Gardnerella vaginalis infection and sexual contact in female children

Gardnerella vaginalis (GV) infection has been reported as being acquired via sexual contact in adults and as an indicator of sexual contact in female children (DeJong, 1985). The purpose of this study was to determine if GV infection was more commonly found in 191 female children who gave a history of sexual contact and/or were infected with Neisseria gonorrhoeae (GC) or Chlamydia trachomatis (CT) (Group 1), compared with 144 female children evaluated for possible sexual abuse and found to have no such history or infection with GC or CT (Group 2), or 31 female children (friends of the authors) without such a history or GC or CT infection (Group 3). Vaginal GV was found in 5.3% of Group 1, 4.9% of Group 2 and 6.4% of Group 3 (p > .05). Also, vaginal GV infection was not related to the type of sexual contact or race, but did increase with age in white female children. Because vaginal GV infection is not more commonly found in children with a history of sexual contact than those without such a history, the finding of GV in a vaginal culture in an individual case would not be a reliable marker of sexual contact. Routine culturing for GV is not recommended as part of a sexual abuse workup.     

Abuse of power in relationships and sexual health

STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health.     

Exploring sexuality profiles of adolescents who have engaged in sexual abuse and their link to delinquency and offense characteristics

Very few studies have taken a specific interest in the various sexual dimensions, beyond delinquent sexual behavior, of adolescents who have engaged in sexual abuse (AESA). Those that went beyond delinquent sexual behavior have report mixed results, suggesting they are a heterogeneous group. The current study used cluster analysis to examine the sexuality profiles of AESA, which included information on several sexual dimensions (atypical and normative fantasies and experiences, drive, body image, pornography, first masturbation, onset of sexual interest and first exposure to sex). Participants (N = 136) are adolescents who have engaged in sexual abuse involving physical contact, for which at least one parent also participated in the study. They were recruited from six specialized treatment centers and three youth centers in Quebec (Canada). Cluster analyses were performed to identify specific sexual profiles. Results suggest three clusters of AESA: 1- Discordant sexuality pertaining to adolescents who show mostly normative sexual interests, 2- Constrictive sexuality, characterizing adolescents who seem to be less invested/interested in their sexuality and 3- Overinvested sexuality for adolescents showing an exacerbated sexuality, including atypical sexual interest. Additional analyses (ANOVAs and Chi-square tests) reveal that five delinquency and offense characteristics were significantly more likely to be present in the Overinvested than the Constrictive cluster: non-sexual offenses, three or more victims, peer victims and alcohol and drug consumption. Advancing our knowledge on this topic can provide relevant data for clinicians to better target interventions.     

Epidemiologic variations in childhood sexual abuse

We retrospectively reviewed records of 566 children ranging from 6 months to 16 years of age who presented to a sexual assault crisis center. They represented 33.2% of all alleged sexual assault victims seen over a 36 month period. There were 103 males (18.2%) and 463 females (81.8%). Significant differences in presentation were demonstrated with respect to the victim's age, sex, and race, but the major factor influencing the variation is the victim/assailant relationship. Younger children were more likely than older children to present with histories of multiple assaults (p less than .0005), by known assailants (p less than .0005), occurring in the child's or assailant's home (p less than .001) and to report less violence (p less than .05). More risk of violence (p less than .0005) or evidence of trauma (p less than .0005) and less reporting of home assaults (p less than .0005) or multiple assault episodes (p less than .0005) were found in assaults by strangers when compared with non-stranger assaults. A lower frequency of reporting was found in females between 7 and 11 years of age. The dynamics of childhood sexual abuse are discussed in relationship to these findings. A number of victim and assailant related factors determine reporting patterns of childhood sexual abuse.     

Revisiting the link between childhood sexual abuse and adult sexual aggression

BackgroundChildhood maltreatment poses a risk factor for adult sexual aggression among men.ObjectiveEfforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse.Participants and settingThis sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression.MethodsMaltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey–Short Form Perpetration.ResultsCSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p < .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p < .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p < .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p < .001) or more (RR = 8.94, p < 0.001) forms of abuse.ConclusionsMultiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.     

Association between child sexual abuse and infectious disease diagnoses

BackgroundThough many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents’ physical health.ObjectiveThe objective of this study was to assess the relationship between CSA and infectious disease diagnoses.ParticipantsOf the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group.Setting and methodsThis matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups.ResultsResults indicate that sexually abused participants had 1.27 times more (95% CI – 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI – 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI – 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI – 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.     

The use of telemedicine in child sexual abuse evaluations

OBJECTIVE: To describe the advantages, disadvantages and current status of child abuse consultations conducted through telemedicine networks. METHOD: The results of a telephone survey of seven statewide telemedicine networks are reported and discussed with respect to goals, funding, technical support and expertise, infrastructure, and extent of use. Quality assurance and liability issues concerning telemedicine child abuse consultations are also reviewed. RESULTS: The goals of telemedicine networks in child abuse are to provide (1) expertise to less experienced clinicians primarily in rural areas; (2) a method for peer review and quality assurance to build consensus of opinions particularly in sexual abuse cases; and (3) support for professionals involved in an emotionally burdensome area of pediatrics. Problems encountered by existing networks include: (1) funding for equipment and reimbursement for consultation; (2) consistent technical support: (3) clinician lack of technical expertise, knowledge, or motivation; and (4) lack of network infrastructure. Legal considerations include licensure exemptions for consulting across state lines, potential for malpractice, patient confidentiality and security of images forwarded over modem lines, and liability of the equipment, consulting site, and the consultant in criminal proceedings. CONCLUSIONS: Telemedicine consultations offer a unique opportunity to raise the standard of care in child abuse evaluations, but success depends on clinician motivation, appropriate infrastructure, and ongoing funding and technical support.     

The sexual abuse of Afro-American and White-American women in childhood

This study examined the prevalence of child sexual abuse in a multi-stage stratified probability sample of Afro-American and white-American women, 18 to 36 years of age, in Los Angeles County. The sample ranged in demographic characteristics by age, marital status, education and the presence of children. Of the total sample of 248 women, 154 (62%) reported at least one incident of sexual abuse prior to age 18, with 57% of Afro-American women and 67% of white-American women having been abused. Sexual abuse before the age of 18 appears to be of equal concern for both ethnic groups, although similarities and differences in the circumstances under which abuse incidents occurred were subtle and deserve attention. The need for identifying contemporary factors that contribute to the prevalence of abuse over the past 40 years is stressed.     

Violence among family members of children and adolescents evaluated for sexual abuse

OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.     

Characteristics of child physical and sexual abuse as predictors of psychopathology

Childhood physical and sexual abuse victims are at increased risk for developing depression, anxiety, and post-traumatic stress disorder (PTSD) in adulthood. Prior findings suggest abuse onset, duration, and severity moderate relationships between victimization and psychopathology. However, because these abuse characteristics are highly intercorrelated, their unique, individual effects on mental health outcomes remain unclear. To address this gap, the present study examined relationships between physical and sexual abuse characteristics and mental health outcomes and whether these relationships differed by sex. A diverse community sample of late adolescents and emerging adults (N = 1270; mean age = 19.68; 51% female) self-reported the onset, duration, and severity of physical and sexual abuse, as well as their depressive, anxiety, and PTSD symptoms. Results of a multivariate regression model (simultaneously evaluating all physical and sexual abuse characteristics) indicated that physical abuse onset in middle childhood and sexual abuse onset in middle childhood or adolescence were associated with all forms of psychopathology; and physical abuse onset at any time was uniquely linked with PTSD. Duration and severity of physical or sexual abuse did not predict psychopathology after accounting for time of onset. Multigroup analyses indicated that adolescence-onset and duration of sexual abuse respectively predicted anxiety and PTSD in females but not males, whereas sexual abuse severity predicted fewer PTSD symptoms in males but not females. Overall, results suggested that abuse occurring after age 5 may have the most deleterious impact on mental health.     

Characteristics of victims and perpetrators of intrafamilial sexual abuse

BackgroundIntrafamilial sexual abuse (SA) is one of the most traumatic experiences a person can experience and comes with lifelong effects. Considering the increase in the number of children in orphanages due to intrafamilial SA in Turkey, addressing this problem in more detail is crucial. For this reason, this study aims to determine the characteristics of intrafamilial SA cases.MethodIn this study, the characteristics of 216 intrafamilial SA cases who were referred to the Ankara Child Advocacy Center between 2010 and 2015 were analyzed retrospectively. The ages of the victims varied between 3 and 17.ResultsThe most common identity of the perpetrator was the biological father (50%), biological sibling (14.4%), stepfather (13.9%), and parent’s boyfriend (12%). Of the perpetrators, 6.5% were female and 93.5% were male. Of the victims, 3.3% had a history of pregnancy. In addition, one out of four victims (27.3%) had experienced physical violence from their parents, the socioeconomic level of the majority of the families (90.2%) was low, the education levels of their parents were low (high-school-level education and below), and one of two families (52.6%) experienced domestic violence. Furthermore, the perpetrators in the biological intrafamilial SA group exhibited similar behavior with the sociolegal group in terms of penetration, and the age distribution of the victims was similar.ConclusionsConsequently, this study has revealed a lot of new information about intrafamilial SA cases. These findings will hopefully be useful in identifying and preventing victims at risk for intrafamilial SA.     

Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review

Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children’s disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.     

Gendered pathways from child sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood

This study aimed to examine the pathways from child sexual abuse to sexual assault victimization and perpetration in adolescence and early adulthood, considering risky sexual behavior and lowered sexual self-esteem as mediator variables. In a two-wave longitudinal study with 2251 college students in Germany, male and female participants provided reports of sexual aggression victimization and perpetration since age 14 (T1) and again a year later (T2), covering the last 12 months. In addition, child sexual abuse (CSA; before the age of 14), risky sexual behavior, and sexual self-esteem were assessed at T1, and risky sexual behavior and sexual-self-esteem were assessed again at T2. Experience of CSA was significantly associated with greater likelihood of sexual aggression victimization and perpetration, lower sexual self-esteem, and more risky sexual behavior in both gender groups at T1 and was directly related to victimization at T2 among male participants. In both gender groups, CSA indirectly contributed to a higher probability of sexual victimization at T2 via its impact on victimization T1. In males, the indirect path from CSA to T2 perpetration via T1 perpetration was also significant. Through its negative impact on sexual self-esteem, CSA indirectly increased the probability of sexual victimization among women and the probability of sexual aggression perpetration among men. Risky sexual behavior mediated the pathway from CSA to sexual victimization at T2 for men and women and the pathway from CSA to sexual aggression perpetration for women. The findings contribute to the understanding of gendered effects of CSA on revictimization and the victim-to-perpetrator cycle.     

Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse

The purpose of this study was to describe behavioural and emotional symptoms and to examine the effect of abuse-related factors, family responses to disclosure, and child self-blame on these symptoms in children presenting for medical evaluations after disclosure of sexual abuse. A retrospective review was conducted of 501 children ages 8–17. Trauma symptoms were determined by two sets of qualitative measures. Abstracted data included gender, ethnicity, and age; severity of abuse and abuser relationship to child; child responses regarding difficulty with sleep, school, appetite/weight, sadness, or self-harm, parent belief in abuse disclosure, and abuse-specific self-blame; responses to the Trauma Symptom Checklist in Children-Alternate; and the parent's degree of belief in the child's sexual abuse disclosure. Overall, 83% of the children had at least one trauma symptom; 60% had difficulty sleeping and one-third had thoughts of self-harm. Child age and abuse severity were associated with 3 of 12 trauma symptoms, and abuse-specific self-blame was associated with 10 trauma symptoms, after controlling for other variables. The children of parents who did not completely believe the initial disclosure of abuse were twice as likely to endorse self-blame as children of parents who completely believed the initial disclosure. Screening for behavioural and emotional problems during the medical assessment of suspected sexual abuse should include assessment of self-blame and family responses to the child's disclosures. In addition, parents should be informed of the importance of believing their child during the initial disclosure of abuse and of the impact this has on the child's emotional response to the abuse.     

The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children

Data obtained from a random sample of 930 adult women in San Francisco provide the soundest basis heretofore available for estimating the prevalence of intrafamilial and extrafamilial sexual abuse of female children. This article describes the methodology of this survey, as well as some of the key findings. For example: 16% of these women reported at least one experience of intrafamilial sexual abuse before the age of 18 years; 12% reported at least one such experience before the age of 14 years; 31% reported at least one experience of extrafamilial sexual abuse before the age of 18 years; and 20% reported at least one such experience before the age of 14 years. When both categories of sexual abuse are combined, 38% reported at least one experience before the age of 18 years; and 28% reported at least one such experience before the age of 14 years. Only 2% of the cases of intrafamilial and 6% of the cases of extrafamilial child sexual abuse were ever reported to the police. A plea is made for the urgent need to recognize the magnitude of the problem of child sexual abuse, and to act to prevent it.     

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.     

Maternal support following childhood sexual abuse: Relationships to child-reported

Maternal support has been conceptualized as a key factor in predicting children’s functioning following sexual abuse; however, empirical evidence for this assumption is rather limited. Prior studies may have failed to find a relationship between maternal support and children’s outcomes due to the methodological weaknesses of the prior literature such as the use of maternal support measures without adequately reported psychometric properties. Moreover, relatively few studies have investigated whether maternal support corresponds with children’s own self-reported symptoms. The aim of the present study was to utilize the only published measure of maternal support with sufficient psychometrics, the Maternal Self-Report Support Questionnaire (MSSQ; Smith et al., 2010), to determine if levels of pre-treatment support are associated with children’s self-reported trauma-related symptoms among 165 treatment-seeking children (M = 10.85, SD = 3.09) and their non-offending mothers. Levels of maternal emotional support corresponded with few of children’s outcomes, and when relationships were observed, emotional support was related to higher levels of symptoms. Maternal levels of blame and doubt were only associated with dissociative symptoms. Maternal support therefore appears to be an ineffective predictor of children’s post-disclosure trajectories and raises the possibility that maternal support is linked with poorer functioning.     

Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Physical and sexual abuse in orphaned compared to non-orphaned children in sub-Saharan Africa: A systematic review and meta-analysis

This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n = 7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR = 0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR = 1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue.     

History of sexual abuse and suicide attempts in alcohol-dependent patients

History of child abuse is considered one of the important risk factors of suicide attempt in general population. At the same time it has been shown that suicide attempts appear significantly more frequently in alcoholics than in healthy individuals. The objective of this study was to investigate associations between history of childhood sexual abuse and suicide attempts in a sample of Polish alcohol dependent patients. A sample of 364 alcohol-dependent subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, family history of psychiatric problems, history of suicide attempts, sexual and physical abuse during childhood and adulthood and severity of alcohol problems. When analyzed by gender, 7.4% of male and 39.2% of female patients had a lifetime history of sexual abuse; 31.9% of the study group reported at least one suicide attempt during their lifetime. Patients who reported suicide attempts were significantly younger (p = 0.0008), had greater severity of alcohol dependence (p = 0.0002), lower social support (p = 0.003), and worse economic status (p = 0.002). Moreover, there was a significant association between history of suicide attempts and family history of psychiatric problems (p = 0.00025), suicide attempts in the family (p = 0.0073), childhood history of sexual abuse (p = 0.009) as well as childhood history of physical abuse (p = 0.002). When entered into linear regression analysis with other dependent variables history of childhood sexual abuse remained a significant predictor of suicide attempt (OR = 2.52; p = 0.035). Lifetime experience of sexual abuse is a significant and independent risk factor of suicide attempts in alcohol-dependent individuals.