Sexual abuse: how to recognize symptoms and signs in a child and in an adolescent

Sexual abuse toward children and adolescents, i.e. the involvement of a child in sexual acts that she or he does not comprehend and cannot give consent to, is a common occurrence. The intervention in suspected sexual abuse is complex and requires an expert multidisciplinary team. A medical exami- nation is also mandatory, ideally by a professional who specialized in child sexual abuse evaluation, even if in chronic abuse clinical evidence is scanty. Sometimes a gynaecologist must suddenly face a disclosure of abuse or a suspect arising by a genital examination or by the unexpected finding of a sexually transmitted infection in a child. So it is important to know what to do and what to avoid.
The article is a systematic description of the procedures validated by the in- ternational guidelines for performing a clinical examination in a child or in an adolescent when sexual abuse is suspected. We start with the documenta- tion of parents’ information and the registration of eventual child’s disclosu- re, with complete medical history and a thorough physical examination. The anogenital region examination is necessary to rule out injuries in cases of re- cent abuse and should be completed with tests for sexually transmitted infec- tions and the collection of forensic evidences. An adequate documentation of the findings, filling in a specific medical record and using photographs, is of paramount importance.

Keywords: sexual abuse; methodology of consultation for abuse; sexually transmitted infections in children.