Sexual Abuse

00:01 I also want to bring your attention to a very sensitive topic, that is the vulvovaginitis in girls can be cause by sexually transmitted diseases.

00:10 However, any sexual activity with a child where consent is not or cannot be given is abuse.

00:17 These includes sexual contact that is accomplished by force or threat of force, regardless of the age of the participants.

00:24 This is also all sexual contact between an adult and a child, regardless whether there is deception of the child or the child understood the sexual nature of the activity.

00:34 It's all abuse.

00:36 Sexual abuse occurs in 1 in 5 girls in the US and sexual abuse has been reported to occur multiple times.

00:47 57% of women and girls who state they'd been abused reported the abuser was a family member and 53% reported that the abuse occurred at home.

00:59 There are some specific findings that we see in the context of sexual abuse.

01:05 The hymen which we reviewed earlier may be disrupted, but it's not always an indication of abuse.

01:11 Young girls may have vaginal discharge or anal itching from sexually transmitted infections.

01:17 Healed genital injuries may be seen with long term abuse such as skin tags or granulation tissue.

01:24 Also, anal dilation may be present.

01:28 In terms of looking for an STI.

01:30 The decision to conduct an STI evaluation must be made on an individual basis.

01:35 Not every child needs an STI evaluation but if you have a high indexes suspicion, one should be performed.

01:42 It is also our duty to find out if there is an STI but then to also report it to the proper authorities.

01:50 Let's now talk about situations that are high risk for finding an STI in a young girl.

01:57 The child has or had symptoms or signs of an STI.

02:01 The suspected perpetrator or abuser is known to have an STI or be at high risk for STIs.

02:09 Siblings, another child, or an adult in the household has an STI or the patient or the parent request testing.

02:17 Lesions that are suspicious for herpes simplex also require testing and evaluation.

02:24 The recommended laboratory tests include gonorrhea from the pharynx, anus and vagina.

02:32 Chlamydia from the anus, and vagina.

02:35 Trichomonas vaginalis and bacterial vaginosis again from the vagina.

02:40 Serology for syphilis, HIV, and hepatitis B.

02:44 Lesions that should be cultured and sent for NAAT with Herpes Simplex virus.

02:51 Remember that 5% of all the girls who have experience sexual abuse will have an STI.

02:57 The American Academy of Pediatrics recommends forensic evidence collection and a completion of rape evidence kit when sexual abuse has occurred.

03:08 This should occur within 72 hours or when there is bleeding or acute injury.

03:13 There are some psychological sequelae of a sexual abuse.

03:18 Some of the outcomes include emotional reactions or symptoms of PTSD and also a distorted self-perception.