INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

Child ; Humans ; East Asian People ; Quality of Life ; Students ; Child Abuse, Sexual ; Young Adult ; Resilience, Psychological

There has been a dramatic increase in very young adolescent pregnancies in recent years, with pregnancies documented in children as young as 10 years old, likely from sexual abuse. This article presents a 10-year-old female who initially consulted at the emergency room in her 27th week of pregnancy as a result of recurrent sexual abuse. Prompt assessment, diagnosis, and appropriate referrals to Obstetrics, Pediatric Adolescent Clinic, Psychiatry, and Child Protection Unit rendered optimal management for the patient. Dilemmas encountered in managing the case included preterm labor, large-for-gestational-age baby, immature pelvis, and approach to the appropriate mode of delivery compounded with management of trauma from sexual abuse. A multidisciplinary approach in managing these dilemmas achieved optimal outcomes with the patient delivering a live baby boy, appropriate for gestational age via cesarean section at term.
Child abuse ; pregnancy in adolescence ; preteen pregnancy ; teenage pregnancy ; sexual

Objective: This study aimed to compare the clinical profile of prepubertal and pubertal female child sexual abuse. Methods: A cross-sectional analytical study involving 43 sexually abused children was done. Each patient was categorized as prepubertal or pubertal based on the Tanner stage. Medical history was gathered using a structured interview and physical examination done with proper documentation after obtaining consent. Blind review by child protection specialists was done on genital images. Descriptive statistics were utilized for all variables. Results: This study showed 11.97% and 22.22% prevalence for prepubertal and pubertal child sexual abuse, respectively. Most prepubertal children disclosed digital vaginal penetration by the father and non-relative household members, while most pubertal children reported penile-vaginal penetration by the boyfriend. Fondling was common to both groups. The majority were repeated abuse and usually happened at the perpetrator’s house. Behavioral changes and genital symptoms were common in prepubertal children. Findings of hymenal trauma were found in 25% of prepubertal girls and half of the pubertal adolescents. The interobserver variability of these hymenal findings was fair. The prevalence of sexually transmitted infections (STIs) was low, none for the prepubertal children, and only 6% of the adolescent had STI, which was Hepatitis B. Conclusion The clinical profile of sexually abused prepubertal children differed from that of pubertal adolescents. There was a higher incidence of hymenal trauma and STIs in adolescents.
Child Abuse, Sexual

Objective: To investigate the associations between adverse childhood experiences (ACE) and substance use behaviors among lesbians to provide a scientific basis for high-risk population identification and formulation of targeted intervention measures. Methods: Lesbians who participated in routine AIDS voluntary counseling, testing services, activities, and peer recommendations were recruited from July to December 2018, with the help of LesPark in Beijing. Convenient sampling method was used. Demographic characteristics, ACE, and substance use behaviors of subjects were investigated using an online platform powered by www.wjx.cn. Subsequently, the associations between ACE and adulthood substance use behaviors were evaluated using the logistic regression model. The SPSS 22.0 was used for statistical analysis. Results: A total of 294 lesbians were recruited in the study, 81.3% (239/294) of them were lesbians, and 18.7% (55/294) were bisexuals. Besides, 55.8% (164/294) of subjects reported they had had ACE, with proportions of lesbians experiencing abuse, neglect, and family dysfunction as 33.3% (98/294), 24.5% (72/294), and 32.7% (96/294), respectively. 55.1% (162/294) of the lesbians reported they had smoked in the past 30 days, 11.2% (33/294) reported having drug-use behavior in the past three months, and 22.8% (67/294) claimed drinking alcohol weekly. Multivariate logistic regression analysis showed that lesbians with ACE were at high risks to smoke (OR=1.87, 95%CI: 1.13-3.08), drink (OR=2.13, 95%CI: 1.18-3.84), and use drugs (OR=3.33, 95%CI: 1.29-8.61) in adulthood. Moreover, lesbians with childhood family dysfunction were at higher risk of smoking cigarettes (OR=2.60, 95%CI: 1.46-4.62) and drinking alcohol (OR=2.65, 95%CI: 1.44-4.87). At the same time, those with abuse experience were at higher risk of drug use (OR=3.17, 95%CI: 1.26-7.96). Conclusions: Substance use behaviors, including cigarette smoking, drinking alcohol, and drugs use, were common among lesbians. Positive associations were found between ACE and adulthood substance use behaviors.
Adult ; Adverse Childhood Experiences ; Child ; Child Abuse/psychology* ; Female ; Humans ; Risk Factors ; Sexual and Gender Minorities ; Substance-Related Disorders/psychology*

INTRODUCTION: Child sexual abuse (CSA) adversely affects a child's growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department(ED) with CSA. METHODS: Children 0-16 years old presenting to KK Women's and Children's Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years old. RESULTS: There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, CONCLUSION The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children.
Adolescent ; Child ; Child Abuse ; Child Abuse, Sexual ; Child, Preschool ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Parents ; Retrospective Studies

This paper reviews relevant literatures at home and abroad. The cases of child sexual abuse are systematically discussed from the aspects of epidemiology and forensic examination, in order to develop and improve the inspection and appraisal thinking and ability of domestic forensic workers in such cases. The paper also briefly introduces the current situation and existing problems of dealing with child sexual abuse cases for case-handling units at base level in China, in order to provide help to the formulation, improvement and development of relevant standards and norms for child protection in China.
Child ; Child Abuse, Sexual/diagnosis* ; Child Protective Services ; China ; Forensic Medicine/methods* ; Humans ; Physical Examination/methods*

The growing problem of child sexual abuse (CSA) in the country has led the government to establish a set of standards for the delivery of hospital-based services to the survivors, in order to ensure that their needs are addressed promptly and effectively. Hence, the establishment of Women and Children Protection Units (WCPU) in all Department of Health (DOH) hospitals was mandated through a department administrative order.1 However, many WCPUs across the country are beset with problems such as inadequate facilities and equipment, and a scarcity of full-time service providers with proper training to handle survivors of CSA.2 These problems impede the delivery of optimal services required in managing clients in the WCPU.
Child Abuse, Sexual ; Survivor ; Child ; Female

A survey done by the World Health Organization in 2014 revealed that only less than 10% of the survivors of child sexual abuse (CSA) received any service—whether it be health, psychosocial, police, or legal.1 In Kenya and Haiti, only 13.4% of the girls and only 7% of the boys who experienced sexual abuse received health services, while in Swaziland, 24% of clients received health services.1 2 3 In several countries, one-stop centers were established to provide legal, medical and psychosocial services for survivors of child sexual abuse and violence in one location. These centers spare clients from visiting multiple institutions to seek help and from the trauma of retelling their personal ordeal to various individuals many times over.4 Psychosocial support is given by a social worker who assesses the client on the first interview. If the social worker detects any signs of abuse, the client is then escorted to an adjacent room where a child-friendly police officer would take care of the legal aspects of the case. A medical doctor performs a thorough physical examination in a separate room. Further special diagnostics and treatment are provided by the center. The staff of the centers must also have undergone appropriate training on the medicolegal aspects of handling clients who come to the center.5 In the Philippines, the establishment, operation, and maintenance of a Women and Children Protection Unit (WCPU) was based on the Administrative Order 1-B s. 1997 of the Department of Health (DOH)6 and the Republic Act 9262 Anti-Violence Against Women and their Children (VAWC) Act of 2004 and its implementing rules and regulations.7 In 2008, the DOH then developed a set of standards for the structures and processes of WCPUs in the country.8
Child Abuse, Sexual ; Survivor ; Child ; Female

PURPOSE: The purpose of this study was to review sexual abuse prevention education program for Korean elementary school students.METHODS: Whittemore and Knafl's integrative review methods were used and Gough's weight of evidence was employed as a quality appraisal tool. Articles published in Korean or English were identified through electronic search engines and scholarly web sites using three keywords: “elementary school student”, “sexual abuse”, and “prevention education”. Peer-reviewed articles published between 2000 and 2018 were included in this review.RESULTS: Twelve articles met the inclusion criteria and were appraised as being high-quality. Among the 12 selected studies, seven were descriptive, while five were intervention studies. Sexual abuse prevention education programs were effective in improving perceptions, knowledge, attitudes, and preventive behaviors among elementary school students. However, deficiencies were found in the variety of educational methods, utilization of experts, and standardization of the content of sexual abuse prevention education.CONCLUSION: We need to provide various educational methods that are appropriate for specific developmental stages, and the sexual abuse prevention content should draw upon the current sexual education program administered to this population. Furthermore, parents and trained teachers or school health teachers should be included to provide effective education programs for elementary students.
Child ; Child Abuse, Sexual ; Education ; Humans ; Korea ; Parents ; School Health Services ; Search Engine ; Sex Offenses