How can a sexually abused child be identified?

How can a sexually abused child be identified?
In most cases, sexual abuse of children is not committed through the use of force and leaves no external signs. The most reliable way to reveal the abuse is on the basis of the victim's verbal description, whether explicit or implied. In addition, there are several signs of possible abuse, some physical and some behavioral.

Physical Signs

• Difficulties in walking or sitting
• Torn clothing or clothing spotted with blood
• Complaints of pain or discomfort in genitalia (a common situation among young girls, unrelated to sexual abuse; and so—it is important to ask the girl what happened).
• Infections or recurrent hematomas in the genital area or in the urinary tract
• Sexually contracted diseases
• Pregnancy, especially in early adolescence
• Bedwetting or soiling after toilet training, and constipation
• Vomiting (3)

Behavioral Signs

 It is important to pay attention to extreme changes in a child's behavior and when needed, consult with professionals or turn to hotlines for help in decoding the symptoms. These behavioral changes include: Sleep disturbances; nightmares; shunning specific people; outbursts of rage; regressive behavior (such as bedwetting thumb sucking, "baby talk" etc.); non- normative sexual behavior; a sharp deterioration in studies; depression; aggression; sexual abuse of other children; extreme interest and significant knowledge about topics related to sex;   display of strange sexual behavior towards other children, mostly as an expression of anger or aggression; sexual abuse of other children; compulsive masturbation; suicide attempts; loneliness and social isolation
Sexual curiosity is of course natural, and the difference between behavior that is permissible and that which is prohibited should be explained to a child. Signs of sexual abuse refer to extreme behavior or actions that are age-inappropriate
These behaviors are not necessarily signs of sexual abuse, but rather are warning signs of a change in the child's emotional situation which sometimes stems from sexual abuse.
When parents or caregivers detect changes in the child's behavior, they should try to ascertain the cause by speaking with the child. In every case of suspicion of sexual abuse or if sexual abuse is revealed, professional counseling should be sought from a Child Protection Officer, or from professionals in a  Child Protection Center. (Written material on identification of sexual abuse is available in Hebrew).

Why is it important to treat the abused child as quickly as possible?
Early treatment is of critical importance. If the child does not receive support, the reactions to the abuse may extend for a long period of time. The sooner a child receives treatment, the less the chances for severe effects of abuse for both the short and long terms.
Sexual abuse can cause physical, emotional, intellectual and social harm. . In addition, it can harm the child's basic world view, self-respect, and sense of security, his capacity to love, and his ability to continue to trust in people. Research also indicates that abuse places the child at risk for development of psychological problems at a young age and later in life. When the trauma of abuse is not treated and support is not provided, child victims must invest all their strengths and energies in keeping the secret to themselves and their reactions to the crisis may continue for a long period of time. In turn, this may cause:

• Depression and anxiety
• Difficulty in placing  trust and in developing intimate and social ties later in life
• Confusion and anxiety with regard to sexual preferences
• Increased risk of additional events of sexual abuse in the future
o Compulsive behavior and addictions, eating disorders, social isolation
o Suicidal thoughts and putting oneself at risk
o Thoughts and concerns with regard to religious faith, sin, and impurity

If the victim does not receive support, his reaction to the crisis may last for a long period of time. The child's ability to cope with the effects of the abuse for the long term, depends on four main factors:

• The characteristics of the abuse—the form of abuse or the combination of different forms of abuse to which the child was exposed; the degree to which the abuse is chronic; its duration and its severity
• The ages at which the abuse began and ended; ; the nature of the relationship with the abuser, and the use of force and threats
• A pressured family or neighborhood environment

• The child's characteristics and his personal coping skills

It is important to remember:

• The sense that a forbidden or negative act has been committed may develop at a very early age, but sometimes it develops later, since the abuser may define the sexual relations as normative—a form of "sex education," within the realm of "parents' rights" or the family's rules. In most cases the abusive act is committed without the use of force, so that the child's disclosure of the abuse does not always include the expression of negative and difficult emotions.
• Incest is usually not the first abusive act, but rather is generally preceded with obscene acts that deteriorate to full exploitation.
• As noted, about half the victims of sexual abuse are boys. Boy victims have less capacity and less willingness to talk about the abuse

The Implications of Keeping the Abuse a Secret

Sexual exploitation often takes place in secret. The child is usually warned not to share the secret with anyone and is afraid or ashamed to do so. The abuser threatens the child that if he reveals the secret, he or his family will be harmed. In some cases the abuser promises the child that "everything will be okay" if he doesn’t reveal anything;  and sometimes the child fears that no one will believe him or even that he will be punished for his part in the act of abuse. Many children feel guilty with regard to their active or passive participation in the act of abuse. This feeling is sometimes aroused when the abuser blames the child for the abuse. When adults in the child's environment do not react to the child's story or react in an inappropriate way to the difficulty which the child is trying to express, this can reinforce the tendency to hide and deny the abuse. All the above highlights the tremendous significance of the child's significant others' reaction to the disclosure of the abuse. 
Sometimes the reaction to the disclosure of the abuse can be no less significant than the abuse itself.  When the reaction of the social environment surrounding the child is supportive, appropriate, and consistent, this significantly increases the chances for coping with the abuse successfully.
Research indicates that young children tend to disclose the abuse to family members, and older children—to family members and to their peers. In addition, several studies demonstrate that victims tend to conduct intensive searches for the right person with whom to share their story; someone who will listen, provide encouragement, and not be judgmental. 
Continuing to keep the secret may cause additional and significant harm, as the child's distress increases, and he feels that he has no support and that no one believes or understands him. In addition, the abuse may recur and last for a longer period of time. Continuing to hide the secret prevents the victim from receiving treatment and can bring about additional harm, since there is a chance that the abuser will abuse additional children from the same or other families.
There are a variety of sources in Hebrew –written materials and video clips-which focus on the issue of concealing the secret of the abuse, and go into this issue in greater detail.

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