Child sexual abuse is the deliberate exposure of minor children to sexual activity. This means a child is forced or talked into sex or sexual activities by another person. Such abuse includes:

• Oral sex
• Pornography
• Sexual intercourse
• Touching (fondling)

Society was reluctant to deal with child sexual abuse a few decades ago. Today, it is considered a serious issue.

It is difficult to determine how often child sexual abuse occurs, because it is more secret than physical abuse. Children are often scared to tell anyone about the abuse. Many cases of abuse are not reported.

Abusers are usually men. They tend to know the person they are abusing. The abuser violates the trust of the younger person, which makes the sexual abuse even more devastating.

Child sexual abuse occurs in all social and economic classes of people. It has the same type of risk factors as physical child abuse, including:

• Alcohol and drug abuse
• Family troubles
• Poverty

Abusers often have a history of physical or sexual abuse themselves.

A small group of repeated abusers have the psychiatric disorder, pedophilia. Their preferred sexual contact is with children.

Symptoms of sexual abuse in chlildren are similar to those of depression or severe anxiety and nervousness. They can include:

• Bowel disorders, such as soiling oneself (encopresis)
• Eating disorders, such as anorexia nervosa
• Genital or rectal symptoms, such as pain during a bowel movement or urination, or vaginal itch or discharge
• Repeated headaches
• Sleep problems
• Stomach aches (vague complaints)

Children who are abused may:

• Display disruptive behaviors such as using alcohol and street drugs or engaging in high-risk sexual behaviors
• Do poorly in school
• Have excessive fears
• Withdraw from normal activities

If you suspect a child has been sexually abused, the child should be examined as soon as possible by a trained health care professional. Most pediatricians, many family medicine doctors, and most emergency room (ER) doctors have been trained to examine cases involving sexual abuse.

Do not delay a doctor's exam for any reason. Many signs of injury related to sexual abuse are temporary. The exam should be done within 72 hours of the event or discovery.

A complete physical exam must always be performed, so that the examiner can look for any signs of physical and sexual abuse. The two forms of abuse may exist together.

Affected areas may include the mouth, throat, penis, anus, and vagina, including the hymen. The hymen is a thin piece of tissue covering the opening of the vagina. It can be affected by abuse.

Your doctor may also order blood tests to check for sexually transmitted diseases, such as syphilis and HIV, and pregnancy in females. These tests can help determine treatment.

Photographs of injuries may help establish what happened. It is extremely important to write down symptoms due to any form of child abuse.

An exam will automatically be scheduled when suspected child sexual abuse is reported to police or child protection agencies. A second exam with an expert abuse examiner should be scheduled after the first exam. A doctor or nurse specialist can be found through child protective services programs anywhere in the United States.

Treatment for the physical signs of sexual abuse is the same as for any types of cuts, bruises, or scrapes. The patient may need medicines to prevent or treat sexually transmitted diseases. Older females may receive medicines to prevent pregnancy.

All children who have been sexually abused or traumatized in any way should receive mental health counseling.

Any suspicion of child sexual abuse must be reported to child protective services and the police. Medical professionals, teachers, and child care professionals are required by law to make a report.

Once a case is reported, child protection agencies and the police must investigate. If the report is considered true, the child must be protected from further abuse. The child may be placed with a non-abusing parent, another relative, or a foster home.

Support groups for abused children, their parents, and caretakers are available and strongly recommended. The following organizations may provide more information:

Child Help USA - www.childhelpusa.org

Prevent Child Abuse America - www.childabuse.org

Rape, Abuse & Incest National Network - www.rainn.org

The biggest issue is the child's mental health. The outcome depends on:

• Family and social support
• The child's personality
• The length of time the child was abused and the type of abuse
• Therapy

• Anxiety disorders
• Depression
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Sleep disorders
• Unsafe sexual activities

Those who have been abused as children have an increased risk of becoming abusers themselves when they reach adulthood.

If you suspect child abuse in any form, immediately call your health care provider, Child Protective Services, or police.

Prevention involves teaching children never to keep secrets and the difference between "good" and "bad" touches. Parents need to begin this work at home. Most schools now have programs to teach young school-aged children about sexual abuse and its prevention.

Teenagers also need to be taught how to avoid rape and date rape.

Constant supervision and vigilance by adults is essential to preventing all forms of child abuse.

Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 36.