Sexual abuse and assault

Sexual assault is common and can affect adults of any age. Young women are most at risk, but males are also sexually violated.

The majority of children presenting for a sexual abuse evaluation have normal findings on physical examination.

Sexually transmitted infections are uncommon in sexually abused pre-pubertal children.

Time elapsed since the most recent sexual assault, and the pubertal status of the child, determine the appropriate management strategy in the acute setting.

Girls have a higher risk than boys of victimisation such as sexual abuse.

The World Health Organization defines sexual violence as "any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic or otherwise directed against a person's sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work".[1]World Health Organization. Understanding and addressing violence against women: sexual violence. 2012 [internet publication]. http://apps.who.int/iris/bitstream/10665/77434/1/WHO_RHR_12.37_eng.pdf

The definitions of child sexual abuse and other sexual offences may vary between countries or within jurisdictions of countries. A current definition from the American Academy of Pediatrics (AAP) is that: "Sexual abuse occurs when a child is engaged in sexual activities that he or she cannot comprehend, for which he or she is developmentally unprepared and cannot give consent, and/or that violate the law or social taboos of society."[2]Jenny C, Crawford-Jakubiak JE; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013 Aug;132(2):e558-67. http://pediatrics.aappublications.org/content/132/2/e558.full http://www.ncbi.nlm.nih.gov/pubmed/23897912?tool=bestpractice.com The AAP further specifies that the "activities may include all forms of oral-genital, genital, or anal contact by or to the child or abuse that does not involve contact, such as exhibitionism, voyeurism, or using the child in the production of pornography."[2]Jenny C, Crawford-Jakubiak JE; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013 Aug;132(2):e558-67. http://pediatrics.aappublications.org/content/132/2/e558.full http://www.ncbi.nlm.nih.gov/pubmed/23897912?tool=bestpractice.com

In most jurisdictions, rape is defined as sexual intercourse or other forms of penile sexual penetration, by one person (the perpetrator) of another person without his or her consent. Depending on the jurisdiction, penetration may be of the mouth, vagina or anus, or may only refer to vaginal penetration. The term sexual assault includes other non-consensual sexual activity.