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Evaluation of sexual abuse in children and adolescents

Kirsten Bechtel, MD
Berkeley L Bennett, MD, MS
Section Editors
Daniel M Lindberg, MD
Amy B Middleman, MD, MPH, MS Ed
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH


Health professionals who care for children in a variety of settings, from clinics and office practices to emergency departments, encounter those who may have been sexually abused. As an example, a clinician may become concerned that a child has been sexually abused because of an unusual injury pattern or behavior identified at the time of a scheduled visit. Alternatively, an evaluation in the emergency department may be initiated when a child is injured or discloses an incident to a caregiver. Specific interviewing skills, evidence-collection procedures, and/or specialized examination techniques may be required to perform a thorough evaluation.

The epidemiology, evaluation, and differential diagnosis of sexual abuse in children and adolescents will be reviewed here. The management and sequelae of childhood sexual abuse and human trafficking, including sex trafficking, are discussed separately. (See "Management and sequelae of sexual abuse in children and adolescents" and "Human trafficking: Identification, evaluation, and management in the health care setting".)


Sexual assault is defined as attempted sexual touching of another person without their consent and includes sexual intercourse (rape), sodomy (oral-genital or anal-genital contact), and fondling [1].

A generally accepted definition of sexual abuse is when a child engages in sexual activity for which he/she cannot give consent, is unprepared for developmentally, cannot comprehend, and/or an activity that violates the law or social taboos of society [2]. This includes fondling and all forms of oral-genital, genital, or anal contact with the child (whether the victim is clothed or unclothed), as well as non-touching abuses such as exhibitionism, voyeurism, or involving the child in pornography [2-4]. Thus, child sexual abuse can include acts that would be considered sexual assault. For purposes of this chapter the term sexual abuse will be used, indicating that the perpetrator is a person of such acts is also responsible for the child's health and welfare.

It is important to distinguish between sexual abuse and "sexual play" [4]. Sexual abuse occurs when there is asymmetry in age or development among the participants, with a coercive quality to the event.

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Literature review current through: Nov 2017. | This topic last updated: Oct 08, 2017.
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