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Abuso e agressão sexual

Last reviewed: 20 Aug 2025
Last updated: 16 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • declaração de contato inapropriado
  • trauma anogenital agudo ou residual (cicatrização) (qualquer alteração); evidência de trauma no hímen (em crianças)
  • infecções sexualmente transmissíveis
Full details

Other diagnostic factors

  • achados genitais normais
  • sequelas emocionais e psicológicas
  • lesões anogenitais
  • lesões não genitais
  • corrimento vaginal ou peniano
  • comportamentos nocivos
  • problemas de comportamento sexual em crianças
  • queixas médicas crônicas de crianças
  • queixas geniturinárias frequentes ou persistentes
  • lacerações no hímen
Full details

Risk factors

  • abuso sexual de outras crianças no domicílio
  • exposição na infância a violência de parceiro íntimo
  • família monoparental
  • adolescentes e mulheres jovens
  • deficiência de aprendizagem ou física
  • Problemas de saúde mental
  • pobreza ou falta de moradia
  • profissionais do sexo
  • vivendo em instituições ou áreas de conflito
  • uso de bebidas alcoólicas ou outras drogas
Full details

Diagnostic investigations

1st investigations to order

  • espécimes forenses
  • testes para Neisseria gonorrhoeae
  • testes para Chlamydia trachomatis
  • exames sorológicos para sífilis
  • testes sorológicos para hepatite B
  • sorologia do HIV
  • gonadotrofina coriônica humana beta na urina
  • teste para Trichomonas vaginalis
  • cultura anogenital: reação em cadeia da polimerase para vírus do herpes simples
  • testes da função hepática
  • creatinina
  • ureia
  • Hemograma completo
Full details

Investigations to consider

  • exame confirmatório para o HIV
  • reação em cadeia da polimerase do ácido ribonucleico (RNA) do HIV
  • ensaio de hemaglutinação para Treponema pallidum para sífilis
  • reagina plasmática sérica rápida para sífilis
  • testes sorológicos para hepatite C
Full details

Treatment algorithm

ACUTE

≤72 horas desde a agressão: crianças pré-púberes

≤72 horas desde a agressão: adolescente ou adulto

>72 horas desde a agressão: crianças pré-púberes

>72 horas desde a agressão: adolescente ou adulto

Contributors

Authors

Sheela Lahoti, MD

Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

SL declares that she has no competing interests.

Rebecca Girardet, MD

Professor

Pediatrics Child Abuse Services

Department of Pediatrics

University of New Mexico

Albuquerque

NM

Disclosures

RG will likely provide expert testimony for a private firm in Albuquerque, NM, on a child sexual abuse civil case in 2025. RG is a member of the American Academy of Pediatrics Executive Committee on Child Abuse and Neglect. RG is the principal investigator for service grants from the New Mexico Crime Victims Reparation Commission that supports child sexual abuse programs at the University of New Mexico.

Simi Abraham, MD

Assistant Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

SA gives expert testimony in cases on this subject.

Michelle Ruda, MD

Associate Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

MR declares that she has no competing interests.

Margaret McNeese, MD

Professor

Division of Community and General Medicine

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

MM declares that she has no competing interests.

Ashley Gibson, MD

Assistant Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

UT Health Houston

Houston

TX

Divulgaciones

AG declares that she has no competing interests.

Arezo Nasrazadani, MD

Assistant Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

UT Health Houston

Houston

TX

Divulgaciones

AN declares that she has no competing interests.

Agradecimientos

Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Michelle Ruda, Dr Simi Abraham, Dr Margaret McNeese, Dr Ashley Gibson, and Dr Arezo Nasrazadani would like to gratefully acknowledge Dr Zoe O'Connor for her contribution to this topic, and Dr Christopher Greeley, Dr Shaina Goldsmith, and Dr Jan Welch, previous contributors to this topic.

Divulgaciones

CG, SG, and JW declare that they have no competing interests.

Revisores por pares

Cindy W. Christian, MD

Professor of Pediatrics

University of Pennsylvania

Perelman School of Medicine

Philadelphia

PA

Divulgaciones

CWC provides medical legal expertise in child abuse cases.

Christopher C. Stewart, MD

Professor of Pediatrics

University of California

San Francisco

CA

Divulgaciones

CCS declares that he has no competing interests.

Ruth Gilbert, MD, MSc, MB ChB

Professor of Clinical Epidemiology

UCL-Institute of Child Health

London

UK

Divulgaciones

RG declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Workowski KA, Bachmann LH, Chan PA, et al; Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Texto completo  Resumen

British Association of Sexual Health and HIV. BASHH national guideline on the management of sexually transmitted infections and related conditions in children and young people. 2021 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Abuso e agressão sexual images
  • Diferenciales

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    • Prolapso uretral
    • Nevo
    Más Diferenciales
  • Guidelines

    • Recommendations for the collection of forensic specimens from complainants and suspects
    • FFLM quality standards for clinicians undertaking paediatric sexual offence medicine
    Más Guidelines
  • Patient information

    Clamídia

    Verrugas genitais

    More Patient information
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