When evaluating a child for possible sexual abuse, a clinician must always consider testing for the presence of sexually transmitted diseases (STDs). Each situation demands an individualized approach, taking into consideration the circumstances of the assault, the age of the child, the characteristics of the alleged offender, and the prevalence of STDs in the community. Unnecessary physical and psychological trauma to the child must be avoided. If an STD is identified, treatment needs to be initiated.
The evaluation of sexual assault in an adolescent must be a coordinated effort including both medical and psychological services, provided in a safe environment. Medical injuries must be evaluated, documented, and treated. Forensic evidence must be collected, and the possibility of sexually transmitted diseases and pregnancy must be addressed. Emotional support and referral for psychological services or further medical treatment should also be provided.
Pediatric sexual abuse is increasingly recognized as a major social and medical problem, yet the topic has been addressed in only a very limited fashion within most undergraduate medical programs. Many physicians are reluctant to initiate involvement with these cases, perhaps because of their relative lack of experience or because they know legal proceedings may follow.
Commercial sexual exploitation of children is defined by the World Congress against Commercial Exploitation of Children as “a fundamental violation of children’s rights. It comprises sexual abuse by the adult and remuneration in cash or kind to the child or a third person or persons. The child is treated as a sexual object and as a commercial object.
