Sexual abuse and assault

Last reviewed: 3 Sep 2022
Last updated: 08 May 2018

Summary

Definition

History and exam

Key diagnostic factors

  • disclosure of inappropriate contact
  • acute anogenital trauma (any change); transections and absent hymen (in children)
  • HIV infection
More key diagnostic factors

Other diagnostic factors

  • normal genital findings
  • depression
  • anogenital lesions
  • labia and perineum injury
  • non-genital injuries
  • vaginal or penile discharge
  • self-destructive behaviour
  • sexualised behaviours in children
  • chronic medical complaints in children
  • frequent or persistent genitourinary complaints
  • hymenal notches
Other diagnostic factors

Risk factors

  • sexual abuse of other children in the home
  • adolescents and young women
  • disability
  • poverty or homelessness
  • sex workers
  • living in institutions or areas of conflict
  • use of alcohol or other drugs
  • lack of community services
More risk factors

Diagnostic investigations

1st investigations to order

  • forensic specimens
  • culture for Neisseria gonorrhoeae
  • culture for Chlamydia trachomatis
  • nucleic acid amplification for Chlamydia trachomatis and Neisseria gonorrhoeae
  • serological tests for syphilis
  • HIV serology
  • urine beta human chorionic gonadotrophin
  • testing for trichomonas
  • anogenital culture: herpes simplex virus polymerase chain reaction (PCR)
  • LFT
  • creatinine
  • urea
  • FBC
More 1st investigations to order

Investigations to consider

  • HIV confirmatory test
  • HIV RNA PCR
  • Treponema pallidum haemagglutination assay for syphilis
  • serum rapid plasma reagin for syphilis
More investigations to consider

Treatment algorithm

ACUTE

≤72 hours since assault: pre-adolescent

≤72 hours since assault: adolescent or adult

>72 hours since assault: pre-adolescent

>72 hours since assault: adolescent or adult

Contributors

Authors

Sheela Lahoti, MD

Associate Professor

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

SL declares that she has no competing interests.

Rebecca Girardet, MD

Professor

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

RG declares that she has no competing interests.

Shaina Groisberg, MD

Child Abuse Pediatrics Fellow

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

SG declares that she has no competing interests.

Michelle Ruda, MD

Child Abuse Pediatrics Fellow

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

MR declares that she has no competing interests.

Margaret McNeese, MD

Professor

Department of Pediatrics

Division of Community and General Medicine

University of Texas Medical School at Houston

Houston

TX

Disclosures

MM declares that she has no competing interests.

Acknowledgements

Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Shaina Groisberg, Dr Michelle Ruda, and Dr Margaret McNeese would like to gratefully acknowledge Dr Zoe O'Connor, paediatric resident from Niklaus Children’s Hospital in Miami, Florida, for her contribution to this topic, and Dr Christopher Greeley and Dr Jan Welch, previous contributors to this topic. CG and JW declare that they have no competing interests.

Peer reviewers

James Lukefahr, MD

Professor of Pediatrics

Child Abuse Division

Department of Pediatrics

University of Texas Health Science Center

San Antonio

TX

Disclosures

JL declares that he has no competing interests.

Suzanne Starling, MD

Medical Director

CHKD-CAP

Professor of Pediatrics

Eastern Virginia Medical School

Norfolk

VA

Disclosures

SS is an author of a reference cited in this topic. SS declares that she has no other competing interests.

Angelo P. Giardino, MD, PhD

Clinical Associate Professor

Pediatrics

Baylor College of Medicine

Medical Director

Texas Children's Health Plan

Houston

TX

Disclosures

APG declares that he has no competing interests.

Ruth Gilbert, MD, MSc, MB ChB

Professor of Clinical Epidemiology

UCL-Institute of Child Health

London

UK

Disclosures

RG declares that she has no competing interests.

  • Sexual abuse and assault images
  • Differentials

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    • Urethral prolapse
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  • Guidelines

    • Recommendations for the collection of forensic specimens from complainants and suspects
    • Updated guidelines for the medical assessment and care of children who may have been sexually abused
    More Guidelines
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