Overview, Causes, & Risk Factors
Child sexual abuse is any experience during childhood or adolescence that
involves inappropriate sexual attention from another person. This person is
usually an adult but can also be an older child, teenager, or even a person
the same age.
Sexual abuse can take place within the family by a parent,
sibling, or other relative. It also can occur outside the family by a friend,
neighbor, caregiver, teacher, or random molester. Children are often afraid to
tell anyone what
has happened. A recent study of girls in 9th through 12th grade found that one
out of five girls were physically and/or sexually abused by a dating
There are three types of sexual abuse: nontouching sexual abuse,
touching sexual abuse, and sexual exploitation.
Nontouching sexual abuse includes:
deliberately exposing a child to the act of sexual intercourse
exposing a child to pornographic material
indecent exposure or exhibitionism
masturbating in front of a child
Touching sexual abuse can include:
any penetration of a child's vagina or anus by an object that doesn't have
a medical purpose
making a child touch an adult's sexual organs
Sexual exploitation can include:
engaging a child for the purposes of prostitution
using a child to film, photograph, or model pornography
What are the causes and risks of the injury?
Sexual abuse happens to children of all religions, ethnic origins, and income
levels. Often the abuser is someone the child knows, rather than a stranger. A
person who was sexually abused as a child is more likely to become an abuser as
an older child or adult.
Experts know that adolescents who have been abused are
at higher risk for other health problems. However, we do not yet know whether
the health problems came before the abuse or if the abuse increased the risk
for the health problem. These problems include the following:
including binge drinking
risky sexual behaviors, including intercourse before age 15 and multiple
suicidal attempts or
Symptoms & Signs
What are the signs and symptoms of the injury?
It is not always easy for an adult to recognize when sexual abuse has taken
place. A child who has been sexually abused may:
be excessively curious about sex
develop frequent urinary tract
engage in inappropriate sex play
feel threatened by physical contact, closeness, or a certain person
have bruises, bleeding, pain, or itching in the genital area
have poor self-esteem
have a premature understanding of sex
have separation anxiety
wet or soil his or her bed
Diagnosis & Tests
How is the injury recognized?
An abuser can make the child very fearful of telling anyone else. An adult
should believe a child who says he or she has been sexually abused. Children
rarely lie about sexual abuse.
When sexual abuse is suspected, the child should be taken to a healthcare
provider who is trained to deal with and recognize sexual abuse. He or she will
ask the child to describe what happened. He or she also will look for injuries
to the mouth, rectum, and vaginal area, if the child is a girl. If the abuse
took place recently, the healthcare provider will do a special examination to
check for sperm. Child protective services need to be notified.
Prevention & Expectations
What can be done to prevent the injury?
Parents need to warn children about possible risks. Children should be taught
about good and bad touches. They need to be told that no one should touch their
private areas. Children should be told not to keep secrets from
their parents, even if someone has threatened to harm them or their parents.
The best way to prevent abuse is to teach children how to solve problems
without using abuse. Teenagers and young adults should be taught that it's
never OK to abuse a partner. Parents and healthcare providers should provide
teens with information and statistics about dating violence. The teens should
be given specific information about behaviors that are part of dating violence.
They should be encouraged to discuss any issues or concerns with a parent or
other appropriate adult.
Since health concerns such as cocaine use are associated with a
higher risk for partner abuse, healthcare providers should address dating
violence when treating teens with these health concerns. Careful screening can
help identify at-risk teens and provide the opportunity to stop the abuse
Treatment & Monitoring
What are the treatments for the injury?
Child protective services monitor sexual abuse cases. Sexually abused children
and their families need professional evaluation and treatment. Child and
adolescent psychiatrists can help abused children regain a sense of
They can help them cope with their feelings of guilt about the abuse and begin
the process of overcoming the trauma. Individual
psychotherapy and group counseling may help. Much of
the healing for many survivors takes place in a support group of other
There is strength, comfort, and hope in hearing the stories of others who share
Antidepressant medicines may be tried, but they are not usually
as successful in treating
depression in children as they are in adolescents and
The child should be checked for
sexually transmitted diseases. Girls of
childbearing age should be tested for pregnancy.
What are the side effects of the treatments?
Antidepressant medicines may cause mild and usually temporary side effects in
some people. The most common side effects are:
A person on antidepressant medicines needs to have blood levels monitored
What happens after treatment for the injury?
Long-term effects can include posttraumatic stress
disorder. Although this nervous disorder can have many causes, in
this case it is a result of physical, mental, or sexual violence. The victim
may have the following conditions:
feelings of anxiety
feelings of isolation
nightmares and flashbacks
a tendency to avoid other people
Children who have been sexually abused usually develop low self-esteem, a
feeling of worthlessness, and an abnormal perspective on sexuality. They may
become withdrawn and mistrustful of adults and attempt suicide. Some sexually
abused children become child abusers or prostitutes in later years. They are
more at risk of abusing alcohol or other drugs to dull the pain.
A person who has been sexually abused may need years of psychotherapy to come
to terms with what has happened. Therapy is most often long-term. It can be
difficult for an adult to come to terms with sexual abuse that occurred when he
or she was a child. It may result in changes in the abused person's life. In
some cases, divorce results when a spouse can't live with a partner's pain and
becomes frustrated at not being able to do anything about it.