Sexual abuse in children and adolescents

From 10-15% of children presenting at a pediatric gynecologist are referred for the determination of possible sexual abuse. In such cases,the careful examination and documentation of all suspicious findings is of extreme importance. Obvious evidence of sexual abuse, such as anogenital injuries without other explanations, the presence of semen or seminal plasma or a pregnancy, is rarely found. The gynecological examination needs to be performed without retraumatizing the potential victim. The physician should be trained to differentiate between normal physiological, non-specific/specific findings and evidence of sexual abuse. An interdisciplinary assessment of the case should be performed. The most important preventive measures are the strengthening of the child's autonomy, the careful identification of family related risk and the systematic cooperation with schools and social organizations.