7 Child sexual abuse World Health Organization（7儿童性虐待世界卫生组织）.pdf

BIBLIOGRAPHY 7 Child sexual abuse SUMMARY ■ The dynamics of child sexual abuse differ from those of adult sexual abuse. In particular, children rarely disclose sexual abuse immediately after the event. Moreover, disclosure tends to be a process rather than a single episode and is often initiated following a physical complaint or a change in behaviour. ■ The evaluation of children requires special skills and techniques in history taking, forensic interviewing and examination; the examiner may also need to address specific issues related to consent and reporting of child sexual abuse. ■ Definitive signs of genital trauma are seldom seen in cases of child sexual abuse, as physical force is rarely involved. The accurate interpretation of genital findings in children requires specialist training and wherever possible, experts in this field should be consulted. ■ Decisions about STI testing in children should be made on a case-by-case basis. If testing is warranted, age-appropriate diagnostic tests should be used. Presumptive treatment of children for STIs is not generally recommended. ■ A follow-up consultation is strongly recommended. Although a physical examination may not be necessary, a follow-up consultation provides an opportunity to assess any psychological problems that may have since arisen and to ensure that the child and his/her caregiver are receiving adequate social support and counselling. 7.1 Definition of child sexual abuse These guidelines adopt the definition of child sexual abuse formulated by the 1999 WHO Consultation on Child Abuse Prevention (62) which stated that: “Child sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give