Sexual abuse occurs when a child engages in sexual activity for which he or she cannot give consent, is unprepared for developmentally, and cannot comprehend. 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 [1-3].
The management and sequelae of childhood sexual abuse will be reviewed here. The epidemiology, evaluation, and differential diagnosis of childhood sexual abuse are discussed separately. (See "Evaluation of sexual abuse in children and adolescents".)
The management of sexual abuse involves prevention of sexually transmitted infections (STI) and pregnancy. Psychosocial support and anticipatory guidance should be offered to the victims and their non-offending caregivers.
STI prophylaxis — The need for STI prophylaxis depends upon whether the patient is pre- or postpubertal:
- Prepubertal – STI prophylaxis is not routinely recommended for prepubertal victims because the incidence of infections is low after sexual assault in this patient population, prepubertal girls have a lower risk of ascending infections, and follow-up is typically assured . Excessive concern by the caregiver or child concerning STI may make prophylactic treatment appropriate. However, cultures must be obtained prior to treatment whenever prophylaxis is prescribed. (See "Evaluation of sexual abuse in children and adolescents", section on 'STI testing'.)
- Postpubertal – For adolescents, STI prophylaxis is recommended for those who present within 72 hours of the event (because of the high prevalence of preexisting asymptomatic infection, the risk of pelvic inflammatory disease, and the possibility of loss to follow-up) . For pubertal females who present after 72 hours, STI prophylaxis should be prescribed if the assailant is known to be infected, the victim has signs or symptoms of infection, or at the victim's request [6,7]. Testing for STI prior to prophylaxis for adolescents is controversial, since identification of a STI is unlikely to provide useful evidence and prophylactic treatment is typically prescribed regardless of culture results [5,7]. (See "Evaluation of sexual abuse in children and adolescents", section on 'STI testing' and "Evaluation and management of adult sexual assault victims", section on 'Laboratory testing'.)