Child sex abuse has existed in society for long period in various forms. People neglected it for generations, as not all types of child abuses are related to molestations. Some are well accepted in form of child marriage. This fact can not be ignored that child marriages are still prevalent in some part of the world. In the name of internal matters and culture, the world abstain from pointing it out. However, the point is that a child remains vulnerable and injured in both cases whether society accepts it or not. There are consequences of child sex (abuse). They go through immense amount of physical pain, psychological trauma, and health issues.
WHO Guidelines on Child Sex Abuse
Child sexual abuse includes any act or practice which exploits or sexualizes a child without their knowledge or consent, including physical contact such as genital examinations or penetration, and non-contact abuse such as exhibitionism, pandering and the distribution of sexually explicit materials.
Every time a child is suspected of abuse, a medical exam should be scheduled to provide medicolegal evidence and provide peace of mind to both child and caregiver.
How to Provide Trauma-Informed Care to Survivors
Many adult victims of child sexual abuse report being further traumatised by how adults responded to their disclosures of abuse; often with disbelief, rigorous questioning, blaming the victim for not speaking up sooner and invalidating their experience. Such responses caused doubt about what the child was reporting re-experiencing trauma resulting in less willingness to disclose further as well as delays in accessing support and care services.
Many victims of sexual assault may be reluctant to seek psychological or medical assistance, believing their symptoms are part of growing up and that problems will resolve themselves naturally. Others fear stigmatisation if they seek mental health help, while perpetrators can block access to healthcare for their victim as a form of control over accessing care they require.
Healthcare workers and police officers should be mindful of the risk that victims could be re-traumatised through interactions with professionals, including interactions such as forensic interviewing which has been shown to cause flashbacks and other symptoms in some victims. Therefore, training in trauma-informed care should be offered to all healthcare workers who might come into contact with victims of child sexual abuse and exploitation.
Myths and stereotypes surrounding sexual assault and exploitation of children and young people must be dispelled. Prosecutors and police officers must recognize that boys and men can both be victims of child sexual abuse (CSA), without presumptions that victims are lying. It's also essential they recognise victims don't always fit a specific profile such as ethnic background or vulnerability status - it is imperative they avoid presuming any boy or man reporting abuse comes from an ethnic minority community.
Offenders often move children and youth around from place to place to exploit them more efficiently, making it hard for police to identify a pattern of abuse or identify its perpetrator.
Prosecutors and police officers must understand the role that grooming plays in child sexual abuse, and be aware that young children are more likely to be sexually abused by someone they know rather than by strangers. Furthermore, children may delay reporting abuse for various reasons including fear of isolation or being disbelieved by authorities.
Victims may commit "survival crime" as a means of protecting themselves and their loved ones from abuse by perpetrators, such as damaging property belonging to both themselves and those associated with their abuser. Such action may involve breaking or damaging personal belongings of the offender and their associates or by breaking laws against abuse.
WHO Clinical Guidelines for Responding to Children and Adolescents Who Have Been Sexually Abused
Health workers need to respond with empathy, respect, and compassion when children disclose sexual abuse. Listening and accepting that what the child says has happened should always be respected; no matter if or whether health workers believe the allegation. Reassuring children they are safe should always be emphasized - informing of sexual abuse shows courage as it shows they want answers about what has occurred - feeling heard will enable more details to come forward, decreasing any emotional problems later.
Health workers can still help children who do not wish to discuss abuse by remaining available and providing care in other ways, such as offering reassurance and comfort, playing games or listening to music - non-traumatizing activities which help children keep busy without thinking too much about what has occurred.
An extensive psychosocial and mental health evaluation must be conducted on any child who has been subjected to abuse in order to assess its severity and to decide upon clinical interventions, such as counseling. Such an evaluation should gather information regarding family and school circumstances, developmental level and functionality, emotional/behavioural concerns as well as any details surrounding abuse.
Understanding the different methods and processes employed by perpetrators in Child Sexual Abuse cases (CSA), including lure, seduction and manipulation (manufactured consent) as well as coercion and aggression is of vital importance in order to assess whether penetrative or nonpenetrative injury has occurred, which will have an impact on medical evaluation and treatment plans of victims.
Health workers must also be mindful of the long-term psychological and health repercussions of CSA. These may include lifetime diagnosis of posttraumatic stress disorder, anxiety and depression, eating disorders, relationship difficulties and self harm thoughts or behaviors. Furthermore, they can lead to physical issues including increased pregnancy risks, noncyclical pelvic pain or menstrual irregularities and sexually transmitted infections which require medical intervention and sexually transmitted infections treatment for treatment.
Preventive healthcare for adolescents who are victims of sexual violence is especially crucial. Female rape victims should receive emergency contraception immediately to reduce the risk of conception; additionally, health workers should conduct baseline urine or serum pregnancy tests on girls who have been raped as this will help identify any existing pregnancies - this is especially crucial as teenage female victims of rape are at a greater risk than their male counterparts of becoming pregnant due to sexual violence.
What Health Workers Need to Know About Child Sexual Abuse
Adults often focus on adult rape and sexual assault, yet children are also victims. Indeed, many adult survivors who were victimized as children (Centers for Disease Control and Prevention 2006) report abuse as children themselves (Child Sexual Abuse Surveillance Center of Virginia 2006). Unfortunately, child sexual abuse prevalence remains underappreciated largely because many victims do not report the crime when it happens; when they do report it may offer inconsistent accounts or struggle to cooperate with investigations.
Abuse occurs in many settings and by various people - family members, friends, acquaintances or strangers alike. Institutions such as schools or childcare facilities also play a part in this problem as teachers and carers often act in positions of trust like them. Unfortunately in some instances gangs perpetrate the abuse while online exploitation often is also involved.
Abusers of children often groom them gradually and introduce sexual activity gradually, by showering them with gifts and attention and slowly introducing sexual activities such as dating sites or watching pornographic material together before starting abuse. Grooming may also include nonsexual activities like watching pornography with them or having them take explicit photographs and videos of themselves.
Health workers must recognize the wide-ranging physical and psychological consequences associated with child sexual abuse. Any health worker suspecting child sexual abuse should conduct a complete assessment of the situation - gathering details about family life and social surroundings as well as developmental level/function and any mental health concerns the child might have.
Reassure the child that their actions do not warrant sexual abuse, and you believe them. Furthermore, explain that sexual abuse is never their fault; some children may have been led to believe otherwise through manipulation; in such instances it's essential that you point out how their behaviors were not responsible.
Health workers should treat a disclosure by a pre-pubertal child of recent sexual assault or other abuse as more urgent than one made earlier, although even in non-urgent situations health workers must follow up and refer any concerns to a specialist for further assessment.
Sexually abused children often present symptoms of sexually transmitted infections (STIs), including vaginal discharge, pain or itching, genital lesions/odor/odor and urinary symptoms. All such issues should be thoroughly researched and treated accordingly, but health workers must wait for specimens for testing before acting presumptively on them. It is particularly crucial that tests with high specificity be administered by health providers with experience in assessing children for sexual abuse, in order to reduce false positive results and their negative impact on child's health.
