Sexual Abuse

Child sexual abuse often covers a wide spectrum of abusive activities. It rarely involves just a single incident and usually occurs over a number of years. Child sexual abuse most commonly happens within the family.

Cases of sexual abuse principally come to light through:

• disclosure by the child or his or her siblings/friends;
• the suspicions of an adult;
• physical symptoms.

Colburn Faller (1989) provides a description of the wide spectrum of activities by adults which can constitute child sexual abuse. These include:

Non-contact sexual abuse

• ‘Offensive sexual remarks’, including statements the offender makes to the child regarding the child’s sexual attributes, what he or she would like to do to the child and other sexual comments.
• Obscene phone calls.
• Independent ‘exposure’ involving the offender showing the victim his/her private parts and/or masturbating in front of the victim.
• ‘Voyeurism’ involving instances when the offender observes the victim in a state of undress or in activities that provide the offender with sexual gratification. These may include activities that others do not regard as even remotely sexually stimulating.

Sexual contact

• Involving any touching of the intimate body parts. The offender may fondle or masturbate the victim, and/or get the victim to fondle and/or masturbate them. Fondling can be either outside or inside clothes. Also includes ‘frottage’, i.e. where offender gains sexual gratification from rubbing his/her genitals against the victim’s body or clothing.

Oral-genital sexual abuse

• Involving the offender licking, kissing, sucking or biting the child’s genitals or inducing the child to do the same to them.

Interfemoral sexual abuse

• Sometimes referred to as ‘dry sex’ or ‘vulvar intercourse’, involving the offender placing his penis between the child’s thighs.

Penetrative sexual abuse, of which there are four types:

• ‘Digital penetration’, involving putting fingers in the vagina or anus, or both. Usually the victim is penetrated by the offender, but sometimes the offender gets the child to penetrate them.
• ‘Penetration with objects’, involving penetration of the vagina, anus or occasionally mouth with an object.
• ‘Genital penetration’, involving the penis entering the vagina, sometimes partially.
• ‘Anal penetration’ involving the penis penetrating the anus.

Sexual exploitation

• Involves situations of sexual victimisation where the person who is responsible for the exploitation may not have direct sexual contact with the child. Two types of this abuse are child pornography and child prostitution.
• ‘Child pornography’ includes still photography, videos and movies, and, more recently, computer-generated pornography.
• ‘Child prostitution’ for the most part involves children of latency age or in adolescence. However, children as young as 4 and 5 are known to be abused in this way.

The sexual abuses described above may be found in combination with other abuses, such as physical abuse and urination and defecation on the victim. In some cases, physical abuse is an integral part of the sexual abuse; in others, drugs and alcohol may be given to the victim.

It is important to note that physical signs may not be evident in cases of sexual abuse due to the nature of the abuse and/or the fact that the disclosure was made some time after the abuse took place.

Carers and professionals should be alert to the following physical and behavioural signs:

• bleeding from the vagina/anus;
• difficulty/pain in passing urine/faeces;
• an infection may occur secondary to sexual abuse, which may or may not be a definitive sexually transmitted disease. Professionals should be informed if a child has a persistent vaginal discharge or has warts/rash in genital area;
• noticeable and uncharacteristic change of behaviour;
• hints about sexual activity;
• age-inappropriate understanding of sexual behaviour;
• inappropriate seductive behaviour;
• sexually aggressive behaviour with others;
• uncharacteristic sexual play with peers/toys;
• unusual reluctance to join in normal activities that involve undressing, e.g. games/swimming.

Particular behavioural signs and emotional problems suggestive of child abuse in young children (aged 0-10 years) include:

• mood change where the child becomes withdrawn, fearful, acting out;
• lack of concentration, especially in an educational setting;
• bed wetting, soiling;
• pains, tummy aches, headaches with no evident physical cause;
• skin disorders;
• reluctance to go to bed, nightmares, changes in sleep patterns;
• school refusal;
• separation anxiety;
• loss of appetite, overeating, hiding food.

Particular behavioural signs and emotional problems suggestive of child abuse in older children (aged 10+ years) include:

• depression, isolation, anger;
• running away;
• drug, alcohol, solvent abuse;
• self-harm;
• suicide attempts;
• missing school or early school leaving;
• eating disorders.

All signs/indicators need careful assessment relative to the child’s circumstances.