Child sexual abuse has become a major issue of public interest worldwide. It can take place in a variety of settings. Many of the cases of sexual abuse in children usually occurs in the homes of the children. Furthermore, it can also take place in schools, or work, where child labor is common. Most noteworthy, child marriage is known as one of the main forms of child sexual abuse.
There are other different types of child sexual abuse and a few include:
- Engaging in sexual activities with a child.
- Indecent exposure of the child’s genitals, female nipples, etc.
- Playing with a child’s genitals.
- Child grooming such as child prostitution.
- Using a child to produce child pornography.
According to the World Health Organization (WHO), millions of children and adolescents across the globe are subjected to sexual abuse, including sexual assault or rape. A 2011 study estimates that 18% of girls, and 8% of boys worldwide have experienced sexual abuse.
Child sexual abuse is defined as the involvement of a child in sexual activity that he or she does not fully comprehend or is unable to give informed consent to. Similarly, if the child is not developmentally prepared and cannot give consent, or if the sexual activity violates the laws of social taboos of society, it is considered an abuse.
In child sexual abuse, physical force or violence is rarely used because the perpetrator would try to manipulate the child’s trust and hide the abuse. The perpetrator is usually likely to be a trusted caregiver. Hence, the sexual abuse can often occur over many weeks or even years in some cases.
Sexual Abuse Risk Factors in Children
Whiles some affected children who have been sexually abused can grow up into adulthood without any physical problems, a number of psychological and emotional damage can occur. They could end up with post-traumatic disorder, depression, low self-esteem, or probably have difficulty in trusting the opposite gender. Likewise, some, in trying to cover the guilt and shame they feel, can end up doing drugs, become alcoholics or even become very promiscuous. Therefore, it is very important to provide children who have suffered sexual abuse with the right psychological and social help in good time.
Knowing these risk factors can consequently help you as a parent or care-giver protect children from suffering this debilitating experience. Here are some of the factors that can put a child at risk of sexual abuse :
- Female sex, however, in some developing countries, the male child constitutes a large number of the victims.
- Children in foster care, adopted children, stepchildren.
- Physically or mentally handicapped children.
- History of past abuse.
- Psychological or cognitive vulnerability.
- Single parent homes or broken homes.
- Social isolation.
- Parents with mental illness or alcohol or drug dependency.
How To Know If A Child Has Been Sexually Abused
There are a few physical and behavioural changes that can indicate to you if a child is being sexually abused. Because most children may not be able to come out and openly report what has happened due to the perpetrator scaring them with a warning not to tell anyone, you have to know what exactly to look out for in the child. Also, the child could simply just be overwhelmed by guilt, shame or fear because of what happened and may not say anything to anyone about it.
Look out for some of these indicators in children. If you find any of these, further probe the child cautiously to tell you whether there has been any sexual abuse.
More often than not, clear physical findings of sexual abuse are seldom seen in children. This is because very little or no force is used. However in some cases, there may be evidence of force and harm and other physical changes would be seen in the child. They include :
- Unexplained genital injury.
- Recurrent vulvovaginitis – this is an inflammation or infection of the vulva and vagina that results in discharge, itching and pain.
- Vaginal or penile discharge.
- Bedwetting and fecal soiling beyond the usual age.
- Anal pain, bleeding or fissures.
- Painful urination.
- Sexually transmitted infections.
- Presence of sperm.
- Regression in behavior and attaining developmental milestones – the child tends to return to younger behaviors.
- Regression in school performance.
- The child becomes withdrawn or very clingy.
- The child becomes unusually secretive.
- Outbursts of anger.
- Depression, self-harm, personality changes, mood swings and becoming insecure.
- The child has an unaccountable fear of particular places or people.
- Eating disorders.
- Sleep disturbances.
- Inappropriate sexualized behaviors.
There are developmentally appropriate sexualized behaviors such as kissing, fondling, masturbation and rhythmic pelvic thrusting. However, these become inappropriate when, for example, a little boy is frequently playing with his penis in public or a girl masturbating repeatedly in school.
Health Problems The Child Can Have
Whiles child sexual abuse can result in a number of health problems, some very common ones include
- Gastrointestinal disorders – chronic abdominal pain, non-ulcer dyspepsia, irritable bowel syndrome, etc.
- Gynecological disorders – chronic pelvic pain, dysmenorrhea, menstrual irregularities, etc.
- Psychological effects – stigmatization, depression, post-traumatic stress disorder, eating disorders, anxiety, sleep disturbances, poor self-esteem, etc.
Steps You Should Take
Child abuse is a criminal offense and also a human right violation. Most children who are being sexually abused would not disclose this immediately. This reluctance to disclose is usually due to fear of the perpetrator who probably told them, they would die or a family member would die if they disclosed it. Some children also feel helpless because no one would believe them if they were to speak up.
Sometimes, a child may not disclose to their mother because usually she is also being abused by the same perpetrator. In this case, disclosure would be to a close friend, peer or teacher. When a child discloses abuse or abuse is identified, you should report it as soon as possible to the police. The child must then be taken to see a healthcare professional.
A thorough assessment and examination of the child would be done. In order to gain more information, the doctor will take a medical history and interview the child. He will then do a head-to-toe physical examination on the child.
Tests and Treatment
A number of diagnostic tests and specimen collection would be done based on prior assessment of the doctor. Pregnancy testing may be done if the child has started menstruating. The child may also be tested for some sexually transmitted infections (STI). The decision to test for STIs is made based on whether
- The child presents with symptoms of an STI e.g. vaginal discharge, genital ulcers.
- The perpetrator is known to have an STI or is at high risk of contracting STIs.
- There is a high prevalence of STIs in the community.
- Anyone in the household is showing symptoms of an STI.
- The patient or parent requests for testing.
After a thorough assessment, the child would be treated based on findings. Psychological counselling and social support should be provided for the child to ensure that any psychological or emotional injury is also treated.