Sexual abuse and assault

Sexual abuse and assault is common and can affect people of any age. Young women and girls are most at risk, but males are also sexually abused and assaulted.

The diagnosis is complex and has major ramifications; it is therefore important to follow diagnostic guidelines.

Rapid healing of genital tissues and other factors can result in normal findings on examination following sexual abuse. This is particularly true for children, among whom the majority have normal physical examinations.

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

The appropriate management strategy is determined by the time elapsed since the sexual assault and the pubertal status of the patient.

The World Health Organization (WHO) 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. The WHO defines child sexual abuse as 'the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developementally prepared and cannot give consent, or that violate the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person'.[2]World Health Organization. ​Report of the consultation on child abuse prevention, 29-31 Mar 1999, WHO, Geneva. 1999 [internet publication]. https://apps.who.int/iris/handle/10665/65900

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 their 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.