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Jun 16

Be Human Stop Child Abuse : Vol 19, 12th June, 2013

  Editorial

Socio-demographic characteristics of sexually abused children

Of the victims, 56.4% (n = 57) were female and 43.6% (n = 44) were male. The mean age was 9.57 +/- 3.5, with a range of 4-17 years. Ninety-three (92.1%) of the victims had been admitted as part of the legal process. The majority (66.3%) of the victims had been abused by an acquaintance, while 33.7% had been abused by a stranger.

Anal or vaginal penetration was reported in 48.5% of the cases. Post-traumatic stress disorder was the most common (54.5%) psychiatric diagnosis established after sexual abuse. (J Forensic Sci. 2010 May;55(3):633-6.)

Little is known about risk/protective factors for sexually coercive behavior in general population youth. Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn.

Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. (Arch Sex Behav. 2010 Oct;39(5):1161-9)

cammo

CMAAO

IMA

IMA

eMedinewS

Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

Dr Good Dr Bad

Situation: A child suspected to be sexually abused was brought to the doctor at 70 hours of the incident.

Dr. Bad: There is no use of any examination now.

Dr. Good: I will examine as per the protocol.

Lesson: Victims who present within 72 hours of the incident have obvious forensic evidence on their clothes and bodies, have continued risk of harm from the perpetrator, have genital or anal injuries, may have suicidal ideations and should receive an urgent evaluation. For prepubertal children who are evaluated more than 24 hours after the incident, the standard protocol should be followed recognizing that yield in evidence collection often decreases after 24 hours.

Situation: A prepubertal girl, who was sexually abused, was brought for examination.

Dr. Bad: I will follow standard examination.

Dr. Good: I will also test for sexually transmitted infections.

Lesson: Prepubertal girls who are likely to have been sexually abused based on history of physical examination should be tested for sexually transmitted infections. These patients should also receive antibiotic prophylaxis regardless of whether test is completed.

Situation: A sexually assaulted adolescent girl was brought for prevention of pregnancy.

Dr. Bad: It is not needed.

Dr. Good:It is needed.

Lesson:The overall risk of pregnancy resulting from sexual assault is 5%. The highest risk occurs during the three days preceding and including ovulation. Emergency contraception should be offered to all prepubertal female patients and should be strongly advised to females at highest risk of pregnancy.

Situation: An adult rape victim came for HIV prophylaxis.

Dr. Bad: It is not needed.

Dr. Good: It is needed.

Lesson: Antiretroviral prophylaxis is generally recommended for any adult rape victim, if it can be initiated within 72 hours of exposure and ideally within 4 hours. For children and adolescents, the decision is made on case to case basis depending on the likelihood of the assailant being HIV-positive, nature of sexual contact, time elapsed since the event and presence or absence of risk factor of HIV infection.

Situation: A sexual abused post pubertal child was brought for STI prophylaxis.

Dr. Bad: It is not needed.

Dr. Good: It is needed.

Lesson: For adolescents, sexually transmitted infections (STI) prophylaxis is recommended for those who present within 72 hours of the incident. STI prophylaxis is not routinely recommended for prepubertal victims because the incidence of infection is low and prepubertal girls have a lower risk of ascending infections and follow up is typically assured.

Readers Response
  1. Dear Sir, Nice updates. Regards:Dr Shantanu

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