From the Guidelines
Common symptoms of sexual abuse in a pediatric patient include physical signs such as unexplained injuries to the genital area, pain or itching in the genital region, and behavioral indicators like age-inappropriate sexual knowledge or behavior, regression to earlier developmental stages, and emotional indicators including depression, anxiety, and low self-esteem. These symptoms may appear individually or in clusters, and no single sign definitively proves abuse has occurred 1. According to the American Academy of Pediatrics, pediatricians should be aware of the physical and behavioral indicators of sexual abuse and be prepared to provide a nonjudgmental supportive environment for adolescents who disclose sexual assault 1.
Physical Indicators
Some physical signs of sexual abuse may include:
- Unexplained injuries to the genital area
- Pain or itching in the genital region
- Difficulty walking or sitting
- Torn or bloody underclothing
- Sexually transmitted infections
Behavioral Indicators
Behavioral symptoms often include:
- Age-inappropriate sexual knowledge or behavior
- Regression to earlier developmental stages
- Sleep disturbances or nightmares
- Fear of certain people or places
- Withdrawal from friends or usual activities
- Changes in eating habits
- Declining school performance
Emotional Indicators
Emotional indicators can include:
- Depression
- Anxiety
- Low self-esteem
- Self-harm behaviors
- Suicidal thoughts
It is essential to understand that these symptoms may appear individually or in clusters, and no single sign definitively proves abuse has occurred 1. Children process trauma differently based on their age, personality, and support systems. If you suspect a child is being sexually abused, it's crucial to report your concerns to child protective services or law enforcement immediately, as early intervention is essential for the child's safety and healing process.
From the Research
Common Symptoms of Sexual Abuse in Pediatric Patients
- Physical complaints, such as gastrointestinal and anogenital complaints, are common in pediatric patients who have been sexually abused 2
- Deviant behavioral responses, including anxiety, withdrawal, and being too outgoing, are also prominent findings in these patients 2
- Fear, anxiety, post-traumatic stress disorder, and behavior problems, such as externalizing or internalizing, or inappropriate sexual behaviors, are common psychological symptoms of sexual abuse in children 3, 4, 5
- Physical signs of abuse may not always be visible, and a detailed medical history from the child and their parents or caregivers is essential in the medical examination of suspected sexual abuse 6
Behavioral and Psychological Symptoms
- Cognitive-behavioral therapy (CBT) has been shown to be effective in addressing the psychological symptoms of sexual abuse in children, particularly in reducing post-traumatic stress disorder (PTSD) and anxiety symptoms 3, 4, 5
- CBT may also have a positive impact on depression and child behavior problems, although the evidence is not as strong 3, 5
- The most prominent finding in pediatric patients who have been sexually abused is a deviant behavioral response, especially in children who have experienced anal/vaginal penetration 2
Medical Examination and Diagnosis
- Physical complaints and physical signs at examinations are often non-specific for sexual abuse, making diagnosis challenging 2
- An experienced examiner should ideally perform the medical examination, and knowledge of current literature is essential in interpreting findings 6
- A detailed medical history and precise observation of the child's behavior during the physical examination are crucial in evaluating suspected sexual abuse 2, 6