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Child Maltreatment - Sexual Abuse

What is sexual abuse?

Sexual abuse of a child occurs when someone has sexual contact with anyone younger than 18 years old. It includes kissing that is not appropriate, showing genitals to the child, fondling the child's genitals, showing sexual materials, or using force to have sex. Sexual exploitation, which includes child prostitution and pornography, is also sexual abuse. Parents, guardians, foster parents, relatives, or someone who cares for the child may be responsible for sexual abuse.

What increases the risk for sexual abuse?

Poor, violent, or crowded living conditions may be one of the reasons why sexual abuse occurs. The following are other possible causes and conditions that may increase the child's risk of sexual abuse:

  • Risks related to the child:

    • The child is 6 years old or younger.

    • The child has learning or memory problems.

    • The child has long-term conditions or special needs.

    • The child has no relatives or friends who can take care of him or her.

  • Risks related to the people the child is around:

    • The child has a single or a teenaged parent.

    • The child is around someone who drinks alcohol or uses drugs.

    • The child is around someone who has a history of family violence, such as physical, sexual, or other abuse.

    • The child is around someone who has a personality disorder, depression, or another mental illness.

    • The child is around someone who has stress due to work or financial problems.

    • The child is around someone who lacks knowledge about the normal development of a child.

What are the signs and symptoms of sexual abuse?

The child may act strangely or differently, have changes in behavior or moods, or trouble sleeping. He or she may be depressed, fearful, or have sexual behaviors that are not right for his or her age. A sexually abused child may also be physically abused. The child may also have any of the following:

  • Scratches, bruises, or bite marks

  • Marks from objects used as restraints, such as belts, ropes, or electrical cords

  • Cuts or scars in the genital area

  • Pain or difficulty urinating or having a bowel movement

  • Pain or itchiness in the genital area

  • Sores, growths, or small blisters in the genital area

  • Blood or discharge from the genital area

  • Stains in his clothing

  • Pregnancy

How is sexual abuse diagnosed?

The child's healthcare provider will examine the child's body closely to look for injuries caused by the abuse. The child may be asked if he or she has been touched, kissed, forced to have sex, or photographed naked. Healthcare providers may also want to know who the abuser is, and how long the abuse has been happening. The child may also need any of the following tests:

  • Blood and urine tests may show if the child has a sexually transmitted infection (STI), other infections, physical injury to an organ, or pregnancy.

  • A culture and smear exam is a sample of vaginal discharge that is tested for STIs.

  • Forensic tests may be done to check hair strands and samples of stains or discharge from the skin, clothing, a blanket, or the scene of the abuse.

  • A pelvic or rectal exam may show any injuries that may have resulted from the abuse.

  • A colposcopy is a procedure using a small scope and light to see the inside of the child's vagina and cervix to check for injuries.

How is sexual abuse treated?

  • Counseling may help the child to feel less scared, depressed, or anxious. The child's healthcare provider may suggest that the child see a counselor to help with how he or she feels.

  • Medicines may be given to decrease the child's pain or prevent an infection. Medicines may also be given if the child has other medical conditions.

  • Surgery may be needed to treat injuries, such as a wound in the genital area.

What are the risks of sexual abuse?

If sexual abuse is not treated, the child may develop serious health and mental problems. Sexual abuse may lead to injuries, unwanted pregnancies, and can be life-threatening. The child's behavior may change, and he or she may develop other serious problems. These include alcohol or drug use, depression, and problems with self-esteem, mood, friendships, and relationships. The child may even have thoughts of harming himself or herself, or others.

How can I care for a child victim of sexual abuse?

  • Let the child rest if he or she needs to. Tell the child's healthcare provider if the child has trouble sleeping.

  • Report sexual abuse. Healthcare providers can help the child if he or she is a victim of sexual abuse. Healthcare providers are required by law to report sexual abuse. A state or county investigator may need to be involved to assess child safety. The child may need to leave a current living situation to protect him or her from the abuse.

Call 911 for any the following:

  • The child has trouble breathing, chest pain, or a fast heartbeat.

  • The child feels like hurting himself or herself, or someone else.

When should I seek immediate care?

  • The child feels that he or she cannot cope with the abuse, or recovery from it.

  • The child has blood or foul-smelling discharge coming from his or her genital area.

  • The child has problems sleeping, urinating, or having bowel movements.

When should I contact the child's healthcare provider?

  • The child is sad or depressed most of the time, or frightened of other people.

  • The child has new signs and symptoms since his last visit.

  • You have questions or concerns about the child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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