Child sexual abuse/incest

Signs of child sexual abuse/incest

Child sexual abuse is difficult to detect because of the secrecy that surrounds it. However, children may indirectly disclose that they have been sexually abused through behavioral signs and indicators. Indicators may be physical, behavioral, or both. Signs and behaviors which may suggest sexual abuse is occurring include:

Physical signs

Behavioral signs

Bleeding or discharge from the vagina or rectum Vaginal or rectal pain, itching, or swelling Infections, warts, or sexually transmitted diseases (STDs) Difficult or painful urination or bowel movements Frequent urination and recurrent urinary tract infections Semen in the vagina, anus, or external genitalia Semen on clothing Torn, stained, or bloodied underwear Difficulty swallowing Complaints of stomach disturbances or recurrent abdominal pain Persistent headaches Difficulty walking or sitting Frequent attempts to run away Promiscuity or prostitution Bruises, scratches, or other unexplained injuries in the genital area or between the inner thighs Bruises, bite marks, or other injuries to breasts, buttocks, lower abdomen, or thighs Pregnancy in adolescents where the identity of the father is vague or secret.

Changes in eating habits including eating disorders and/or loss of appetite Acts of self-mutilation (e.g., cutting, biting, pulling, or cutting one's hair) Changes in dress (e.g., long sleeves or pants to cover bruises, reluctance to wear skirts) Poor interpersonal relationships Poor hygiene habits Lack of self-confidence Withdrawal or isolation Aggression or bullying Stealing Drug or alcohol use Suicidal ideation Excessive bathing Nightmares and sleep disturbances Sudden fear of the dark Unexplained fear of a particular person or caregiver Unusual knowledge of sexual matters or particular attention to adults of a particular sex Unusual interest in the genitals of others Acting out adult sexual behavior with adults, dolls, or other children Open displays of sexuality (i.e. repeated public masturbation) Frequent lying or cursing Poor grades or truancy Depression or anxiety Regressed behavior (i.e. bed-wetting, separation anxiety, insecurity)

Some of the above signs such as depression, anxiety and poor grades may be attributed to the normal growing pains of adolescence and some may be symptoms of more serious disorders such as depression, anorexia or body image disturbances. Fear of a particular person, aggression, and attempts to run away may be the result of a traumatic experience that isn't necessarily tied to sexual abuse.

However, some of the signs outlined above are without question signs of incest or other sexual abuse. See How to Report Suspected Incest/Child Sexual Abuse for more information.

Seek immediate medical attention if you note any of the physical signs. You have a responsibility to speak frankly with the doctor and to express your concerns about possible physical abuse or incest. If parents or caregivers are unable or unwilling to protect a child from further abuse, the matter becomes a child protection concern and in many jurisdictions, requires statutory intervention.

Make the safety of the child your first priority: consult a physician if you note any of the above physical signs. Provide information about the child's health, and outline any information he or she may have related to the suspected abuse. If the doctor's examination of the child confirms your suspicions, be sure you get a written doctor's report. You should discuss your medical and legal options with the physician.

The above behavioral signs should also raise concern and prompt you to spend as much time as possible with the child. Initiate discussion and show interest—ask questions. Increase the amount of time you spend together and build a trusting, open relationship characterized by open lines of communication. Be sure the child knows that your love and support are unconditional—let him/her know it's important to you that he/she feel happy, safe, and confident.

Get to know the child's teachers, counselors, caregivers, coaches, friends, and peers: find out more about their activities and about the people with whom they associate. Learn about your child's friends and get to know their families.

If you suspect sexual abuse, chances are you also have an idea who the offender is. Your local child abuse or crisis center has trained advocates to whom you can speak about your concerns of incest or sexual abuse.