Evaluation of clinical findings in cases of child sexual abuse

Child sexual abuse (CSA) is a severe problem with physical, emotional, social, moral, cultural, and legal dimensions, which is estimated to be quite common worldwide.

In this retrospective study including 262 CSA cases admitted to our outpatient clinic between 2013 and 2022, we examine the characteristics of the victim and the abuse and examination findings in cases of CSA.

In our study, most of the victims were females over the age of 12, and most of the suspects were known to the child. Approximately half of the incidents (50.1%) occurred in a home. These data are essential in determining the risk factors of CSA cases and in terms of early detection and timely prevention. Vaginal penetration (40.8%) and anal penetration (32.4%) are frequently present in the history of CSA victims. A history of vaginal penetration was associated with acute and healed laceration findings in the hymen (p<0.05). Similarly, a history of anal penetration was associated with decreased sphincter tone, ecchymosis and abrasion in the anal mucosa, reflex anal dilatation, and acute anal fissure findings (p<0.05). As the time between the abuse and the examination increased, examination findings decreased in the anogenital region, which can heal quite quickly and without leaving a trace.

Preventing CSA is possible by analyzing risk factors well and reaching at-risk cases as early as possible. Acute and non-acute hymeneal lacerations that may be associated with vaginal penetration, anal fissure and other traumatic findings that may be associated with anal penetration should be carefully reviewed. However, it should be kept in mind that anogenital injuries with rapid regeneration ability may heal without leaving any symptoms and abuse may occur without leaving any symptoms.