Approach

The diagnosis of sexual abuse and sexual assault is complex. It is important to follow diagnostic guidelines, although victims may have normal physical findings.

In children, disclosure of inappropriate contact may be the only indicator of sexual abuse. Other features that should prompt sexual abuse evaluation in a child include frequent genito-urinary complaints without a clear aetiology, sexualised behaviours, and sexual abuse of other children in the home. Initial assessment of child victims of sexual abuse includes psychosocial and medical components, and varies according to the child's pubertal status and the time elapsed since the most recent sexual contact. For all paediatric patients, providers must ensure that the child will be returning to a safe environment and that mandatory reporting to the relevant child protection agency has been done.

Adults may report sexual assault soon after the assault, or they may later seek medical care without necessarily disclosing why, unless specifically but sensitively asked. Post-assault medical care should include both meeting healthcare needs and consideration of evidence collection for medico-legal purposes. Good documentation is crucial, and can be supported by the availability of standardised forms for record-keeping.[17] Rape is a profoundly disempowering experience, and it is essential that care is provided in a way that supports individuals in reclaiming control over their lives.

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