If the abuse happened recently, the doctor will do a special examination to check for sperm.
Child protective services need to be notified.
What are the treatments for the injury? Child protective services monitors sexual abuse cases. Sexually abused children and their families need professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem. They can help them cope with their feelings of guilt about the abuse, and begin the process of overcoming the trauma. Individual psychotherapy and group counselling may help. A main part of the healing for many survivors is found in a support group of other survivors. There is strength, comfort, and hope in hearing the stories of others who share their pain. Antidepressant medications may be tried, but they are not usually as successful in treating depression in children as they are in adolescents and adults.
The child should be checked for sexually transmitted diseases. Girls of childbearing age should be tested for pregnancy.
What are the side effects of the treatments? Antidepressant medications may cause mild and usually temporary side effects in some people. The most common side effects are:
dry mouth
constipation
dizziness
drowsiness
agitation
nausea
A person on antidepressant medications needs to have blood levels montitored frequently.
What happens after treatment for the injury? A person who has been sexually abused may need years of psychotherapy to come to terms with what happened to them. Therapy is most often long-term. It can be difficult for an adult to come to terms with sexual abuse that occurred when he or she was a child. It may result in changes in the abused person's life. In some cases, divorce results when a spouse can't live with a partner's pain, and becomes frustrated at not being able to do anything about it.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 7/02/2005 Contributors Potential conflict of interest information for reviewers available on request
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