Recognizing child sexual abuse An unrelenting challenge

Child sexual abuse (CSA) is a concerning problem with serious consequences. As the impact of CSA can be severe, it is important that CSA is recognized at an early stage in order to stop the abuse and offer adequate support. However, the unfortunate fact remains that the majority of sexual abuse cases is not recognized. There are several difficulties in the assessment of alleged sexual abuse in children. First, children are often restrained to disclose CSA due to various reasons. Second, most symptoms are non-specific for CSA. Third, signs of penetrative trauma at anogenital examination are often absent. Fourth, until other transmission routes have been excluded, diagnosing a sexually transmitted infection in a child is not conclusive for CSA.
We aimed to increase knowledge regarding the symptoms and behavior which can be displayed in children who experienced CSA. This thesis describes research regarding the diagnostic value of different aspects in the psycho-medical evaluation of alleged CSA. We pursued the pediatric assessment of alleged CSA. Subsequently we studied the psychosocial and physical complaints, the sexual behavior and sexual knowledge, in children involved in the Amsterdam Sexual Abuse Case.