Sexual Abuse Flashcards
What is sexual abuse?
Forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening
Doer sexual abuse always include physical contact?
No
What forms of sexual abuse don’t include physical contact?
- Involving children in looking at, or in the production of, sexual images
- Watching sexual activities
- Encouraging children to behave in sexually inappropriate ways
- Grooming a child in preparation for abuse (including via the internet)
Can children commit sexual abuse?
Yes
What’s % of UK children are subject to sexual abuse at some the?
4%
Who usually perpetrates sexual abuse?
Someone close to the child
What is the limitation of statistics about child sexual abuse?
It is often unrecognised, and therefore frequently missed
What % of 18-24 year olds consider they have been sexually abused (as per NSPCC survey)?
11%
Why does sexual abuse often go unrecognised?
Sexually abused children may not manifest any signs or symptoms, and they may not allege it is happening for fear of not being believed
What are sexually abused children at higher risk of when they grow up?
- Further sexual abuse
- Promiscuity
- Teenage pregnancy
- Mental health problems
- Drug misuse
- Difficulties with relationships
- Difficulty protecting their own children
How might child sexual abuse present?
- Allegation
- Physical symptoms
- Emotional/behavioural changes
- Psychosomatic
When might an allegation of child sexual abuse occur?
- In the acute period
- Weeks or years after the event
What is important when an allegation of sexual abuse is made in the acute period?
Forensic evidence must be gathered as a matter of urgency
Are allegations of child sexual abuse more commonly made in the acute phase or weeks/years later?
Weeks/years later
When is it more common for allegations of child sexual abuse to be made weeks/years later?
In cases of intra-familial abuse
How might symptoms linked to sexual abuse be discovered?
- Incidentally by a carer
- Reported by the child
- Found on examination
What physical symptoms may be linked to sexual abuse?
- Constipation
- Dysuria
- Enuresis
- Recurrent urinary tract infections
- Vaginal discharge or vulvovaginitis
- Recurrent itching or soreness
What needs to be excluded when children present with physical symptoms suspicious of sexual abuse?
Medical causes
Give 2 examples of medical causes that can cause physical symptoms similar to those linked to sexual abuse?
- Lichen sclerosus et atrophicus
- Rectal fissures
When are sudden changes in behaviour particularly suspicious for sexual abuse?
If associated with other changes, e.g. new people in the household
What can be helpful when determining if a sudden behavioural change is related to sexual abuse?
Asking the child alone if there is anything worrying them or if they have a bad secret
What emotional/behavioural changes may be associated with sexual abuse?
- Sleep disturbance or nightmares
- Anxiety, depression, withdrawal
- Aggression, attention seeking and/or poor concentration
- Sexualised behaviour
- Encopresis
What emotional/behavioural changes may be associated with sexual abuse in older children/adolescents?
- Self harm
- Suicidal ideation
- Running away
Give 3 examples of psychosomatic symptoms that can be related to sexual abuse?
- Headaches
- Changing in eating behaviour
- Abdominal pains
What should be done in children presenting as victims of sexual abuse acutely?
- Intimate body swabs taken for forensic evidence (semen, saliva, hair, and other substances)
- Clothing examined for semen and DNA
Where should forensic investigations undertaken in acute cases of sexual abuse be carried out?
In a sexual abuse referral centre
What investigations may be carried out when sexual abuse is taken, irrespective of time frame?
- Serum and urine samples for STDs
- Pregnancy testing if appropriate
What is offered after the acute presentation of sexual abuse?
Psychological assessment and treatment
Who interviews a child following an allegation of sexual abuse?
A trained police officer and social worker
Where is a child interviewed after an allegation of sexual abuse?
A purpose-built suit with video-recording
What is the interview that occurs with the child after an allegation of sexual abuse termed?
The ‘achieving best evidence’ (ABE) interview
What interview style is adopted in the ABE interview?
The police and social worker will hear details of what happened without asking direct questions
Does the ABE occur before or after medical examination?
If the medical examination is urgent (aka within the forensic time frame), the ABE interview will occur after
What care needs to be taken during medical examination if it is being performed before the ABE interview?
Health professionals should only ask questions pertinent to the examination so they do not contaminate the verbal evidence
Who’s permission should you seek prior to performing an examination in cases of sexual abuse?
The child and care giver’s
What should the child be reminded of prior to performing an examination for sexual abuse?
How to keep safe
Who should carry out the examination of the anogenital area following sexual abuse?
A senior doctor
What is done with intimate body swabs taken during examination in cases of acute sexual assault?
They are labelled and given to the police officer in the case
What should be used to enable detailed examination of the genitalia and anus?
A colposcope
Should photo documentation be obtained when performing an examination in cases of sexual abuse?
Yes
What form of consent is required when performing an anogenital examination in cases of sexual abuse?
Written consent from the parent/carer with parental responsibility, and the child if old enough
What needs to be considered when looking for changes in the hymen in sexual abuse examinations?
There is much variation in normal anatomy, and the size and appearance of the hymen changes from birth to puberty
In what position are the genitalia examined during a sexual abuse examinations in girls?
Frog legged position and, if tolerated, knee-chest position
What might be found on examination in cases of acute genital injury?
- Erythema
- Bruising
- Lacerations
What injury might vaginal penetration lead to?
Laceration to the hymen
In what position does laceration to the hymen caused by vaginal penetration most commonly occur?
Between 3 and 9 o’clock
What may be found on examination of the hymen in non-acute allegations of penetration?
Notches and transections in the hymen
How can notches and transections in the hymen be demonstrated?
With a swab or Foley catheter
Are notches and transections of the hymen commonly found in cases of non-acute penetration?
No, they are only found in a small perfect of victims
In what position is the anus examined in sexual abuse examinations?
Left lateral
What may be found on examination following the actual or attempted application of a blunt penetrating force to the anus in the acute setting?
- Erythema
- Bruising
- Laceration
What might be found on examination following non-acute actual or attempted application of a blunt penetrating force to the anus?
- Lacerations
- Reflex anal dilatation
What is reflex anal dilatation?
When the anus dilates to reveal the rectum after separating the buttocks for up to 30 seconds
In what proportion of children with a history of anal abuse is reflex anal dilatation seen?
1/3
Is reflex anal dilatation ever seen in children without a history of anal abuse?
It is seen in small numbers of children
What needs to be excluded when reflex anal dilatation is found on examination?
Constipation
What might be found on general examination in acute allegations of sexual abuse?
Other injuries to the body, such as bruising, scratches, or bite marks
What documentation is required at the conclusion of a sexual abuse examination?
A body map
What happens to the DVD of evidence produced by a sexual abuse examination?
It is taken for peer review and court proceedings
What % of children alleging historic abuse have normal physical findings?
90%
