Abstract
Global exposure of children to sexual abuse is widespread. Disclosure may be extremely upsetting for both families and medical professionals. This review provides medical practitioners with practical tips for a stepwise approach of the child who discloses sexual abuse. Having secured a private examination room, the physician should approach the child and caregivers separately to determine the level of concern for abuse and the urgency of the situation. The medical evaluation is based on the information gathered, including a complete physical examination, inspection of the genitalia, collection of forensic evidence, and testing for sexually transmitted diseases. On a case-by-case basis, the need for surgical intervention, prophylactic treatment, and immunization is discussed. Finally, important questions for the medical team to address are outlined with the goal of supporting the child and his/her family and ultimately stopping the abuse.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Jenny C, Crawford-Jakubiak JE, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013;132:e558–67.
Kellogg N, American Academy of Pediatrics Committee on Child Abuse and Neglect. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506–12.
Finkelhor D, Vanderminden J, Turner H, Shattuck A, Hamby S. Youth exposure to violence prevention programs in a national sample. Child Abus Negl. 2014;3:677–86.
Nikolaidis G, Petroulaki K, Zarokosta F, Tsirigoti A, Hazizaj A, Cenko E, et al. Lifetime and past-year prevalence of children’s exposure to violence in 9 Balkan countries: the BECAN study. Child Adolesc Psychiatry Ment Heal. 2018;12:1.
Soldatou A, Pantzios SI, Panagiotou M-R, Panagiotopoulos T, Nicoletos T, Michala L. Child sexual abuse among medical school students: experiences and perceptions. Int J Impot Res. 2020. https://doi.org/10.1038/s41443-020-0267-z.
Kellogg ND, Koek W, Nienow SM. Factors that prevent, prompt, and delay disclosures in female victims of child sexual abuse. Child Abus Negl. 2020;101:104360.
Schaeffer P, Leventhal JM, Asnes AG. Children’s disclosures of sexual abuse: learning from direct inquiry. Child Abus Negl. 2011;35:343–52.
Malloy LC, Lyon TD, Quas JA. Filial dependency and recantation of child sexual abuse allegations. J Am Acad Child Adolesc Psychiatry. 2007;46:162–70.
Malloy LC, Mugno AP, Rivard JR, Lyon TD, Quas JA. Familial influences on recantation in substantiated child sexual abuse cases. Child Maltreat. 2016;21:256–61.
Crawford-Jakubiak JE, Alderman EM, Leventhal JM. Care of the adolescent after an acute sexual assault. Pediatrics. 2017;139:e20164243.
Christian CW. Timing of the medical examination. J Child Sex Abus. 2011;20:505–20.
Christian CW. Professional education in child abuse and neglect. Pediatrics. 2008;122:S13–7.
Donaruma-Kwoh MM, Tran XG, Giardino AP. Do pediatric chief residents recognize details of prepubertal male genital anatomy. Clin Pediatr (Phila). 2010;49:756–9.
Dubow SR, Giardino AP, Christian CW, Johnson CF. Do pediatric chief residents recognize details of prepubertal female genital anatomy: a national survey. Child Abus Negl. 2005;29:195–205.
Broaddus CA, Hermanns MS, Burks BK. Therapeutic interventions for survivors. In: “Intimate” violence against women: when spouses, partners, or lovers attack. Michigan: Praeger; 2006.
Smith T, Chauvin-Kimoff L, Baird B, Ornstein A. The medical evaluation of prepubertal children with suspected sexual abuse. Paediatr Child Health. 2020;25:180–94.
Wong G. Forensic medical evaluation of children who present with suspected sexual abuse: How do we know what we know? J Paediatr Child Health. 2019;55:1492–6.
Adams JA. Understanding medical findings in child sexual abuse: an update for 2018. Acad Forensic Pathol. 2018;8:924–37.
Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, et al. Updated guidelines for the medical assessment and care of children who may have been sexually abused. J Pediatr Adolesc Gynecol. 2016;29:81–7.
Russell D, Higgins D, Posso A. Preventing child sexual abuse: a systematic review of interventions and their efficacy in developing countries. Child Abus Negl. 2020;102:104395.
Manheim M, Felicetti R, Moloney G. Child sexual abuse victimization prevention programs in preschool and kindergarten: implications for practice. J Child Sex Abus. 2019;28:745–57.
Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018;18:5.
WHO. Guidelines for medico-legal care for victims of sexual violence. World Health Organization; 2014. http://www.who.int/violence_injury_prevention/publications/violence/med_leg_guidelines/en/.
Berkoff MC, Zolotor AJ, Makoroff KL, Thackeray JD, Shapiro RA, Runyan DK. Has this prepubertal girl been sexually abused? JAMA. 2008;300:2779–92.
Block RW, Palusci VJ. Child abuse pediatrics: a new pediatric subspecialty. J Pediatr. 2006;148:711–2.
Jenny C. Medicine discovers child abuse. JAMA. 2008;300:2796–7.
The Royal College of Paediatrics and Child Health. Guidelines on paediatric forensic examinations in relation to possible child sexual abuse. London: The Royal College of Paediatrics and Child Health; 2015.
ACGME. ACGME program requirements for graduate medical education in child abuse pediatrics. Chicago, Illinois: Accreditation Council for Graduate Medical Education; 2019. p. 1–54.
Killough E, Spector L, Moffatt M, Wiebe J, Nielsen-Parker M, Anderst J. Diagnostic agreement when comparing still and video imaging for the medical evaluation of child sexual abuse. Child Abus Negl. 2016;52:102–9.
Adams JA, Farst KJ, Kellogg ND. Interpretation of medical findings in suspected child sexual abuse: an update for 2018. J Pediatr Adolesc Gynecol. 2018;31:225–31.
Gallion HR, Milam LJ, Littrell LL. Genital findings in cases of child sexual abuse: genital vs vaginal penetration. J Pediatr Adolesc Gynecol. 2016;29:604–11.
Workowski KA. Centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61 Suppl 8 :S759–62.
Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59:1–110.
US Department of Justice Office on Violence against Women. A national protocol for sexual assault medical forensic examinations adults/adolescents. Washington, DC: US Department of Justice Office on Violence against Women; 2013.
Sakelliadis EI, Spiliopoulou CA, Papadodima SA. Forensic investigation of child victim with sexual abuse. Indian Pediatr. 2009;46:144–51.
Holmes MM, Resnick HS, Kilpatrick DG, Best CL. Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol. 1996;175:320–5.
ACOG committee opinion No. 777 summary: sexual assault. Obstet Gynecol. 2019;133:850–1.
Practice bulletin summary No. 152: emergency contraception. Obstet Gynecol. 2015;126.
Francis JKR, Gold MA. Long-acting reversible contraception for adolescents: a review. JAMA Pediatr. 2017;171:694–701.
Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep. 2015;64:1–137.
Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis. 2002;29:38–43.
Kennedy AC, Prock KA. “I Still Feel Like I Am Not Normal”: a review of the role of stigma and stigmatization among female survivors of child sexual abuse, sexual assault, and intimate partner violence. Trauma Violence Abus. 2018;19:512–27.
McElvaney R, Nixon E. Parents’ experiences of their child’s disclosure of child sexual abuse. Fam Process. 2019. https://doi.org/10.1111/famp.12507.
Leventhal JM, Murphy JL, Asnes AG. Evaluations of child sexual abuse: recognition of overt and latent family concerns. Child Abus Negl. 2010;34:289–95.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Michala, L., Soldatou, A. What to do when a child reports sexual harassment and sexual assault to a medical professional. Int J Impot Res 34, 8–17 (2022). https://doi.org/10.1038/s41443-020-00345-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41443-020-00345-z