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性虐待和性侵犯

最后审阅: 10 Nov 2024
最后更新: 17 Oct 2023

小结

定义

病史和体格检查

关键诊断因素

  • 披露不适当的接触
  • 急性生殖器创伤(变化);处女膜横断或缺失(儿童)
  • 性传播感染
完整详情

其他诊断因素

  • 生殖器检查的结果一般是正常的
  • 情绪和心理障碍
  • 肛门及生殖器病变
  • 阴唇与会阴损伤
  • 非生殖器损伤
  • 阴道或阴茎溢液
  • 伤害行为
  • 儿童性行为问题
  • 儿童慢性医学疾病
  • 频繁发生或顽固性泌尿生殖系统疾病
  • 处女膜凹痕
完整详情

危险因素

  • 家里的其他孩子被性虐待
  • 儿童期遭受亲密伴侣暴力
  • 青少年和年轻女性
  • 残疾
  • 贫困和无家可归人群
  • 性工作者
  • 居住于社会收容机构或者冲突地区的人群
  • 服用酒精或者其它药物的人群
完整详情

诊断性检查

首要检查

  • 法医学标本
  • 淋病奈瑟菌检测
  • 沙眼衣原体检测
  • 梅毒血清检测
  • 乙型肝炎血清学检测
  • HIV 血清学
  • 尿 β-人绒毛膜促性腺激素
  • 阴道滴虫检测
  • 肛门生殖器样本培养:单纯疱疹病毒聚合酶链反应(Polymerase chain reaction, PCR)
  • 肝功能检测 (LFT)
  • 肌酐
  • 尿素
  • 全血细胞计数(FBC)
完整详情

需考虑的检查

  • 艾滋病确诊检测
  • 艾滋病病毒核酸扩增检测
  • 梅毒螺旋体血凝集试验用于检验梅毒
  • 血清梅毒快速血浆反应素检测
完整详情

治疗流程

急症处理

受侵犯后72小时内:未进入青春期

受侵犯后72小时内:青少年或成人

受侵犯72小时后:未进入青春期

侵犯发生72小时后:青少年或成人

撰稿人

作者

Sheela Lahoti, MD

Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

利益声明

SL declares that she has no competing interests.

Rebecca Girardet, MD

Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

利益声明

RG is a Paediatric Co-Leader for the STI chapter for the Royal College of Paediatrics and Child Health 'Purple book'. This is an unpaid advisory position.

Simi Abraham, MD

Assistant Professor

Division of Child Protection Pediatrics

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

利益声明

SA gives expert testimony in cases and delivers educational lectures on this subject.

Michelle Ruda, MD

Assistant Professor

Division of Child Safety and Integrated Care

Department of Pediatrics

University of Texas Medical School at Houston

Houston

TX

利益声明

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

利益声明

MM declares that she has no competing interests.

Ashley Gibson, MD

Assistant Professor

Department of Pediatrics

UT Health Houston

Houston

TX

利益声明

AG is employed by the University of Texas Health Science Center at Houston. She has given expert testimony in cases of child abuse and neglect. She has applied for an institutional grant related to screening for social determinants of health.

鸣谢

Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Michelle Ruda, Dr Simi Abraham, Dr Margaret McNeese, and Dr Ashley Gibson 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.

利益声明

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

同行评议者

James Lukefahr, MD

Professor of Pediatrics

Child Abuse Division

Department of Pediatrics

University of Texas Health Science Center

San Antonio

TX

利益声明

JL declares that he has no competing interests.

Suzanne Starling, MD

Medical Director

CHKD-CAP

Professor of Pediatrics

Eastern Virginia Medical School

Norfolk

VA

利益声明

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

利益声明

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

利益声明

RG declares that she has no competing interests.

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