Paediatrics: Sexual abuse

Sexual abuse

This involves forcing or enticing a child or young person to take part in sexual activities whether or not the child is aware of what is happen-ing. This may include physical contact, and penetrative or non-penetrative acts. It may also involve non-contact activities, such as looking at or being involved in pornographic or other sexual activities, and includes abuse via the Internet.

Presentation

Children who have been victims of sexual abuse may present in a number of ways, including:

•   Sexually transmitted infections: gonorrhoea; Chlamydia; Trichomonas vaginalis.

•   Pregnancy.

•   Vaginal bleeding in prepubertal girls

•   Genital or peri-anal injury with an absent or unsuitable explanation.

·  Behavioural changes:

•   self-harm;

•   withdrawal;

•   aggression;

•   sexualized behaviour;

•   unexplained deteriorating school performance.

•   Disclosure by the child.

•   s wetting and/or faecal soiling.

Signs

Few signs are diagnostic and there may be no findings in 50–90%.

Acute signs

•   Girls: acutely—tears in hymen; vaginal bleeding; bruising around genital area; and ‘hand’ grip marks.

•   Boys: bruising to genital area; urethral injury; torn frenulum of penis.

•   Anal signs: anal fissure; gaping anus; swelling of anal margin. Note: these signs may disappear rapidly.

Chronic signs

•   These signs are more difficult to interpret.

•   In girls the following that may be suggestive of previous, repeated penetrative trauma:

•   scar in posterior fourchette;

•   old tear or scar of the hymen;

•   complete absence of tissue at posterior hymen

In both sexes: anal fissure and scars when other causes have been excluded.