Sexual Abuse in Child
Three type of sexual abuse, molestation, sexual intercourse and rape are commonly seen in childhood. Child molestation includes touching or fondling the genitals of child or asking the child to fondle the adult's genitals. Forced exposure to pornography or sexual act is also included in child molestation.
Sexual intercourse includes vaginal, oral or rectal penetration or attempted penetration. 10% of sexual abuse is assaultive, forced intercourse - Rape.
Incest is the sexual mistreatment of children by family members and this is most common also. Child may also have sexual mistreatments by friends and acquaintances and rarely by strangers. 90% victims of incest are females. In incest 1/3rd of children are less than 6 yr old, one third between 6-12 yr and one third in age group of 12-18 yr. Incidence of incest is five times higher with step father. Most incest involves father and daughter and father is an alcoholic.
Child discloses an incestuous relationship to her mother, girlfriend, friend's mother or a counselor.
Symptoms
Medical conditions with sexual abuse include genital or anal trauma, genital infections, urinary tract infections, bedwetting and inappropriate sexual behaviour child may become pregnant, attempt suicide and can show run away behaviour.
Investigation
Only 50% children have abnormal physical findings as there is long delay before a child seeks help. Gentle interview with child will help. Pictures or dolls are used to clarify the body parts. Child should not be exposed to repeated interviews. Female victims should be preferably examined by a female physician.
Treatment
All sexual abuse are criminal offence. All victims of sexual abuse require psychologic support. Parents may deny the incidence. Victim of single non violent episode of molestation requires only assurance. In case of rape child requires services of psychologist.
The victim of multiple episodes of sexual abuse need long term psychotherapy.
Medications to prevent pregnancy are given to postmenarcheal girls who have experienced vaginal intercourse in last 24 hrs. Medication to be given for sexually trammitted disease if present.
Treatment of incest requires a coordinated multidisciplinary approach. Offending parents require psychologic evaluation.
Sociopaths are untreatable
With intervention most incest victim lead normal adult lives.
Prevention
Best protection for children is alert adult who will not leave them in high risk situation. Children should be encouraged to "say no", "tell some one" and don't keep secrets.
