Child sexual abuse is the deliberate exposure of minor children to sexual activity. This means a child is forced or talked into sex or sexual activities by another person. Such abuse includes touching (fondling), sexual intercourse, oral sex, pornography, and other sexual activity.

With the exception of sexual abuse among family members (incestuous relationships), child sexual abuse was not clearly described until the late 1970s. The problem is far more common than had been thought. Indeed, the medical literature up through the mid-1970s contained articles about children and sexually transmitted diseases, such as gonorrhea. However, there was no discussion of how the children caught such disease. There was great reluctance in society to deal with this issue, but after 30 years of examination worldwide, child sexual abuse is now considered a serious issue.

It is difficult to determine how common child sexual abuse is. It is often more secret than physical abuse. Children are often scared to tell someone about the event. According to the American Academy of Child and Adolescent Psychiatry, it is reported up to 80,000 times a year, but the actual number of unreported events is probably much higher.

Abusers are usually men. They usually know the person they are abusing. This is the case in 80 to 90% of cases. Because the abuser violates the trust of the younger person, it makes the sexual abuse even more psychologically devastating.

Child sexual abuse occurs in all social and economic classes of people, but it has the same type of risk factors as physical child abuse, including poverty, disordered families, and abuse of alcohol and street drugs. Abusers often have a history of physical or sexual abuse themselves.

A small group of repeated abusers suffer from the psychiatric disorder pedophilia, in which the preferred sexual contact is with children.

Symptoms of child abuse are similar to those seen in depression or severe anxiety and nervousness. They can include:

• Repeated headaches
• Stomach aches (vague complaints)
• Bowel disorders, such as soiling oneself (encopresis)
• Eating disorders, such as anorexia nervosa
• Sleep problems
• Genital or rectal symptoms, such as pain during a bowel movement or urination, or vaginal itch or discharge

Children may withdrawal from normal activities, have excessive fears, do poorly in school, and display disruptive behaviors such as using alcohol and street drugs or engaging in high-risk sexual behaviors.

If you suspect a child has been sexually abused, the child should be examined as soon as possible by a trained healthcare professional.

A doctor's exam should not be delayed for any reason. Many signs of injury related to sexual abuse are temporary. Ideally, the exam should occur within 72 hours of the event or discovery. A complete physical exam must always be performed, so that the examiner can look for any signs of physical and sexual abuse. The two forms of abuse may co-exist.

Affected areas may include the mouth, throat, penis, anus, and vagina, including the hymen. The hymen is a thin piece of tissue covering the opening of the vagina. There are some normal variations to this structure, but it can be affected by abuse.

Your doctor may also order blood tests to check for sexually transmitted diseases, such as syphilis and HIV, and pregnancy in females. These tests can help determine treatment.

Photographs of injuries may help establish what happened.

Most pediatricians, many family medicine doctors, and most emergency room (ER) doctors have training in examining cases involving sexual abuse. It is extremely important to write down physical findings related to any form of child abuse. A second exam with an expert abuse examiner should be scheduled after the first exam. A doctor or nurse specialist can be found through child protective services program anywhere in the United States.

An exam will automatically be scheduled when suspected child sexual abuse is reported to police or child protection agencies.

Treatment for any physical signs of sexual abuse is the same as for any form of cuts, bruises, or scrapes. The patient may need medicines to prevent or treat sexually transmitted diseases. Older females may receive medicines to prevent pregnancy.

All children who have been sexually abused or traumatized in any way should receive mental health counseling.

Suspicion of child sexual abuse must be reported to child protective services and the police. Medical professionals, teachers, and child care professionals are required by law to make a report.

Once a case is reported, child protection agencies and the police must investigate. If the allegation is considered true, the child must be protected from further abuse. Placement with a non-abusing parent, another relative, or a foster home may result.

In physical abuse cases, the goal of child protection agencies is to educate an abusing caretaker and attempt to re-join the family together, if safe. .

Support groups for abused children, their parents, and caretakers are available and strongly recommended. The following organizations may provide more information:

Child Help USA - http://www.childhelpusa.org/

Prevent Child Abuse America - http://www.childabuse.org/

Mental health is the major issue. Outcome depends on psychotherapy, family and social support, the nature and length of time the child was abused, and the individual characteristics of the child.

• Post-traumatic stress disorder (PTSD)
• Depression
• Eating disorders
• Sleep disorders
• Anxiety disorders
• Participation in unsafe sexual activities. Those who have been abused as children have an increased risk of becoming abusers themselves when they reach adulthood.

If you suspect child abuse in any form, immediately call your health care provider, child protective services, or police.

Prevention involves teaching children never to keep secrets and the difference between "good" and "bad" touches. Parents need to begin this work at home. Most schools now have programs to teach young school-aged children about sexual abuse and its prevention.

Teenagers also need education about how to avoid rape and date rape.

Constant supervision and vigilance by adults is essential to preventing all forms of child abuse.