Child Molestation Child Sexual Abuse

Overview, Causes, & Risk Factors

Child sexual abuse is any experience during childhood or adolescence thatinvolves inappropriate sexual attention from another person. This person isusually an adult but can also be an older child, teenager, or even a personthe same age.

Sexual abuse can take place within the family by a parent,stepparent,sibling, or other relative. It also can occur outside the family by a friend,neighbor, caregiver, teacher, or random molester. Children are often afraid totell anyone whathas happened. A recent study of girls in 9th through 12th grade found that oneout of five girls were physically and/or sexually abused by a datingpartner.

There are three types of sexual abuse: nontouching sexual abuse,touching sexual abuse, and sexual exploitation.

Nontouching sexual abuse includes:

  • deliberately exposing a child to the act of sexual intercourse
  • exposing a child to pornographic material
  • indecent exposure or exhibitionism
  • masturbating in front of a child
  • Touching sexual abuse can include:

  • any penetration of a child’s vagina or anus by an object that doesn’t havea medical purpose
  • fondling
  • making a child touch an adult’s sexual organs
  • Sexual exploitation can include:

  • engaging a child for the purposes of prostitution
  • using a child to film, photograph, or model pornography
  • What are the causes and risks of the injury?

    Sexual abuse happens to children of all religions, ethnic origins, and incomelevels. Often the abuser is someone the child knows, rather than a stranger. Aperson who was sexually abused as a child is more likely to become an abuser asan older child or adult.

    Experts know that adolescents who have been abused areat higher risk for other health problems. However, we do not yet know whetherthe health problems came before the abuse or if the abuse increased the riskfor the health problem. These problems include the following:

  • adolescent pregnancy
  • alcohol use,including binge drinking
  • cocaine abuse
  • risky sexual behaviors, including intercourse before age 15 and multiplepartners
  • smoking
  • suicidal attempts orthoughts
  • unhealthy weightmanagement, including eating disorders
  • Symptoms & Signs

    What are the signs and symptoms of the injury?

    It is not always easy for an adult to recognize when sexual abuse has takenplace. A child who has been sexually abused may:

  • act seductively
  • be excessively curious about sex
  • develop frequent urinary tractinfections
  • engage in inappropriate sex play
  • feel threatened by physical contact, closeness, or a certain person
  • have bruises, bleeding, pain, or itching in the genital area
  • have nightmares
  • have poor self-esteem
  • have a premature understanding of sex
  • have separation anxiety
  • lack confidence
  • masturbate excessively
  • wet or soil his or her bed
  • Diagnosis & Tests

    How is the injury recognized?

    An abuser can make the child very fearful of telling anyone else. An adultshould believe a child who says he or she has been sexually abused. Childrenrarely lie about sexual abuse.

    When sexual abuse is suspected, the child should be taken to a healthcareprovider who is trained to deal with and recognize sexual abuse. He or she willask the child to describe what happened. He or she also will look for injuriesto the mouth, rectum, and vaginal area, if the child is a girl. If the abusetook place recently, the healthcare provider will do a special examination tocheck for sperm. Child protective services need to be notified.

    Prevention & Expectations

    What can be done to prevent the injury?

    Parents need to warn children about possible risks. Children should be taughtabout good and bad touches. They need to be told that no one should touch theirprivate areas. Children should be told not to keep secrets fromtheir 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 problemswithout using abuse. Teenagers and young adults should be taught that it’snever OK to abuse a partner. Parents and healthcare providers should provideteens with information and statistics about dating violence. The teens shouldbe given specific information about behaviors that are part of dating violence.They should be encouraged to discuss any issues or concerns with a parent orother appropriate adult.

    Since health concerns such as cocaine use are associated with ahigher risk for partner abuse, healthcare providers should address datingviolence when treating teens with these health concerns. Careful screening canhelp identify at-risk teens and provide the opportunity to stop the abusecycle.

    Treatment & Monitoring

    What are the treatments for the injury?

    Child protective services monitor sexual abuse cases. Sexually abused childrenand their families need professional evaluation and treatment. Child andadolescent psychiatrists can help abused children regain a sense ofself-esteem.They can help them cope with their feelings of guilt about the abuse and beginthe process of overcoming the trauma. Individual psychotherapy and group counseling may help. Much ofthe healing for many survivors takes place in a support group of othersurvivors.There is strength, comfort, and hope in hearing the stories of others who sharetheir pain.

    Antidepressant medicines may be tried, but they are not usuallyas successful in treating depression in children as they are in adolescents andadults.

    The child should be checked for sexually transmitted diseases. Girls ofchildbearing age should be tested for pregnancy.

    What are the side effects of the treatments?

    Antidepressant medicines may cause mild and usually temporary side effects insome people. The most common side effects are:

  • agitation
  • constipation
  • dizziness
  • drowsiness
  • dry mouth
  • nausea
  • A person on antidepressant medicines needs to have blood levels monitoredfrequently.

    What happens after treatment for the injury?

    Long-term effects can include posttraumatic stressdisorder. Although this nervous disorder can have many causes, inthis case it is a result of physical, mental, or sexual violence. The victimmay 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, afeeling of worthlessness, and an abnormal perspective on sexuality. They maybecome withdrawn and mistrustful of adults and attempt suicide. Some sexuallyabused children become child abusers or prostitutes in later years. They aremore at risk of abusing alcohol or other drugs to dull the pain.

    A person who has been sexually abused may need years of psychotherapy to cometo terms with what has happened. Therapy is most often long-term. It can bedifficult for an adult to come to terms with sexual abuse that occurred when heor she was a child. It may result in changes in the abused person’s life. Insome cases, divorce results when a spouse can’t live with a partner’s pain andbecomes frustrated at not being able to do anything about it.

    Article type: xmedgeneral