Sexual Abuse in Children

Objectives

After completing this article, readers should be able to:

1. List three reasons why children may not reveal sexual abuse.

2. Be familiar with a normal hymen in a preadolescent and adolescent female.

3. Recognize a laceration of the hymen rim.

4. Describe the immediate and long-term adverse behavioral consequences and the physical consequences of sexual abuse.

5. Discuss why results of the genital examination may be normal after sexual abuse.

6. Appreciate the importance of a properly conducted forensic interview in sexual abuse.

From the Editor: This comprehensive review of sexual abuse offers insights into every aspect of management. Some general pediatricians are better equipped than others to deal with sexual abuse, depending on training, experience, and the availability of community resources. Recognizing the value of a multidisciplinary team approach, each pediatrician must decide what his or her role should be and at what point a referral is necessary.—LFN

Case Study

Mary, a normal and healthy 5-year-old, is the only child in a recently divorced family. The mother has custody of Mary, and the father has weekend visitation. The father is remarried to a woman who has two children. Mary has been objecting to her weekend visits with her father. She is masturbating “frequently” according to the mother, who isolates Mary for this behavior. Mary has complained about burning when she urinates. The mother has noted that Mary’s genital area is red. She concluded that this was due to the masturbation. Mary has begun to suck her thumb. The preschool teacher called the mother to report that Mary was inviting boys to touch her genitalia. Mary also is refusing to do her school work. When her mother questioned her, Mary replied that her stepbrother had touched her privates and told her not to tell anyone or he would be in trouble. The mother comes to your …