Child Sexual Abuse and Neglect

Sexual abuse of children is the involvement of children or adolescents in sexual activities that he or she does not fully understand and can include exhibitionism, fondling, oral-genital contact, and rectal or vaginal penetration. By adulthood, 26% of girls and 5% of boys experience sexual abuse. It is the healthcare provider's responsibility to advise the parents unless they are suspected of abuse and enlist help from other medical specialists or child protective services. A variety of nonspecific presenting symptoms including but not limited to pain, anogenital bleeding, vaginal/urethral discharge, dysuria, urinary tract infection, sexualized behavior, and suicidality are possible. It is also common for the initial presentation of suspected sexual abuse in the absence of any physical symptoms. In such cases, it is important to be mindful that the assailant is often an individual that is close to the victim, such as a close relative or even the parent. All patients presenting within 72 hours of the suspected abuse or presenting with any concerning symptoms should be evaluated emergently, preferably by a sexual assault nurse examiner or child abuse pediatrician if available. In those presenting without symptoms and greater than 72 hours following the suspected abuse, specialized outpatient follow-up should be arranged for further evaluation and treatment. A good understanding of state-specific legislation regarding consent and treatment of minors is essential when treating victims of child sexual abuse.