{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:29:58Z","timestamp":1789705798366,"version":"4.0.1"},"reference-count":40,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T00:00:00Z","timestamp":1732924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Child sexual abuse (CSA) is a widespread and alarming issue, with an estimated global prevalence of 12\u201313% (affecting 18% of girls and 8% of boys). Despite its prevalence, many physicians working with children have insufficient knowledge of the medical diagnosis of CSA. This lack of expertise, combined with the sensitive and complex nature of these cases, often hampers proper identification and management. Diagnosing CSA is particularly challenging and requires specialized skills. A majority of children assessed for suspected sexual abuse present with normal genital and anal findings, which complicates the diagnostic process. Barriers such as professional isolation, societal taboos, and the sensitive nature of the subject often result in diagnostic failures. Accurate medical history taking, diagnosis, and documentation of findings are essential for ensuring a precise diagnosis, safeguarding children, and supporting legal proceedings. However, achieving these goals remains elusive without standardized guidelines and adequately trained healthcare professionals. Training of professionals in observing and reporting child sexual abuse is badly needed. This review explores the current state of medical diagnosis in suspected cases of CSA. This article is based on a selective review of pertinent literature retrieved from various databases, including PubMed and the overall index of the Quarterly Update.<\/jats:p>","DOI":"10.3390\/jcm13237297","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T11:48:56Z","timestamp":1733226536000},"page":"7297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Diagnosis of Child Sexual Abuse"],"prefix":"10.3390","volume":"13","author":[{"given":"Roland","family":"Csorba","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Duisburg-Essen, D-45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9561-9388","authenticated-orcid":false,"given":"Zeynep","family":"Atas Elfrink","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Duisburg-Essen, D-45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Tsikouras","sequence":"additional","affiliation":[{"name":"Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/1077559511403920","article-title":"A global perspective on child sexual abuse: Meta-analysis of prevalence around the world","volume":"16","author":"Stoltenborgh","year":"2011","journal-title":"Child. Maltreat"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1177\/1524838016683455","article-title":"Sexual violence against older people: A review of the empirical literature","volume":"19","author":"Bows","year":"2018","journal-title":"Trauma. Violence Abuse"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.chiabu.2018.02.020","article-title":"The economic burden of child sexual abuse in the United States","volume":"79","author":"Letourneau","year":"2018","journal-title":"Child. Abuse Negl."},{"key":"ref_4","first-page":"413","article-title":"Child sexual abuse and subsequent offending and victimisation: A 45-year follow-up study","volume":"79","author":"Ogloff","year":"2012","journal-title":"Trends Issues Crime Crim. Justice"},{"key":"ref_5","unstructured":"Kaplan, R., Adams, J.A., and Starling, S.P. (2011). Medical Response to Child Sexual Abuse. A Resource for Professionals Working with Children and Families, STM Learning."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1556\/650.2017.30771","article-title":"Female child sexual abuse","volume":"158","author":"Enyedy","year":"2017","journal-title":"Orv. Hetil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1542\/peds.62.3.382","article-title":"Sexual abuse, another hidden pediatric problem: The 1977 C. Anderson Aldrich lecture","volume":"62","author":"Kempe","year":"1977","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3089","DOI":"10.1001\/jama.286.24.3089","article-title":"Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the adverse childhood experiences study","volume":"286","author":"Dube","year":"2001","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1001\/archpsyc.56.7.609","article-title":"Costs of health care use by women HMO members with a history of childhood abuse and neglect","volume":"56","author":"Walker","year":"1999","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/PSY.0b013e3181bb2b46","article-title":"A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood","volume":"71","author":"Wegman","year":"2009","journal-title":"Psychosom. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1017\/S1121189X00000233","article-title":"Childhood sexual abuse and psychosis: Aetiology and mechanism","volume":"18","author":"Bebbington","year":"2009","journal-title":"Epidemiol. Psichiatr. Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s11934-009-0070-3","article-title":"The relationship between sexual abuse and interstitial cystitis\/painful bladder syndrome","volume":"10","author":"Mayson","year":"2009","journal-title":"Curr. Urol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/S0145-2134(02)00339-3","article-title":"Children referred for possible sexual abuse: Medical findings in 2384 children","volume":"26","author":"Heger","year":"2002","journal-title":"Child. Abuse Negl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.acap.2023.11.013","article-title":"Initial Medical Assessment of Possible Child Sexual Abuse: History, History, History","volume":"b24","author":"Dubowitz","year":"2024","journal-title":"Acad. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.chiabu.2008.09.003","article-title":"Primary care pediatricians\u2019 experience, comfort and competence in the evaluation and management of child maltreatment: Do we need child abuse experts?","volume":"33","author":"Lane","year":"2009","journal-title":"Child. Abuse Negl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e20193327","DOI":"10.1542\/peds.2019-3327","article-title":"Childhood Sexual Abuse: A Call to Action in Pediatric Primary Care","volume":"146","author":"Ghastine","year":"2020","journal-title":"Pediatrics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e281","DOI":"10.1542\/peds.2008-0450","article-title":"Girls Who Disclose Sexual Abuse: Urogenital Symptoms and Signs After Genital Contact","volume":"122","author":"DeLago","year":"2008","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1542\/peds.2008-1416","article-title":"I can tell you because you\u2019re a doctor","volume":"122","author":"Finkel","year":"2008","journal-title":"Pediatrics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e558","DOI":"10.1542\/peds.2013-1741","article-title":"The evaluation of children in the primary care setting when sexual abuse is suspected","volume":"132","author":"Jenny","year":"2013","journal-title":"Pediatrics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.3928\/00904481-20121126-10","article-title":"Children\u2019s Disclosures of Child Sexual Abuse","volume":"41","author":"Finkel","year":"2012","journal-title":"Pediatr. Ann."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/j.1467-8624.2011.01704.x","article-title":"The Development of Communicative and Narrative Skills Among Preschoolers: Lessons From Forensic Interviews About Child Abuse","volume":"83","author":"Hershkowitz","year":"2012","journal-title":"Child. Dev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ceci, S.J., and Bruck, M. (1995). Jeopardy in the Courtroom: A Scientific Analysis of Children\u2019s Testimony, American Psychological Association. [1st ed.].","DOI":"10.1037\/10180-000"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1146\/annurev-lawsocsci-110413-030913","article-title":"Interviewing Children","volume":"10","author":"Lyon","year":"2014","journal-title":"Annu. Rev. Law. Soc. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1037\/law0000347","article-title":"The influence of transition prompt wording on response informativeness and rapidity of disclosure in child forensic interviews","volume":"28","author":"Garcia","year":"2022","journal-title":"Psychol. Public Policy Law"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.jpag.2016.05.001","article-title":"Genital findings in cases of sexual abuse: Genital vs. vaginal penetration","volume":"29","author":"Gallion","year":"2016","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_26","first-page":"692","article-title":"Physical examination in child sexual abuse\u2014Approaches and current evidence","volume":"111","author":"Herrmann","year":"2014","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_27","first-page":"638","article-title":"Digital photo documentation of forensically relevant injuries as part of the clinical first response protocol","volume":"109","author":"Verhoff","year":"2012","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jpag.2017.10.006","article-title":"Anogenital findings in 3569 pediatric examinations for sexual abuse\/assault","volume":"31","author":"Smith","year":"2018","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_29","unstructured":"Kaplan, R., and Adams, J.A. (2011). Interpretation of genital and anal findings in children and adolescents with suspected sexual abuse: State of the science. Medical Response to Child Sexual Abuse: A Resource for Professionals Working with Children and Families, STM Learning."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1542\/peds.113.1.e67","article-title":"Genital anatomy in pregnant adolescents: \u201cNormal\u201d does not mean \u201cNothing happened\u201d","volume":"113","author":"Kellogg","year":"2004","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"106283","DOI":"10.1016\/j.chiabu.2023.106283","article-title":"Interpretation of medical findings in suspected child sexual abuse: An update for 2023","volume":"145","author":"Kellogg","year":"2023","journal-title":"Child. Abuse Negl."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Csorba, R., Lamp\u00e9, R., and P\u00f3ka, R. (2010). Surgical repair of blunt force penetrating anogenital trauma in an 18-month-old sexually abused girl: A case report. Eur. J. Obstet. Gynecol. Reprod. Biol., 153.","DOI":"10.1016\/j.ejogrb.2010.07.035"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e1094","DOI":"10.1542\/peds.2006-0964","article-title":"Healing of hymenal injuries in prepubertal and adolescent girls: A Descriptive study","volume":"119","author":"McCann","year":"2007","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s00414-013-0878-8","article-title":"Genital findings in boys suspected for sexual abuse","volume":"127","author":"Trubner","year":"2013","journal-title":"Int. J. Legal Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.chiabu.2013.03.011","article-title":"Anal findings in children with and without probable anal penetration: A retrospective study of 1115 children referred for suspected sexual abuse","volume":"37","author":"Myhre","year":"2013","journal-title":"Child. Abuse Negl."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.chiabu.2008.07.007","article-title":"The international epidemiology of child sexual abuse: A continuation of Finkelhor (1994)","volume":"33","author":"Pereda","year":"2009","journal-title":"Child. Abuse Negl."},{"key":"ref_37","unstructured":"(2014, January 15). U.S. Department of Health & Human Services: Child Maltreatment 2012, Available online: https:\/\/www.acf.hhs.gov\/archive\/cb\/report\/child-maltreatment-2012."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1080\/10538712.2011.607753","article-title":"Neurodevelopmental biology associated with childhood sexual abuse","volume":"20","author":"Spratt","year":"2011","journal-title":"J. Child. Sex. Abuse"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1542\/peds.106.1.100","article-title":"Forensic evidence findings in prepubertal victims of sexual assault","volume":"106","author":"Christian","year":"2000","journal-title":"Pediatrics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1542\/peds.2010-3498","article-title":"Forensic evidence collection and DNA identification in acute child sexual assault","volume":"28","author":"Thackeray","year":"2011","journal-title":"Pediatrics"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7297\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:43:28Z","timestamp":1760114608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/23\/7297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,30]]},"references-count":40,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13237297"],"URL":"https:\/\/doi.org\/10.3390\/jcm13237297","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,30]]}}}