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The growing body of literature and research on child sexual abuse that
we have witnessed in the latter part of this century was kindled primarily
by adult women speaking out about their childhood experiences of sexual
abuse. Despite significant numbers of documented cases and psychiatric
discourse at the end of the 19th century about child sexual abuse, the
issue was spoken about as a rare problem. The ‘Battered baby syndrome’
identified in the 1960’s by Kemp drew attention to the issue of child
physical abuse The Women’s Movement in the 1970s lobbied to place
the issue of child sexual abuse on the social, health and political agenda.
Retrospective studies of adults sexually abused as children revealed that
1:3-5 women have experienced sexual abuse in childhood. These
findings are well documented and has opened the door to a growing
awareness that child sexual abuse is a significant problem affecting the
lives of 1: 3-5 girls and generally about 1:6-7 boys by the age of 18 years
. In approximately 90% of cases, the offender is either a member of the
child’s family or is well known to the child and family.
Key points
Definition
Though the laws on child sexual abuse vary in different jurisdictions, child
sexual abuse is a crime, which occurs when an adult or older person uses
his/her power, authority or position to impose upon a child any sexual
activity.
Features of child sexual abuse may include the following:
Key points
B Prepubertal
Postpubertal
• coercion may also involve the use of drugs, alcohol and peer
pressure
Legal considerations
Child sexual abuse is a crime. Since children do not have the capacity to
consent to sexual contact, any person engaging in sexual activity with a
child has committed an offence. Investigation by police and charges being
laid are possible following a report. Medical Officers who receive a report
and/or provide medical examination may be called to provide expert
opinion on medical findings in criminal proceedings. Medical
examinations should be carried out within the particular protocols and
with an understanding of the interagency roles and policies.
Key points
Key points
A child who has reported sexual abuse, because of the sensitive nature of
the material that needs to be explored needs to be treated with sensitivity
and respect. It is important that the doctor’s intervention is not perceived
by the child as a continuation of the abuse. Any examination that needs to
be performed must be explained to the child in age appropriate language
and must only be done with the consent and cooperation of the child.
The doctor has two major functions when involved in the assessment of a
child/young person who has disclosed sexual abuse or about whom there
is a suspicion of sexual abuse:
Acute assessments
Children and young people who present within 72 hours of the reported
abusive event must be seen immediately so that both medical and
medico-legal issues can be dealt with. Because the possibility of
pregnancy can occur in post-pubertal girls if there has been ejaculation
near the genital area, the possibility of administering the ‘morning-after
pill’ must be considered. Children should be offered a medical
examination as soon as possible after their disclosure of sexual abuse so
the anxiety that they and their non-offending parents experience can be
addressed.
Forensic evidence
In the medical assessment of children who have reported sexual abuse
there may be forensic evidence to collect particularly if the assessment is
performed soon after the reported abuse.
The physical evidence on the child’s body may be in the form of minor or
major injuries consistent with the history of abuse. These must be
documented on the body and genital diagrams of the child in the forensic
protocol.
The other evidence present on the child’s body may be the remains of
seminal fluid if the offender ejaculated. Forensic specimens are taken
from any parts of the body where traces of seminal fluid may remain and
these specimens are retained in secure circumstances for future forensic
examination.
Investigation v. assessment
The doctor should obtain the history of sexual abuse from the adult
accompanying the child and from any referring agency. In the case of a
very young child, only sufficient detail to ensure an adequate examination
is necessary. The investigative interview with the child should be
conducted by the police and child protection services. If a young child
repeats the history to a large number of people, their evidence may
become contaminated and unable to be used in legal proceedings.
• Fears
• Behaviour problems
• Sexualized behaviours
• Penetration
• Force
• Maternal support
Key points
Conclusion
The doctor who first assesses the child who has reported sexual abuse
has a key role to play in the recovery process of this child and, by
engaging in a multidisciplinary response helps to ensure the child’s future
safety.
William Kemp
1994