Management of childhood sexual abuse

Childhood sexual abuse is increasingly recognized as a major problem in the United States. These children are frequently seen by the primary care provider, and physicians must be able to evaluate them. Common presentations for sexually abused children include direct allegations, suspicions by the caretaker, unexplained vaginal trauma or bleeding, sexually transmitted disease, and a wide spectrum of behavioral problems including sexual promiscuity and runaway behavior. The interview and physical examination must be performed in a quiet, private area and sufficient time allocated to allow a thorough evaluation. All sexual abuse must be reported to the local child abuse authorities. Any abnormalities must be carefully described and treated. Evidence collected should be handled according to a protocol and given to authorities. Postexamination counseling should include explanation of findings, legal implications of sexual abuse, and anticipatory guidance about common psychological sequelae of abuse.