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 exam.
Sexually transmitted infections are uncommon in sexually abused prepubertal 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 victimization 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".
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: "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." 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."
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 only refer to vaginal penetration. The term sexual assault includes other nonconsensual sexual activity.
History and exam
Key diagnostic factors
- disclosure of inappropriate contact
- acute anogenital trauma (any change); transections and absent hymen (in children)
- HIV infection
Other diagnostic factors
- normal genital findings
- anogenital lesions
- labia and perineum injury
- nongenital injuries
- vaginal or penile discharge
- self-destructive behavior
- sexualized behaviors in children
- chronic medical complaints in children
- frequent or persistent genitourinary complaints
- hymenal notches
- sexual abuse of other children in the home
- adolescents and young women
- poverty or homelessness
- sex workers
- living in institutions or areas of conflict
- use of alcohol or other drugs
- lack of community services
1st investigations to order
- forensic specimens
- culture for Neisseria gonorrhoeae
- culture for Chlamydia trachomatis
- nucleic acid amplification for Chlamydia trachomatis and Neisseria gonorrhoeae
- serologic tests for syphilis
- HIV serology
- urine beta human chorionic gonadotropin
- testing for trichomonas
- anogenital culture: herpes simplex virus polymerase chain reaction (PCR)
Investigations to consider
- HIV confirmatory test
- HIV RNA PCR
- Treponema pallidum hemagglutination assay for syphilis
- serum rapid plasma reagin for syphilis
within 72 to 96 hours since assault: preadolescent
within 72 to 96 hours since assault: adolescent or adult
>96 hours since assault: preadolescent
>96 hours since assault: adolescent or adult
- Lichen sclerosus
- Urethral prolapse
- Updated guidelines for the medical assessment and care of children who may have been sexually abused
- Sexually transmitted diseases treatment guidelines, 2015
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