Sexual Abuse

Alerting features that should prompt you to CONSIDER sexual abuse:

• Persistent or recurrent dysuria or anogenital discomfort, or an anal or genital symptom (for example, bleeding or discharge) in a girl or boy, without a medical explanation (for example, worms, urinary infection, skin conditions, poor hygiene or known allergies).

• Gaping anus in a girl or boy observed during an examination, without a medical explanation (for example, a neurological disorder or severe constipation).

• Evidence of a foreign body in the vagina or anus, indicated by, for example, offensive vaginal discharge.

• Hepatitis B in a child younger than 13 years if there is no clear evidence of vertical transmission, non-sexual transmission from a member of the household or blood contamination.

• Hepatitis B in a young person aged 13–15 years if there is no clear evidence of vertical transmission, non-sexual transmission from a member of the household, blood contamination or that the infection was acquired from consensual sexual activity with a peer.

• Hepatitis B in a young person aged 16 or 17 years and there is:

  • no clear evidence of vertical transmission, non-sexual transmission from a member of the household, blood contamination or that the infection was acquired from consensual sexual activity and
  • a clear difference in power or mental capacity between the young person and their sexual partner (in particular when the relationship is incestuous or with a person in a position of trust, for example, a teacher, sports coach or minister of religion) or
  • concern that the young person is being exploited.

• Anogenital warts in a child younger than 13 years if there is no clear evidence of vertical transmission or non-sexual transmission from a member of the household.

• Anogenital warts in a young person aged 13–15 years if there is no clear evidence of vertical transmission, non-sexual transmission from a member of the household or that the infection was acquired from consensual activity with a peer.

• Anogenital warts in a young person aged 16 or 17 years and there is:

  • no clear evidence of non-sexual transmission from a member of the household, or that the infection was acquired from consensual sexual activity and
  • a clear difference in power or mental capacity between the young person and their sexual partner (in particular when the relationship is incestuous or with a person in a position of trust) or
  • concern that the young person is being exploited.

• Gonorrhoea, chlamydia, syphilis, genital herpes, hepatitis C, HIV or trichomonas infection in a young person aged 13–15 years if there is no clear evidence of vertical transmission, blood contamination or that the STI was acquired from consensual sexual activity with a peer. (In these circumstances, consider should include discussion of your concerns with a named or designated professional for safeguarding children.)

• Gonorrhoea, chlamydia, syphilis, genital herpes, hepatitis C, HIV or trichomonas infection in a young person aged 16 or 17 years and there is:

  • no clear evidence of blood contamination or that the STI was acquired from consensual sexual activity and

• a clear difference in power or mental capacity between the young person and their sexual partner (in particular when the relationship is incestuous or with a person in a position of trust) or

• concern that the young person is being exploited.

• Pregnancy in a young woman aged 13–15 years.

• Pregnancy in a young woman aged 16 or 17 years and there is:

  • a clear difference in power or mental capacity between the young woman and the putative father (in particular when the relationship is incestuous or with a person in a position of trust) or

  • concern that the young woman is being exploited or

  • concern that the sexual activity was not consensual.

Alerting features that should prompt you to SUSPECT sexual abuse:

• Persistent or recurrent genital or anal symptom (for example, bleeding or discharge) in a girl or boy, without a medical explanation, that is associated with behavioural or emotional change.

• Genital, anal or perianal injury in a girl or boy, with an absent or unsuitable explanation.

• Anal fissure, when constipation, Crohn’s disease and passing hard stools have been excluded as the cause.

• Gonorrhoea, chlamydia, syphilis, genital herpes, hepatitis C, HIV or trichomonas infection in a child younger than 13 years if there is no clear evidence of vertical transmission or blood contamination.

• Unusual sexualised behaviours in a prepubertal child (for example, oral–genital contact with another child or doll, requesting to be touched in the genital area, or inserting or attempting to insert an object, finger or penis into another child’s vagina or anus).