J Forensic Sci, 2019

doi: 10.1111/1556-4029.14033
PAPER Available online at: onlinelibrary.wiley.com

PSYCHIATRY & BEHAVIORAL SCIENCE

Serena Maria Curti ,1 M.D.; Francesco Lupariello ,1 M.D.; Elena Coppo,2 M.D.;
Evan Julian Praznik,3 B.S.; Sara Simona Racalbuto,2 Psy.D.; and Giancarlo Di Vella,1 M.D., Ph.D.

Child Sexual Abuse Perpetrated by Women:

Case Series and Review of the Literature†

ABSTRACT: The literature on child sexual abuse (CSA) perpetrated by female sexual offenders (FSOs) is exiguous, and many studies have
focused on judicial databases. The present retrospective study, instead, analyzed clinical and judicial data of a group of both victims and alleged
FSOs, to additionally include women who have not been convicted by the criminal justice system, but who hold strong clinical suspicions of
being perpetrators of CSA. The medical records and the Court files of 11 children and their eight suspected FSOs have been collected and criti-
cally reviewed in light of the literature to date. This approach allowed for a deeper understanding of the relationship between child and FSO.
The authors hypothesize that the victims’ severe psychopathological outcomes were a result of a failure to develop appropriate attachments with
their prospective caregivers, which could have been damaged by the pathological relationship with FSOs, who were the victims’ caregivers.

KEYWORDS: forensic science, forensic psychiatry, child abuse, sex offenses, offenders, criminal justice

Sexual offenders are historically and culturally perceived as
men. The fact that a woman can commit a sexual crime contrasts
with the common belief that women are sexually passive and do
not have the desire, or even the potential to commit this type of
crime; this belief is also supported due to a woman’s propensity
for caregiving and motherhood, as well as by purely anatomical
reasons (1).
Despite the intellectual resistance in recognizing the existence
of sexual crimes perpetrated by women, since the late 1980s the
interest in female sexual offenders (FSOs) has gradually
increased (2). Despite the growing research effort however,
knowledge about women who commit sexual offenses is still in
its infancy compared to that of their male counterpart.
Concerning the prevalence of women who commit sexual
abuse on children, the data are strongly influenced by the type
of source from which they are extracted. For example, studies
on official data of convicted FSOs underestimate the prevalence
of the phenomenon because the percentage of cases that do not
come to the attention of the judicial system is very high (3), as
victims often experience extreme difficulty in reporting the
abuse (4,5).
1
Dipartimento di Scienze della Sanita Pubblica e Pediatriche, Sezione di
Medicina Legale, “Universita degli Studi di Torino”, corso Galileo Galilei
22, 10126 Torino, Italia.
2
Dipartimento di Pediatria d’Emergenza, “A.O.U. Citta della Salute e della
Scienza di Torino”, piazza Polonia 94, 10126 Torino, Italy.
3 which are otherwise difficult to study with quantitative methods.
Graduate School of Professional Psychology, University of Denver, 2450
S. Vine Street, Denver, CO 80210.
Corresponding author: Serena Maria Curti, M.D. E-mail: serenamaria.curti@
gmail.com
†
Presented in part at the 70th Annual Scientific Meeting of the American
Academy of Forensic Sciences, February 19–24, 2018, Seattle, WA.
Received 30 Dec. 2018; and in revised form 1 Feb. 2019; accepted 1 Feb.
2019.
In the last 30 years, some surveillance studies attempted to
estimate the phenomenon. In a study published in 1995, among
121 men receiving psychological therapy services for sexual
abuse, 60% identified a woman as offender (6). Recently, the
Australian Royal Commission reported that 10% of child sexual
abuses (CSAs) are perpetrated by females (7). In the 2016
meta-analysis by Cortoni et al., victims of CSA reported to be
victimized by a woman in 11.6% of cases, in contrast to a small
percentage of cases attributable to FSOs (2.2%) when the source
was represented by the official Police reports (8).
Beyond the numbers, CSA perpetrated by women generates
serious short- and long-term consequences for the victims
(9,10). In the studies in which the victims have been asked to
report the outcomes of the abuse suffered from FSOs, they
described psychiatric and psychological disorders, problems
within the sexual sphere and intimacy, alcohol or drug addic-
tion, self-harm behaviors such as self-mutilation, and suicide
attempts (9–12). In a study published in 2004, victims who
had been sexually abused by both male and female offenders
argued that the violence perpetrated by FSOs inflicted more
psychological damage on them than those perpetrated by
males (13).
In light of the importance of the topic, this retrospective study
used a qualitative approach for the analysis of clinical and judi-
cial data of a small number of cases of suspected CSA perpe-
trated by women. This approach has been chosen as particularly
appropriate for studies that attempt to investigate phenomena
Few authors have thus far explored the implications on those
who suffer the greatest harm from abuse—the victims. In the
present study on the other hand, clinical and judicial data of
both the victims and the alleged FSOs have been analyzed,
allowing for a complete view of the relationships between the
two parties.

© 2019 American Academy of Forensic Sciences 1

2 JOURNAL OF FORENSIC SCIENCES

The Court files of the nine cases were acquired. Through

Materials and Methods
A retrospective analysis of the cases managed between
January 2012 and December 2017 by the “Bambi” Unit of the
Pediatric Hospital “Regina Margherita” of Turin (Italy) was
performed. The unit is composed of a multidisciplinary team
(Pediatricians, Psychologists, Pediatric Nurses, Medical Examin-
ers, Social Workers), which is specifically trained in the
assessment and identification of suspected abuse on children
aged 0–14 years. Among all of the cases, those, which were
reported to the Judicial Authority for suspected sexual abuse per-
petrated by a female offender, were identified and studied after
obtaining the authorization for access to the Court files. Subse-
quently, a database containing clinical and judicial data was cre-
ated (Table 1). The data which emerged from the analysis of the
case series have been critically evaluated in light of the literature
available to date.
Results
During the 6-year-long period taken into consideration, the
“Bambi” unit managed a total of 1042 cases. Forty-three per-
cent of the visits (446 cases) were performed with suspicion of
child sexual abuse (CSA), 38% (398 cases) of physical mal-
treatment, 6% (64 cases) of neglect, and 8% (81 cases) of
mixed forms of abuse. In 5% of the medical records (53
cases), the information about the type of suspected abuse was
not available. The overall cases of suspected CSA, including
those classified as mixed forms of abuse (CSA and physical
abuse and/or neglect), were 494. Among these, after a careful
and multidisciplinary assessment, 341 cases (69%) were
reported to the Judicial Authority due to highly suggestive indi-
cations of CSA. Within this group, offenders were identified in
319 cases as a result of the child being able to disclose the
abuse, or the accompanying adult being able to identify the
individual suspected of CSA. In nine cases out of 319 (2.8%),
the suspected offender was female (female sexual offender,
FSO). Two victims were sisters; in their case, the suspected
FSO was the same.
these files, two further suspected victims, who were sister and
brother of two children who had been visited at the “Bambi”
unit, were identified. Therefore, the total number of suspected
victims rose to 11, with the inclusion of eight FSOs. Table 2
summarizes the cases, and Tables 3–5 summarize the main
results.
The Victims
The mean age at the time of the alleged CSA was 6.1 years
(2.77 SD, range 3–10 years). In nine cases (81.8%), the victim
was female, in the remaining two cases (18.2%) male. Nine vic-
tims (81.8%) were Caucasian, one African (9.1%), and one Latin
American (9.1%). No child had physical or mental illness. At
the visit in the “Bambi” unit, no child had extragenital lesions.
The inspection of the ano-genital area, in the supine “frog-leg”
and the prone knee–chest positions, was possible in nine cases
out of 11. The following findings were observed: perianal ery-
thema in two cases (22.2%); genital erythema in one case
(11.1%); abrasions on the labia majora in one case (11.1%); anal
fissures in one case (11.1%). In 5 cases, the ano-genital inspec-
tion was negative (55.5%); among these, in one case the accom-
panying caregiver reported that the girl had a vulvar bruising in
the days immediately following the alleged trauma. The follow-
ing signs of psychological distress were reported at the time of
visit, prior to any psychological therapy: rigid and hypercontrol-
ling behavior in four cases (36.4%); anxiety in three cases
(27.3%); bully and overbearing behavior in three cases (27.3%);
hyperactivity in two cases (18.2%); initial structuring of a “false
Self” in one case (9.1%); regressed mental functioning, not
appropriate for age, in one case (9.1%); predisposition for
depression in one case (9.1%); nothing relevant in two cases
(18.2%). Incidentally, the “false Self” is associated with a patho-
logical child’s need for compliance with the parents’ expecta-
tions, leading to the creation of a defensive facßade that can
cause lack of spontaneity and feelings of emptiness and death
which overlay or contradict the original Self (14). In 9 of the 11
cases (81.8%), the child made disclosures about the abuse. These

TABLE 1––Clinical and judicial data of the selected cases of suspected child sexual abuse perpetrated by women.

Victim’s data Perpetrator’s data Crime’s data

• Age at the time of abuse;
• Sex;
• Ethnicity;
• Lesions in the genital/perineal/anal area
appreciable during the visit
• Extragenital lesions on
physical examination;
• Signs of psychological distress
reported at the visit;
• Preexisting pathologies;
• Disclosure about the abuse;
• Physical and/or psychological
outcomes after months/years.
• Age at the time of the
discovery of the abuse;
• Ethnicity;
• Schooling and profession;
• Physical and/or
psychiatric diseases;
• Psychological issues;
• Family history;
• Personal history of sexual
and/or physical abuse;
• Previous deviant behaviors;
• Male partner and type
of relationship;
• Duration of the criminal career;
• Role of the perpetrator with
respect to the victim;
• Perception of the crime.
• Intra- or extrafamilial abuse;
• Other types of abuse on the same victim;
• Emotional involvement of the victim;
• Duration of the abuse;
• Abuse setting;
• Level of violence;
• Child’s interrogation (yes/no, time
period between the report to the
Judicial Authority and the testimony;
child’s competence to testify);
• Criminal procedure outcome;
• Civil procedure outcome
 TABLE 2––Summary of the cases (NA: not available, JA: Judicial Authority). It continues in the following four pages.

Victims 1 2 3 4 5 6 7 8 9 10 11

Age (years) 4 4 9 4 10 3 10 5 9 5 4
Sex Female Female Female Female Male Female Female Male Female Female Female
Ethnicity Caucasian Caucasian Caucasian Caucasian Latin American Caucasian African Caucasian Caucasian Caucasian Caucasian
Diseases No No No No No No No No No No No
Mental delay No No No No No No No No No No No
Psychological Nothing Bully and Rigid and Regressed mental Predisposition Rigid and Bully, Hyperactivity, Hyperactivity, Bully, Nothing
distress relevant overbearing hypercontrolling functioning, not for depression, hypercontrolling overbearing, anxiety anxiety overbearing, relevant
behavior behavior. Initial appropriate anxiety and behavior rigid and rigid and
structuring of for age social hypercontrolling hypercontrolling
a “false Self” isolation behavior behavior
Disclosure Yes (mother) Yes (foster Yes (foster Yes (mother, Yes (JA) Yes (parents, Yes (mother, Yes (mother) No Yes (mother) No
(to who) mother, mother) psychologist) teachers, teachers,
psychologist) psychologist, JA) psychologist)
Physical Genital erythema Two abrasions on NA None NA Perianal erythema, None Perianal None None None
findings labia majora anal fissures erythema
Clinical Phobias, Sexualized Sexualized Phobias, Depression and Sexualized Somatoform Aggressiveness, Phobias Sexualized Sexualized
outcomes disproportionate behaviors, behaviors, dissociative social isolation behaviors, disorders, stuttering, behaviors behaviors
fears compulsive compulsive symptoms. compulsive phobias about phobias,
masturbation, masturbation, Urinary masturbation, physical depression
rejection of phobias disorders aggressiveness, integrity, i with cognitive
the maternal rejection of nsomnia, symptoms
figure, the mother, nightmares.
depression and urinary disorders, Disorganized
social isolation nightmares, attachment,
phobias, rituals search for
dangerous
situations

Victims 1 2 3 4 5 6 7 8 9 10 11

FSOs A B C D E F G H

Age (years) 55 47 65 52 47 66 33 70
Ethnicity Caucasian Caucasian Caucasian Caucasian Caucasian Caucasian Caucasian Caucasian
CURTI ET AL.

Schooling/Job NA High school/ Middle Middle Middle Middle Middle school/ NA/retired
.

bartender school/retired school/nanny school/ school/retired unemployed

cleaning
person
Diseases NA Predisposition None None Major depressive No Major depressive None
for depression disorder. disorder, eating
HIV, cirrhosis disorder
Psychological NA Simple person, NA Simple person, Simple person, NA Borderline Authoritarian and
issues without tools. without tools, without tools. personality intrusive behavior
Feelings of “a child among Negligent disorder. Simple
disappointment. the children” behavior toward person. Impulsivity
Negligent the son. Previous and aggressiveness
behavior suicide attempts
toward the
daughters
Family history NA Mother: major Nothing relevant NA Adult son: Nothing NA
depressive Nothing gambling relevant
disorder; relevant and drug
brother#1: addiction
schizophrenia;
brother#2: drug
addiction
Social Married Violent and Married. Married. Her Violent former Married Divorced. Married. Adult
background drug-addicted Adult son: husband was husband. Very old son: violent
former partner violent with present during Drug-addicted current with his wife
his wife the CSA but current partner partner
he did not
intervene
CHILD SEXUAL ABUSE PERPETRATED BY WOMEN
3
 4
TABLE 2—Continued.

Victims 1 2 3 4 5 6 7 8 9 10 11

Personal history NA Father: alcoholic NA NA NA NA Violent and NA

of child abuse and violent, abusing father
he sexually
abused of
her sister
Deviant NA No No No Previous No Prostitution and NA
behaviors business as participation in
drug dealer; pornography films
currently even during
alcoholic and pregnancy;
drug-addicted abandonment
of the newborn
daughter

Victims 1 2 3 4 5 6 7 8 9 10 11
JOURNAL OF FORENSIC SCIENCES

FSOs A B C D E F G H

Role Neighbor Biological mother Paternal grandmother Nanny Neighbor Paternal grandmother Biological mother Paternal grandmother
Caregiver Occasionally Usually Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally
Perception Denial Denial Denial Denial Denial Denial Denial Denial
of crime
Crime
Intra/ Extra Intra Intra Extra Extra Intra Intra Intra
extrafamilial
abuse
Other types of None Assisted violence, Assisted violence, Assisted violence Physical maltreatment, None None Verbal violence Assisted violence Assisted violence Assisted violence
abuse on the neglect neglect assisted violence
same victim
Relationship Strong bond Fear of the FSO Inversion of Strong bond, Strong bond, a lot Extremely exclusive Admiration, FSO Very strong bond Fear of the FSO Very possessive Very possessive
between FSO adult-child roles possessive of time spent together and morbid relationship as a model to relationship relationship
and victim relationship be imitated
Setting of Neighbors’ house Maternal house Maternal house Paternal house Victim’s house, park Neighbor’s house, Paternal house Maternal house Paternal house Paternal house
the abuse camping
Level of violence Genital fondling, Fondling, kissing, NA Genital fondling, Masturbation, kissing Verbal coercion, genital Genital fondling, kissing, Fondling, coercion Involvement/ Oral-genital sex Oral-genital sex
vagina penetration coercion to watch kissing, fondling, vagina involvement/ exposure to watch sexual exposure to
by fingers sexual intercourses involvement/ penetration by fingers to pornography intercourses pornography
exposure to and objects
pornography

Victims 1 2 3 4 5 6 7 8 9 10 11

FSOs A B C D E F G H

Child’s NA Yes No Yes Yes Yes No Yes Yes NA NA

interrogation
Time between NA NA 310 days 270 days 165 days 190 days 138 days NA NA
the report
to the
JA and the
child’s
testimony
Child’s NA Competent Competent Incompetent Competent Incompetent Competent NA NA
competence
to testify
Criminal Investigations Dismissal of Dismissal of Dismissal of Acquittal of Conviction to Dismissal of Dismissal of Dismissal of the Investigations Investigations
procedure ongoing the charges the charges the charges the defendant 7-years the charges the charges for charges for ongoing ongoing
outcome for lack for lack for lack sentence for the lack of evidence lack of
of evidence of evidence of evidence defendant’s evidence
suicide
Civil procedure NA Removal of Removal of the Prohibition Any form of Economic Removal of the Prohibition to see Protected NA NA
outcome the child from child from to see the protection compensation child from the defendant meetings with
the family, the family, defendant to the victim’s the family, the defendant
followed by followed family followed by
adoption by entrustment entrustment to
to a foster family a community
 CURTI ET AL. . CHILD SEXUAL ABUSE PERPETRATED BY WOMEN 5

TABLE 3––Summary of the main results about the victims. family member, the psychologist, the teachers, and the Judicial
Authority in one case; exclusively to the Judicial Authority in
Mean age (years) 6.1  2.77
Sex 9 females one case. Information on the medium- and long-term clinical
2 males outcomes (months/years after the alleged abuse) was available in
Ethnicity 9 Caucasian all the cases. They are represented by: onset of specific phobias
1 African or disproportionate and unjustified fears in seven cases (63.6%);
1 Latin American
sexualized behaviors and pervasive ideas concerning sex in five
Ano-genital
findings
• Not available visit: cases (45.4%); compulsive masturbation in three cases (27.3%);
2 of the 11 cases. depression and social isolation in two cases (18.2%); violent
• Available visit: 9 of the 11 cases: rejection of the maternal figure in two cases (18.2%); urinary
o No findings: 5 of
disorders in two cases (18.2%); aggressiveness toward adults,
the 9 cases (55.5%); peers, and/or animals in two cases (18.2%); insomnia and night-
o Presence of findings: 4 of
mares in two cases (18.2%); depression with cognitive symp-
the 9 case (44.5%): toms in one case (9.1%); obsessive behaviors and rituals in one
■ Perianal erythema: 2 cases; case (9.1%); somatoform disorders in one case (9.1%); stuttering
■ Genital erythema: 1 case; in one case; disorganized attachment in one case (9.1%); search
■ Abrasions on the labia for dangerous situations in one case (9.1%); dissociative symp-
majora: 1 case; toms in one case (9.1%).
■ Anal fissures: 1 case.
Disclosure 81.8% (9 of the 11 victims)
The Female Sexual Offenders (FSOs)
The mean age of the suspected FSOs at the time of the dis-
TABLE 4––Summary of the main results about the FSOs. covery of the alleged sexual abuse was 54.4 years (12.33 SD,
range 33–70 years). All FSOs were Caucasian women (100%).
Mean age (years) 54.4  12.33
Ethnicity 100% Caucasian Information on education was available in six of the eight cases:
Psychiatric • None: 62.5% Five FSOs (62.5%) had completed middle school and one
diseases (5 of the 8 women) (12.5%) completed high school. Regarding their prospective pro-
• Major depressive fessions, three of the eight alleged FSOs (37.5%) were retired,
disorder: one was a bartender (12.5%), one was a cleaning person
25% (2 of (12.5%), one was a nanny (12.5%), and one was unemployed
the 8 women) (12.5%). In one case, this information was not available. Seven
• Borderline out of eight alleged FSOs (87.5%) had no physical pathologies;
personality disorder: in one case, there was a diagnosis of HIV infection and liver cir-
12.5% (one of rhosis. None of the cases involved a diagnosis of mental retarda-
the 8 women) tion. With regard to psychiatric disorders, they were observed as
• Eating disorder: follows: major depressive disorder, borderline personality disor-
12.5% (one of der, and eating disorder in one case (12.5%); major depressive
the 8 women) disorder with previous suicide attempts in one case (12.5%); no
• Not available psychiatric disorder in five cases (62.5%); and no available
information: information in one case. The most significant psychological
12.5% (one of issues of the FSOs were identified with the following results:
the 8 women) simple person, without the tools to cope with stressful life events
Personal history 37.5% (3 of the 8 women) in four cases (50%); negligent behavior toward the child in two
of abuse cases (25%); feelings of disappointment toward other people and
(in childhood and life in one case (12.5%); impulsivity and aggressiveness in one
adulthood)
Deviant behaviors 25% (2 of
case (12.5%); authoritarian and intrusive behavior in one case
the 8 women) (12.5%); and no available information in three cases. The FSO
Alcohol and 12.5% (one of family histories were positive for psychiatric disorders in two
drug abuse the 8 women) cases (25%): in the first one, two FSO’s brothers suffered
Role with respect Paternal 45.4% (5 of respectively from schizophrenia and drug addiction, and the
to the victim grandmother the 11 victims)
Mother 27.3% (3 of FSO’s mother suffered from major depressive disorder; in the
the 11 victims) second one, the FSO’s adult son suffered from gambling and
Neighbor 18.2% (2 of drug addiction. In the remaining cases, there was no relevant (3/
the 11 victims) 8) or sufficient (3/8) information. Regarding the social back-
Nanny 9.1% (one of the
11 victims)
ground, five of the alleged FSOs out of 8 (62.5%) lived with
Perception Denial: 100% their husbands, two of the eight (25%) had recently started a
of the crime relationship, and one of the eight (12.5%) was single. In addi-
tion, three of the eight (37.5%) had a violent adult son, two of
the eight (25%) were separated by a former abusing partner, and
one of the eight (12.5%) had a current drug-addicted partner.
were made exclusively to a family member in four cases; to a Two out of eight (25%) were in charge of the local social care
family member and the psychologist in two cases; to a family services. In the personal history of two of the eight alleged FSOs
member, the psychologist, and the teachers in one case; to a (25%), there was reported physical abuse during childhood by
6 JOURNAL OF FORENSIC SCIENCES

TABLE 5––Summary of the main results about the crime.

Child sexual abuse Intrafamilial: 72.7% (8 of the 11 cases)

Extrafamilial: 27.3% (3 of the 11 cases)
Other types of abuse Yes: 72.7% (8 of the 11 victims):
on the same victim • Assisted violence: 72.7% (8 of the 11 victims);
• Neglect: 18.2% (2 of the 11 victims);
• Physical maltreatment: 9.1% (one of the 11 victims);
• Verbal violence: 9.1% (one of the 11 victims).
No: 27.3% (3 of the 11 victims).
Level of violence Genital fondling 63.6%
Coercion to witness the FSO engaged in sexual intercourse 45.5%
Kissing on the lips 27.3%
Anus/vagina penetration by fingers and/or objects 27.3%
Involvement/exposure to pornographic content 18.2%
Oral-genital sex 18.2%
Verbal coercion 9.1%
Not available information 9.1%
Interrogation of the victim Realized in the 75% of the cases (6 of the 8 cases
of which the Court file was available). In these cases:
• The child was declared
competent: 66.7% (4 of the 6 cases);
• The child was declared
incompetent: 33.3% (2 of the 6 cases).
Mean time between the report to the Judicial
Authority and the child’s testimony: 7 months.
Criminal procedure outcome • Investigations still ongoing: 27.3% (3 of the 11 cases).
• Available Court file in 8 of the 11 cases:
o Dismissal of the charges:
■ For lack of evidence: 62.5% (5 of the 8 cases);
■ For the suicide of the defendant
during the investigations: 12.5% (one of the 8 cases);
o Acquittal of the defendant: 12.5% (one of the 8 cases);
o Conviction to 7-year sentence: 12.5% (one of the 8 cases).
Civil procedure • Any form of protection: one of the 7 cases;
outcome of the dismissed
or acquitted criminal procedures
• Some form of protection (6 of the 7 cases):
o Removal of the child from the
biological family (3 of the 6 cases, 50%), followed by:
■ The adoption: 16.7% (one of the 6 cases);
■ The entrustment to a
foster family: 16.7% (one of the 6 cases);
■ To a community: 16.7% (one of the 6 cases);
o Prohibition to see the
defendant: 33.3% (2 of the 6 cases);
o Protected meetings with
the defendant: 16.7% (one of the 6 cases).

their father; for six of the eight, there was no information. The
presence of previous deviant behaviors was also investigated
with the following results: One of the FSOs had been a drug
dealer and was currently addicted to drugs and alcohol (12.5%);
another FSO had participated in pornographic movies, had been
a prostitute, and had abandoned her newborn daughter (12.5%);
in four cases, there were no deviant behaviors in the personal
history (50%); and in two cases, the data were not available.
Regarding the FSO criminal behaviors, the duration was difficult
to evaluate in the absence of any kind of confession by the sus-
pects; the maximum estimated duration of abuse on the same
victim was around 2 years. However, according to the testi-
monies of individuals close to the family, four FSOs out of eight
would have previously abused other children of the family, older
than the current victims (other sons/daughters, grandchildren,
cousins).
The role of the suspected FSOs with respect to the victim was
distributed as follows: The woman was the paternal grandmother
for five of the 11 victims (45.4%); the biological mother for
three of the 11 victims (27.3%); the neighbor for two of the 11
victims (18.2%); and the nanny for one victim (9.1%). In all
cases, the FSO was the victim’s caregiver, usually (one case,
12.5%) or occasionally (seven cases, 87.5%).
All FSOs denied the allegations.
The Crime
In reference to the 11 alleged victims, the crime would have
occurred within the family in 72.7% of the cases (eight of 11),
while it would be an extrafamilial abuse in 27.3% of the cases
(three of 11). Other types of abuse were perpetrated on the same
victim in eight of the 11 cases (72.7%), as follows: assisted vio-
lence in seven cases (63.6%); neglect in two cases (18.2%); physi-
cal maltreatment in one case (9.1%); verbal violence in one case
(9.1%); and no other type of violence in three cases (27.3%). Data
about the affective relationships between the victims and the
alleged FSOs emerged from the psychological interviews and the
observations of the Consultants of the Judge. They can be
 CURTI ET AL.
summarized as follows: strong bond, trust, and affection toward
the perpetrator in six cases (54.5%); feelings of fear in two cases
(18.2%); inversion of adult-child roles in one case (9.1%); extre-
mely exclusive and morbid relationship in one case (9.1%); admi-
ration, FSO as a model to be imitated, in one case (9.1%). The
setting of the abuse was represented by: the home of the separated,
not-cohabiting parent in five cases (62.5%); the home where the
child lived with both parents in three cases (27.3%); during the
time spent with the occasional, extrafamilial caregiver in three
cases (27.3%). The level of violence has been identified as fol-
lows: verbal coercion in one case (9.1%); involvement/exposure to
pornography in two cases (18.2%); coercion to watch the FSO
engage in intimate behaviors in five cases (45.4%); kissing on the
lips in three cases (27.3%); genital fondling in seven cases
(63.6%); oral-genital sex in two cases (18.2%); anus/vagina pene-
tration by fingers and/or objects in three cases (27.3%); no avail-
able information, in one case.
The Court file was available for eight of the 11 cases, while
in three of the 11 cases, investigations are still ongoing. On the
basis of the available files, the following information emerged.
The Judicial Authority proceeded with the interrogation of the
child in six out of eight cases (75%). The mean time between
the report of the alleged abuse to the Judicial Authority and the
child’s testimony was 7 months (range 4.5–10 months). Two
children out of 6 were declared incompetent witnesses by the
psychologist Consultant of the Judge. The criminal procedure
outcomes were the following: dismissal of the charges for lack
of evidence in five cases (62.5%) and for the suicide of the
defendant during the investigations in one case (12.5%); acquit-
tal of the defendant in one case (12.5%); conviction of a 7-year
sentence and economic compensation in one case (12.5%). In
the cases which concluded with the dismissal or the acquittal of
the criminal procedure, six out of seven children (85.7%)
received some form of protection at the end of the civil proce-
dure: removal of the child from the biological family (3 of 6,
50%), followed by the adoption (one of six) or the entrustment
to a foster family (one of six) or to a community (one of six);
prohibition to see the defendant (two of six, 33.3%); protected
meetings with the defendant (one of six, 16.7%).
Discussion
Many previous studies on female child sexual offenders have
focused on judicial databases, and for this reason have many
limitations. In fact, only the FSOs who had committed severe
violent acts were convicted (15), and therefore, these studies
may have reflected a more clinically serious form of abuse than
the average case of CSA perpetrated by women. Furthermore,
the unification of data for statistical purposes necessary leads to
a loss of in-depth analysis of the cases. This study attempts to
overcome some of these limitations because it examines a lim-
ited population of women, who have, with high probability,
committed child sexual offenses, which have been considered
serious enough to be reported and investigated by the Judicial
Authority; therefore, it includes also FSOs who have not been
convicted by the criminal justice system.
The percentage of FSOs on the total number of cases of sus-
pected CSA managed by the “Bambi” unit and reported to the
Judicial Authority in the period taken into consideration (2012–
2017) was 2.8% (versus 97.2% of alleged male child sexual
offenders). Compared to previous clinical studies, the percentage
of FSOs in the present sample is at the lower limit of the range
(2%–39%) (8,12). The low representation of FSOs could be
. CHILD SEXUAL ABUSE PERPETRATED BY WOMEN 7
supported by the fact that the health professionals of the “Bambi”
unit do not investigate trauma during their multidisciplinary
assessment of the child; in Italy, this task is entrusted exclusively
to the Judicial Authority. The disclosures provided by the chil-
dren gathered by the “Bambi” team were spontaneously offered
and were affected by the limited duration of their visit. In this
regard, the victims of the FSOs rarely reveal the abuse (4,5)
because they usually are emotionally attached to the offender,
who is in most cases their caregiver. For example, Rosencrans
reported that 95% of girls abused by their mothers had not spo-
ken to anyone about the violence (16). The FSOs usually mystify
and confound their sexual acts as a game or an appropriate care
activity, which the victim learns to identify as a habit. The habit-
ual nature of this type of interaction prevents victims from per-
ceiving and reporting the abuse (17). Most of the victims’
disclosures quoted by the literature occur in the context of a psy-
chotherapeutic relationship in adulthood; only a small part of dis-
closures occurs, however, in childhood (18). The extremely high
prevalence of disclosure in the present sample (81.8%) is influ-
enced by a selection bias: The cases were identified starting from
the suspected offender on the basis of the statements made by the
child during the visit and, to a lesser extent, by the accompanying
adult. In fact, there are no tools for predicting the gender of the
child sexual offender exclusively on the basis of the characteris-
tics of the victim or of the crime. For this reason, it is important
to deepen the investigation on these two fronts.
As for the victims, they were very young: The mean age was
6.11 years, with limited variability (SD 2.77 years); 63.6% were
aged ≤5 years. These data are consistent with the literature (e.g.,
in Peter’s sample (4): 5.84 years  2.84 SD), and it is supported
by the fact that the abuse often occurs in the context of caregiv-
ing activities (16). It is interesting that some of the victims were
aged ≥9 years (36.4%): This group was victimized by FSOs
who were only occasionally the caregivers; compared to the
group of younger victims (≤5 years of age), the sexual
approaches were different (e.g., involvement/exposure to porno-
graphic content), and suggestive of a more evolved relational
code; furthermore, the victims less likely were emotionally
attached and dependent on the FSO, but on the contrary devel-
oped fear toward her. The existence of this group of older vic-
tims suggests that some FSOs abuse not only very young
children, but indiscriminately children to whom they have access
to for reasons of care and surveillance, modulating the emotional
and sexual approach on the relational skills of the victim.
Considering the gender, female victims were numerically pre-
dominant (81.8% females vs. 18.2% males). These data confirm
the trend described by the literature according to which female
child sexual offenders typically offend on girls, especially when
the victims are very young (4,19,20).
The conclusion that the offender is more likely to be female if
the child has a disability (21) was not confirmed because none
of the victims had physical, psychological, or cognitive diseases.
This suggests that this previously described correlation deserves
further corroboration.
Instead, the association between female-perpetrated CSA and
other forms of abuse on the same victim was confirmed: In the
present sample, 72.7% of children had suffered other forms of
abuse, the most frequent of which was represented by assisted
violence. These data are consistent with previous studies accord-
ing to which sexual violence perpetrated by women, especially
during caregiving, is often accompanied by other forms of abuse
(21,22). These data could be used to address prevention efforts
on specific populations of potential high-risk victims.
8 JOURNAL OF FORENSIC SCIENCES
Regarding the analysis of the level of sexual violence, the
authors categorized the items according to whether the abuse
involved “noncontact abuse/exposure to sexual content” (verbal
coercion, exposure/involvement in pornographic content, coer-
cion to witness sexual intercourse by the FSO), henceforth called
“level 1”; “contact, nonpenetrative abuse” (genital fondling, mas-
turbation, oral-genital sex), “level 2”; and “penetrative abuse”
(anus or vagina penetration with fingers or objects), “level 3.”
Taking into account the highest level of violence in the cases
where there were sexual acts belonging to multiple levels, level
1 represented 10% of the abuses, level 2 60%, and level 3 30%.
These percentages are consistent with a recent study, in which
13% of the CSA perpetrated by FSOs did not include physical
contacts, 66% implied nonintrusive acts and 21% penetration
(23). The distribution of the level of violence after splitting the
sample into two groups according to victims’ age (group A with
age ≤5 years, group B with age ≥9 years) is shown in Table 6.
Regardless of the age, the most frequent level of violence is
nonpenetrative contact. The authors’ hypothesis is that the FSOs
perpetrated the abuse as an “extension” of child daily care (e.g.,
washing, dressing, application of genital creams). In no case did
the woman demand sexual acts from the child; however, they
were always active in manipulating the minor (more or less
intrusively) in the attempt to create a special and exclusive rela-
tionship, strengthened by the victim’s physical gratification.
Only the youngest victims (group A) underwent penetrative acts
(level 3). This could be explained by the “Skin-Ego” theory
(24): In the early years of life, the child has a poor understand-
ing of where his body ends and where the body of others begins.
The envelope that covers his or her body, the skin, is the site on
which he or she creates the first impressions about himself or
herself, and the world and people who take care of him or her.
At this stage, the child experiences stimuli over the skin through
fantasy. In the early years, the child is therefore unaware of his
or her own body boundaries, perceiving the caregiver’s skin as
his or her own (fantasy of a “common skin”) and not identifying
himself or herself as a separate being. With growth, the child
gradually develops the sense of self, the comprehension of body
internal and external, and of individuality. Group A children
may not yet have achieved complete awareness of their body
boundaries and therefore would have allowed, without fear or
frustration, penetrative actions compared to group B.
Analysis of the level of violence can predict injuries on the
victim. Contrary to the common belief, only in less than 1% of
cases of CSA there are significant physical findings (25,26).
Heger et al., reported that only 0.6%, out of a total of 2384 sus-
pected victims of CSA, had physical signs of abuse; in cases
where there was penetration, 6% of females and 1% of males
had abnormal, but not necessarily diagnostically significant, find-
ings (27). In the present case series, 55.5% of visits were com-
pletely negative for physical findings. When there were
significant findings, these were completely nonspecific in almost
all cases (genital/perianal erythema, anal fissures). Only in one
case was there a sign suggestive of genital trauma (abrasions of
the labia majora), and in a further case, both the victim and the
TABLE 6––Distribution of the level of violence according to victims’ age
(group A: victims with age ≤5 years; group B: victims with age ≥9 years).
Group A Group B
Level 1 0 1
Level 2 4 2
Level 3 3 0
accompanying adult reported a vulvar bruising in the days
immediately after the alleged trauma, but it was not observable
at the time of the medical visit. This confirms that genital fond-
ling and penetration with fingers and small objects do not leave
lasting signs, but only fleeting erythema, and that even severe
injuries heal quickly thanks to the high restorative ability of
young tissues (28).
Therefore, in most cases the diagnosis cannot be made on the
basis of ano-genital lesions. This must be taken into account
because the judicial outcome of CSA cases is heavily influenced
by the medical examination, as a conviction is more probable
when there are documented physical findings (15,29).
The criminal procedure outcome of the present case series has
documented a clear prevalence of the “nonconviction” eventual-
ity: The charges have been dismissed in 75% of the cases, for
lack of evidence (62.5%) or for the defendant’s suicide during
the investigation (12.5%), while the defendant has been acquitted
in 12.5% of the cases. In only one case (12.5%), the FSO was
convicted to a 7-year house arrest sentence and to economic
compensation of the victim’s family. This result is not surpris-
ing: The literature definitively stated that the genre of the sexual
offender has an important impact on the outcome of the criminal
process. Women are perceived as less guilty, less violent, and
less dangerous, and therefore, they are less likely convicted than
men (19,30). The Judges also consider factors such as the socio-
family situation and parental status in issuing a sentence (31).
Moreover, in the event of a conviction, the FSOs receive less
lengthy sentences and concessions during the sentence, which is
frequently served outside of prison (32).
Society seems to have a “blind spot” on female child sexual
offenders. In a paper presented at the National Symposium on
Child Victimization, it was reported that among 83 cases of chil-
dren reporting to be sexually abused by women, only one case
had a trial despite sexual abuse having been suspected following
a medical examination (10). Blackwell et al., studied the prison
population after Pennsylvania implemented guidelines for sen-
tencing and concluded that the FSOs still had a lower probability
of serving their sentences in prison than their male counterparts
(33). This was consistent with previous studies which reported
that efforts to control the discretion of convictions through sen-
tencing guidelines had not been successful (34,35). These ele-
ments, together with the belief that women cannot harm children
and the evidence that the rate of recidivism for sexual crimes is
extremely low among the FSOs (36), could lead men who are in
charge of the justice system to reserve a less severe treatment
for the FSOs (37).
The element that may have had the greatest influence on the
outcome of the criminal procedures of the present sample is the
testimony of the child. In six of the eight cases (75%), the vic-
tim was interrogated by the Judicial Authority. Among these, in
two cases the child was declared to be an incompetent witness
by the Consultant psychologist of the Judge and the testimony
was rendered invalid. In all cases (with the exception of one) in
which the child had made disclosures about the abuse to family
members and healthcare providers, had been interrogated by the
Judge, and the testimony had been declared valid, the criminal
trial was concluded with the dismissal or the acquittal of the pro-
cedure. One of the elements that may have compromised the
possibility of obtaining the evidence necessary for the conviction
could be the period of time between the first report to the Judi-
cial Authority and the interrogation. Considering the cases ended
with a nonconviction, this period was significantly long, on aver-
age 8.5 months. In the present case series, the alignment
 CURTI ET AL.
between the clinical expression of the child’s suffering and the
system of justice appears therefore characterized by a consider-
able latency period which could affect the victim’s memory. The
construction of memory is particularly complex in children due
to the risk of suggestibility and a difficulty in correctly identify-
ing the source of memories (lived/assisted/narrated experiences).
Children are fragile witnesses because they are educated not to
contradict adults and to appear complacent. They are also sug-
gestible: The statements, insinuations, or actions of adults can
create in them a “false memory,” which can assume for the child
a real connotation (38). The Judges and experts who are
involved in the collection of the minors’ testimony should there-
fore possess specific skills in forensic psychology and make
every effort to ensure that the interrogation is performed as soon
as possible.
Nevertheless, in 87.5% of cases in which the criminal proce-
dures were dismissed or the defendant acquitted, there were
some forms of protection for the child, set by the civil proce-
dure. These measures indicate that the Judicial Authority has
identified a strong prejudice for the minor’s health, and made
efforts to abolish or reduce contacts with the alleged FSO.
In the only case in which the FSO was convicted, the victim
manifested massive psychopathological symptoms, which devel-
oped from the moment when the FSO had been removed from
the girl’s life: compulsive masturbation, pervasive ideas with
sexual content, violent manifestations of refusal toward the
maternal figure, aggressiveness toward the parents, younger
children and animals, sexualized and scurrilous language, diffi-
culty in urinating and defecating, nightmares, thoughts of death,
and obsessive rituals. The criminal procedure was also influ-
enced by the fact that the girl consistently revealed the abuse
in detail to several witnesses. She was also interrogated and
told the Judge about the sexual “games” with which the defen-
dant used to entertain her. Finally, the Judge’s psychologist
Consultant, after a careful assessment, confirmed beyond a rea-
sonable doubt the fact that the girl had been abused. This rein-
forces the theory that a timely and complete psychological
evaluation of the minor as well as the correct collection of the
testimony is necessary in order to crystallize the victim’s dis-
closure about the abuse.
Regarding the female child sexual offenders of the present
sample, the average age at the time of the discovery of suspected
CSA was 54.4 years (12.33 SD). In particular, 62.5% of the
FSOs were over 50 years of age. This datum clearly differs from
the literature, according to which the FSOs are on average 25–
35 years (17,39–43). The reason for this discrepancy could be
that the current victim may not have been the first one and that
the FSOs may have previously abused other children in the fam-
ily. In fact, the suspicion that the woman had directed past sex-
ual attentions to siblings, grandchildren, older cousins, and in
one case to the father of the current victim emerged from the
Court files for 66.7% of the alleged FSOs. When these “first-
generation” victims grew old, the FSO could have replicated the
abusive behavior on the new children of the family to which she
had easy access.
The analysis of the role of the offender with respect to the
victim has made it possible to identify situations of intrafamilial
abuse for 72.7% of the victims and extrafamilial for 27.3%. In
particular, the alleged FSO was the paternal grandmother of
45.4% of the victims, and the biological mother of 27.3%. As
for extrafamilial abuses, they were committed against two vic-
tims (18.2%) and one victim out of 11 (9.1%), respectively, by a
neighbor and the nanny. The abuse setting was always
. CHILD SEXUAL ABUSE PERPETRATED BY WOMEN 9
represented as the house in which the offender lived, both in the
case in which she lived with the victim (27.3%) and in the case
that she was only an occasional caregiver (63.6%), with the
exception of a single case in which the FSO was the nanny and
the abuse occurred in the house of the girl’s parents as well as
at the playground (9.1%). The situation outlined above is consis-
tent with the literature according to which most of the CSAs per-
petrated by women takes place in an intrafamilial setting. For
example, in a research article on the self-reports of victims of
FSO (18), in 71% of the cases the victims indicated one or more
women of the family as sexual offenders: in 67% of cases the
mother alone, in 22% the grandmother and the mother, and in
11% the mother and a sister were reported as the offender. On
the other hand, among those who had suffered an extrafamilial
abuse, 75% had been victimized by a baby-sitter, and 25% by
members of the local church (18).
Considerable evidence has been gathered that FSOs more fre-
quently have a personal history of trauma and abuse, even of a
sexual nature, than their male counterpart (21,44,45). This is also
confirmed by the present sample: 37.5% of the FSOs had been
abused by their former partner and/or their father. This datum is
affected by the unavailability of information for some of the
FSOs, so the percentage may in fact be higher. It is possible to
hypothesize that negative life experiences, nonprotective family
context, and individual fragilities may prevent a physiological
investment of the FSO’s libido on an adult partner that could
instead be perceived as threatening and demanding. The search
for sexual intimacy with a child-age partner may result from a
need for emotional security, gratified by the child’s vulnerability
and dependence (46). The literature reported that alcohol or drug
abuse, and mental, physical, or learning disorders are more fre-
quent among female compared to male sexual offenders (21,47).
Some studies have shown that FSOs have a high prevalence of
mental disorders such as depression, bipolar disorder, and
schizophrenia or personality disorders (22,46,48). Many authors
have found dependent and passive personalities (48,49), low
self-esteem (50,51), poor social skills (49), and fear toward the
male gender (52,53) within FSOs.
In the present sample, one FSO out of eight was actively
dependent on drugs and alcohol, and had liver cirrhosis and HIV
infection; in two cases, there was a personal history of deviant
behavior, demonstrated in one case by previous drug dealing
activity, and in the other one by prostitution even during preg-
nancy as well as participation in pornography films and aban-
donment of the newborn daughter. Regarding mental illnesses,
37.5% of the women were suffering from depression (in two
cases “major depressive disorder,” in one case “predisposition
for depression”); in one of these cases, eating disorder and bor-
derline personality disorder were present. The previous elements
(physical and/or mental illnesses, personality disorders, personal
history of abuse, deviant behavior, dependence on alcohol or
drugs) describe the FSOs as a group of women with complex
life stories, characterized by trauma, disabilities, and vulnerabili-
ties that could contribute to the development of dysfunctional
relational patterns (54).
Previous studies suggest that FSOs are a heterogeneous popu-
lation. Some authors have tried to define descriptive categories
(17,47,50,55,56) which fit to large judicial samples, but are not
exhaustive in understanding the totality of cases, especially those
included in the “gray area” of the diagnostic difficulty and are
therefore classified with the nonconvicted cases. In this regard,
none of the categories described so far fit satisfactorily in all of
the present cases. In fact, the authors have observed in most
10 JOURNAL OF FORENSIC SCIENCES
cases an exclusive and morbid relationship between victim and
FSO, the latter equipped with low social skills, poor tools to
cope with stressful life events, and more at ease in relating to
children than adults. These women did not behave predatorily,
nor did they seek their own sexual gratification, but instead
favored the construction of a pathological intimacy, and used
abusive acts as a channel of privileged communication with the
victim. They were egosyntonic; that is, their behaviors and feel-
ings were in harmony with their psychological needs, so that
they did not perceive the abuse as such, and they denied any
accusations during the investigations. Sexual acts were perceived
by them as “normal routines” during moments of engaging in
care and play.
This hypothesis of functioning of the FSO-victim dyad would
explain the serious psychopathological consequences on child
victims, which include dissociative disorders, disorganized
attachment, somatoform disorders (abdominal pain, urinary dis-
orders, stuttering), predisposition for depression and social isola-
tion, strongly aggressive behavior, violent rejection of the
maternal figure, phobias, serious sexualized behavior (compul-
sive masturbation and pervasive ideas about sex), insomnia, and
nightmares. Therefore, it is possible to detect the important and
early presence of post-traumatic symptoms, even though thera-
peutic programs and protective measures have been set for the
minors. This suggests that children who are exposed at an early
age to sexual abuse by the caregiver may develop a pervasive
and disabling symptomatology to a greater degree than older vic-
tims and those abused by noncaregiver figures. Further studies
would be necessary in order to confirm this theory, given the
small number of the present sample, but this hypothesis has a
solid foundation in the studies on the developmental trauma
spectrum disorders (57), on the attachment theory (58–61), and
on neurobiological aspects of trauma (62,63).
Bowlby (58,59) postulated that humans would develop an
innate attachment system, which functions to protect an infant
from predators. Attachment would respond to primary care needs
that push the child toward a unique and principal attachment fig-
ure (primary caregiver). The search for physical contact would
represent the most explicit manifestation of attachment. A suc-
cession of positive experiences on the responsiveness of the
caregiver is crucial to constitute a secure attachment, which is a
very important premise for the normal psychological develop-
ment of the child. If this mechanism fails for any reason, the
strategies implemented by the child are drastic, and can include
aggression and avoidance. Main and Solomon (64) described
disorganized attachment, characterized by strong inconsistencies,
fragmentation, alternation of aggression and detachment, strongly
stereotypical behavior, unmotivated rage, and lack of adaptation.
The origin of this attachment pattern would likely have mani-
fested from traumatic experiences of the child. This has serious
consequences and can be the basis of various behavioral disor-
ders, personality disorders, and dissociative disorders. A strong
correlation has been described between experiences of child
abuse and the presence of borderline personality disorder,
attachment problems, and cognitive impairment (60,61). Our
hypothesis is that the victims of the present sample who were
exposed at an early age to a distorted relationship with the care-
giver have suffered a failure to develop a physiological attach-
ment, with very serious dysfunction of the psychological area.
From a neuropathological point of view, adequate responses
to the care requests of the child play a role in determining the
physiological development of the central nervous system, in par-
ticular the prefrontal orbital cortex, which is the most advanced
level of the limbic system and has the ability to self-regulate
internal excitatory states (65). The quality of care by the attach-
ment figure could therefore influence the correct development of
the nervous system. In fact, early abused children show patho-
logical responses to physiological stimuli such as hunger, thirst,
sleep, and pain (66).
This neuropsychiatric basis could motivate the severity and
longevity of the victims’ clinical symptomatology, which have
been abused by their caregivers during their formative years of
attachment system. An early trauma on this system, by the peo-
ple who would instead be responsible for its formation, during a
phase of biological immaturity represents a serious attack on the
child’s psychological defenses, with the concrete risk of reper-
cussions, even of structural nature, on the neurological system.
This last hypothesis deserves further research because it would
open new ways for understanding the long-term consequences of
child abuse.
Future Directions
The present study provides an in-depth analysis of case series
of child sexual abuse perpetrated by women. It describes a small
group of very young victims who suffered abuse in the course
of daily caregiving activities, thereby developing a very strong
bond to the offenders who were also the principal attachment
figure. The physical gratification of the child, which was not
perceived as abuse by the women, was the privileged means of
communication with the child. The victims developed significant
and long-lasting psychopathological symptoms starting from the
moment of detachment from the offender following the investi-
gations of the Judicial Authority. The authors hypothesize a fail-
ure in the development of a correct attachment system in the
victims, which would have been damaged by the pathological
relationship with the caregiver, especially for the group of
younger victims. This hypothesis should be confirmed by neu-
ropathological studies, and it would open new ways for under-
standing the psychological outcomes of child sexual abuse
perpetrated by women.
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