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Child Sexual Abuse

Alternate Names

  • child molestation
  • Female reproductive organs
  • Male genitourinary system

Definition

Child sexual abuse is any experience during childhood or adolescence that involves inappropriate sexual attention or behavior from another person. The abuser is usually an adult but can also be an older child, teenager, or sometimes even a person the same age.

Risks

What are the causes and risks of the injury?

Sexual abuse happens to children of all religions, ethnic origins, and income levels. Most 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.
Experts know that adolescents who have been abused are at higher risk for other health problems. However, we do not yet know whether the health problems came before the abuse or if the abuse increased the risk for the health problem. These problems include:
  • adolescent pregnancy
  • alcohol use, including binge drinking
  • cocaine abuse
  • risky sexual behaviors, including intercourse before age 15 and multiple partners
  • smoking
  • suicidal attempts or thoughts
  • unhealthy weight management, including eating disorders

Prevention

What can be done to prevent the injury?

Parents need to warn children about possible risks. Children should be taught the difference between good and bad touches. They need to be told that no one except a health professional should touch their private areas, and then only in a medically appropriate setting. Children should be told not to keep secrets from their parents, even if someone has threatened to harm them or their parents.
The best way to prevent abuse is to teach children how to solve problems without using abuse. Teenagers and young adults should be taught that it is never permissible to abuse a partner. Parents, along with pastoral, educational and healthcare professionals should provide teens with information and statistics about dating violence. The teens should be given specific information about behaviors that are part of dating violence. They should be encouraged to discuss any issues or concerns with a parent or other appropriate adult.
Since unhealthy behaviors such as cocaine use are associated with a higher risk for partner abuse, healthcare professionals should address dating violence when treating teens with these health issues. Careful screening can help identify at-risk teens and provide the opportunity to stop the abuse cycle.

Diagnosed

How is the injury recognized?

An 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 healthcare professional who is trained to deal with and recognize 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 genital areas.
If the abuse took place recently, the healthcare professional may do a special examination to check for sperm or semen stains. Child protective services officials need to be notified.

Treatments

What are the treatments for the injury?

Child protective services officials monitor 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 counseling may help. Much of the healing for many survivors takes place in a support group of other survivors. There is strength, comfort, and hope in hearing the stories of others who share their pain.
Antidepressant medicines 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 infections. Girls of childbearing age should be tested for pregnancy.

Side Effects

What are the side effects of the treatments?

Antidepressant medicines may cause mild and usually temporary side effects in some people. The most common side effects are:
  • agitation
  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • nausea
A person on antidepressant medicines needs to have blood levels monitored frequently.

After Treatment

What happens after treatment for the injury?

Long-term effects can include posttraumatic stress disorder. Although this nervous disorder can have many causes, in this case it is a result of physical, mental, or sexual violence.
The victim may have the following conditions:
  • depression
  • feelings of anxiety
  • feelings of isolation
  • irritability
  • nightmares and flashbacks
  • a tendency to avoid other people
Children who have 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 or attempt suicide.
Some sexually abused children become child abusers or prostitutes in later years. They are also at higher risk of abusing alcohol or other drugs to dull the pain.
A person who has been sexually abused most often needs long-term, sometimes years, of psychotherapy to come to terms with what has happened. 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 cannot live with a partner's pain and becomes frustrated at not being able to do anything about it.

Sources

Sheehy, Susan, Emergency Nursing Principles and Practice, 3rd Edition, 1997.

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