Medscape is available in 5 Language Editions – Choose your Edition here.


Child Sexual Abuse in Emergency Medicine Follow-up

  • Author: Ann S Botash, MD; Chief Editor: Kirsten A Bechtel, MD  more...
Updated: Nov 12, 2015

Further Outpatient Care

Most sexually abused children should be referred for mental health counseling.

Follow up for medical problems (eg, genitourinary complaints) should be arranged with the child's primary care physician.

If the community has a child abuse referral center, the children should be referred there for follow-up care according to local protocol.


Further Inpatient Care

Inpatient care is recommended if the child's safety is in jeopardy or if the child has an acute traumatic injury requiring inpatient treatment.

Occasionally, treatment for a STD requires hospital admission and inpatient treatment.

Severe mental or emotional trauma may necessitate inpatient admission and care.


Inpatient & Outpatient Medications

Prophylactic antibiotics in prepubertal sexually abused children are indicated in rare cases.

Prophylactic antibiotics may be given to pubertal sexually abused children after an acute assault.

Use of postassault pregnancy prevention options should be discussed with the pubertal sexual assault victim.



Complications of sexual abuse may include infection and psychological/social problems.



Sexually abused children have significantly higher occurrences of the following:

  • Eating disorders
  • Suicidal behaviors
  • Self-injury
  • Psychosis[23]

Children who are sexually abused may be at increased risk of reabuse.

Ongoing emotional/psychological problems may be indicative of abused children's false beliefs about themselves and the sexual abuse experience.


Patient Education

Families are usually concerned about injury in the child. Reassurance may involve an explanation that children can be sexually abused and have no physical findings to support their allegations.

For excellent patient education resources, visit eMedicineHealth's Children's Health Center. Also, see eMedicineHealth's patient education articles Child Abuse and Sexual Assault and Abuse.

Contributor Information and Disclosures

Ann S Botash, MD Director, Child Abuse Referral and Evaluation Program, Professor and Vice Chair for Educational Affairs, Department of Pediatrics, State University of New York Upstate Medical University

Ann S Botash, MD is a member of the following medical societies: Academic Pediatric Association, American Pediatric Society, Society for Pediatric Research, Ray E Helfer Society, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Kirsten A Bechtel, MD Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine; Co-Director, Injury Free Coalition for Kids, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

  1. American Academy of Pediatrics. Guidelines for the evaluation of sexual abuse of children: subject review. American Academy of Pediatrics Committee on Child Abuse and Neglect. Pediatrics. 1999 Jan. 103(1):186-91. [Medline].

  2. US Department of Health and Human Services, Administration for Children and Families. Child Maltreatment 2005 [Web site]. US Department of Health and Human Services. Available at Accessed: March 20, 2008.

  3. Leetch AN, Woolridge D. Emergency department evaluation of child abuse. Emerg Med Clin North Am. 2013 Aug. 31(3):853-73. [Medline].

  4. Jenny C, Crawford-Jakubiak JE. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013 Aug. 132(2):e558-67. [Medline].

  5. Palusci VJ, Palusci JV. Screening tools for child sexual abuse. J Pediatr (Rio J). 2006 Nov-Dec. 82(6):409-10. [Medline].

  6. Floyed RL, Hirsh DA, Greenbaum VJ, Simon HK. Development of a screening tool for pediatric sexual assault may reduce emergency-department visits. Pediatrics. 2011 Aug. 128(2):221-6. [Medline].

  7. Berson NL, Herman-Giddens ME, Frothingham TE. Children's perceptions of genital examinations during sexual abuse evaluations. Child Welfare. 1993 Jan-Feb. 72(1):41-9. [Medline].

  8. Palusci VJ, Cyrus TA. Reaction to videocolposcopy in the assessment of child sexual abuse. Child Abuse Negl. 2001 Nov. 25(11):1535-46. [Medline].

  9. Starling SP, Jenny C. Forensic examination of adolescent female genitalia: the Foley catheter technique. Arch Pediatr Adolesc Med. 1997 Jan. 151(1):102-3. [Medline].

  10. Myhre AK, Adams JA, Kaufhold M, Davis JL, Suresh P, Kuelbs CL. Anal findings in children with and without probable anal penetration: a retrospective study of 1115 children referred for suspected sexual abuse. Child Abuse Negl. 2013 Jul. 37 (7):465-74. [Medline].

  11. Adams JA, Kaplan RA, Starling SP, Mehta NH, Finkel MA, Botash AS, et al. Guidelines for medical care of children who may have been sexually abused. J Pediatr Adolesc Gynecol. 2007 Jun. 20(3):163-72. [Medline].

  12. Kellogg ND, Menard SW, Santos A. Genital anatomy in pregnant adolescents: "normal" does not mean "nothing happened". Pediatrics. 2004 Jan. 113(1 Pt 1):e67-9. [Medline].

  13. Adams JA, Botash AS, Kellogg N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Arch Pediatr Adolesc Med. 2004 Mar. 158(3):280-5. [Medline].

  14. Black CM, Driebe EM, Howard LA, Fajman NN, Sawyer MK, Girardet RG, et al. Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse. Pediatr Infect Dis J. 2009 Jul. 28 (7):608-13. [Medline].

  15. Leder MR, Leber AL, Marcon MJ, Scribano PV. Use of APTIMA Combo 2: the experience of a child advocacy center. J Child Sex Abus. 2013. 22 (3):297-311. [Medline].

  16. Hammerschlag MR. Appropriate use of nonculture tests for the detection of sexually transmitted diseases in children and adolescents. Semin Pediatr Infect Dis. 2003 Jan. 14(1):54-9. [Medline].

  17. Sexual Assault and Abuse and STDs. Centers for Disease Control and Prevention. Available at June 4, 2015; Accessed: November 13, 2015.

  18. Girardet R, Bolton K, Lahoti S, Mowbray H, Giardino A, Isaac R, et al. Collection of forensic evidence from pediatric victims of sexual assault. Pediatrics. 2011 Aug. 128(2):233-8. [Medline].

  19. Thackeray JD, Hornor G, Benzinger EA, Scribano PV. Forensic evidence collection and DNA identification in acute child sexual assault. Pediatrics. 2011 Aug. 128(2):227-32. [Medline].

  20. Santucci KA, Nelson DG, McQuillen KK, Duffy SJ, Linakis JG. Wood's lamp utility in the identification of semen. Pediatrics. 1999 Dec. 104(6):1342-4. [Medline].

  21. Santucci KA, Hsiao AL. Advances in clinical forensic medicine. Curr Opin Pediatr. 2003 Jun. 15(3):304-8. [Medline].

  22. Muram D, Elias S. Child sexual abuse--genital tract findings in prepubertal girls. II. Comparison of colposcopic and unaided examinations. Am J Obstet Gynecol. 1989 Feb. 160(2):333-5. [Medline].

  23. Cutajar MC, Mullen PE, Ogloff JR, Thomas SD, Wells DL, Spataro J. Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Arch Gen Psychiatry. 2010 Nov. 67(11):1114-9. [Medline].

  24. Adams JA. Medical evaluation of suspected child sexual abuse. J Pediatr Adolesc Gynecol. 2004 Jun. 17(3):191-7. [Medline].

  25. Adams JA, Harper K, Knudson S, et al. Examination findings in legally confirmed child sexual abuse: it''s normal to be normal. Pediatrics. 1994 Sep. 94(3):310-7. [Medline]. [Full Text].

  26. Berenson AB, Chacko MR, Wiemann CM, et al. A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol. 2000 Apr. 182(4):820-31; discussion 831-4. [Medline].

  27. Botash AS. Child Abuse Evaluation and Treatment for Medical Providers. 2008. ChildAbuseMD. Available at

  28. Botash AS. Examination for sexual abuse in prepubertal children: an update. Pediatr Ann. 1997 May. 26(5):312-20. [Medline].

  29. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR. August 4. Vol. 55:1-84. [Full Text].

  30. Christian CW, Lavelle JM, De Jong AR, et al. Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics. 2000 Jul. 106(1 Pt 1):100-4. [Medline].

  31. Emans SJ, Woods ER, Flagg NT, et al. Genital findings in sexually abused, symptomatic and asymptomatic, girls. Pediatrics. 1987 May. 79(5):778-85. [Medline].

  32. Evans H. Vaginal discharge in the prepubertal child. Pediatr Case Rev. 2003 Oct. 3(4):194-202. [Medline].

  33. Finkel MA. Anogenital trauma in sexually abused children. Pediatrics. 1989 Aug. 84(2):317-22. [Medline].

  34. Finkelhor D. Current information on the scope and nature of child sexual abuse. Sexual Abuse of Children: The David and Luc Center for the Future of Children. 1994. Vol 4: 31-53.

  35. Kellogg N. The evaluation of sexual abuse in children. Pediatrics. 2005 Aug. 116(2):506-12. [Medline]. [Full Text].

  36. Muram D, Levitt CJ, Frasier LD, et al. Genital injuries. J Pediatr Adolesc Gynecol. 2003 Jun. 16(3):149-55. [Medline].

  37. Siegel RM, Schubert CJ, Myers PA, Shapiro RL. The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics. 1995 Dec. 96(6):1090-4. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.