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Child sexual abuse, also called child molestation, is a form of
child abuse Child abuse or child maltreatment is , , and/or maltreatment or of a child or children, especially by a parent or a caregiver. Child abuse may include any act or by a parent or a caregiver that results in actual or potential harm to a chil ...

child abuse
in which an adult or older adolescent uses a
child Biologically, a child (plural children) is a human Humans (''Homo sapiens'') are the most abundant and widespread species In biology Biology is the natural science that studies life and living organisms, including their anat ...

child
for
sexual stimulation Sexual stimulation is any stimulus (including bodily contact) that leads to, enhances and maintains sexual arousal, and may lead to orgasm Orgasm (from Ancient Greek, Greek ὀργασμός ''orgasmos'' "excitement, swelling"; also sexual cl ...
. Forms of child sexual abuse include engaging in sexual activities with a child (whether by asking or pressuring, or by other means),
indecent exposure Indecent exposure is an expression that describes the deliberate public exposure by a person of a portion of their body in a manner contrary to local standards of appropriate behavior. Laws and social attitudes regarding indecent exposure vary s ...
(of the genitals, female nipples, etc.),
child grooming Child grooming is befriending and establishing an emotional connection with a child, and sometimes the family, to lower the child's inhibitions with the objective of sexual abuse Sexual abuse, also referred to as molestation, is abusive sexual ...
, and
child sexual exploitation Commercial sexual exploitation of children (CSEC) is a commercial transaction that involves the sexual exploitation of a child, or person under the age of consent. CSEC involves a range of abuses, including but not limited to: the prostitution of c ...
, including using a child to produce
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography Pornography (often shortened to porn) is the portrayal of Human sexual activity, sexual subject matter for the exclusive purpo ...
. Child sexual abuse can occur in a variety of settings, including home, school, or work (in places where
child labor Child labour ( British English) or child labor (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the Un ...

child labor
is common).
Child marriage Child marriage is a or , formal or informal, between a under - typically age 18 - and an or another child. * * * * The vast majority of child marriages are between a girl and a man or older boy, and are rooted in . Although the (legal adu ...
is one of the main forms of child sexual abuse;
UNICEF UNICEF, also known as the United Nations Children's Fund, is a United Nations The United Nations (UN) is an intergovernmental organization that aims to maintain international peace and international security, security, develop friendly ...

UNICEF
has stated that child marriage "represents perhaps the most prevalent form of sexual abuse and exploitation of girls". The effects of child sexual abuse can include
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
,
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi r ...
,
anxiety Anxiety is an emotion characterized by an unpleasant state of inner wikt:turmoil, turmoil, often accompanied by nervous behavior such as pacing back and forth, Somatic anxiety, somatic complaints, and Rumination (psychology), rumination. It incl ...

anxiety
,
complex post-traumatic stress disorder Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to exposure to an extremely traumatic event or series of events in a context in which the individual p ...
, propensity to further
victimization Victimisation (American and British English spelling differences#-ise.2C -ize .28-isation.2C -ization.29, or victimization) is the process of being victimised or becoming a wikt:victim, victim. The field that studies the process, rates, incidence, ...

victimization
in adulthood, and physical injury to the child, among other problems. Sexual abuse by a family member is a form of
incest Incest ( ) is between family members or close . This typically includes sexual activity between people in (blood relations), and sometimes those related by ( or ), adoption, or . The is one of the most widespread of all cultural s, both in ...
and can result in more serious and long-term
psychological trauma Psychological trauma is damage to a person's mind The mind is the set of faculties responsible for mental Phenomenon, phenomena. Often the term is also identified with the phenomena themselves. These faculties include thought, imagination, memo ...
, especially in the case of
parental incest Incest ( ) is human sexual activity between family members or close kinship, relatives. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by Affinity (law), affinity (marriage ...
. The global prevalence of child sexual abuse has been estimated at 19.7% for females and 7.9% for males. Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles, or cousins; around 60% are other acquaintances, such as "friends" of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases. Most child sexual abuse is committed by men; studies on female child molesters show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls. The word ''
pedophile Pedophilia (American and British English spelling differences, alternatively spelt paedophilia) is a psychiatric disorder in which an adult or older adolescent experiences a primary or exclusive sexual attraction to prepubescent children. Althou ...
'' is commonly applied indiscriminately to anyone who sexually abuses a child, but child sexual offenders are not pedophiles unless they have a strong sexual interest in
prepubescent Preadolescence, also known as pre-teen or tween, is a stage of Human development (biology), human development following early childhood and preceding adolescence.New Oxford American Dictionary. 2nd Edition. 2005. Oxford University Press. It comm ...
children. Under the law, ''child sexual abuse'' is often used as an
umbrella term In linguistics, hyponymy (from Greek language, Greek ὑπό, ''hupó'', "under", and ὄνυμα, ''ónuma'', "name") is a semantics, semantic relation between a hyponym denoting a subtype and a hypernym or hyperonym denoting a supertype. In oth ...
describing criminal and civil offenses in which an adult engages in sexual activity with a
minor Minor may refer to: * Minor (law), a person under the age of certain legal activities. ** A person who has not reached the age of majority * Academic minor, a secondary field of study in undergraduate education Music theory *Minor chord ** Barbe ...
or exploits a minor for the purpose of sexual gratification. The
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologist A psychologist is a professional A professional is a member of a profession or any person who earns a living from a speci ...
states that "children cannot consent to sexual activity with adults", and condemns any such action by an adult: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."


Effects


Psychological

Child sexual abuse can result in both short-term and long-term harm, including
psychopathology Psychopathology is the study of Abnormal psychology, abnormal cognitions, behaviour and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. It can b ...
in later life. Indicators and effects include
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
,
anxiety Anxiety is an emotion characterized by an unpleasant state of inner wikt:turmoil, turmoil, often accompanied by nervous behavior such as pacing back and forth, Somatic anxiety, somatic complaints, and Rumination (psychology), rumination. It incl ...

anxiety
,
eating disorders An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders i ...
, poor
self-esteem Self-esteem is an individual's subjective evaluation of their own worth. Self-esteem encompasses beliefs about oneself (for example, "I am unloved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith an ...
,
somatizationSomatization is a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such a ...
,
sleep disturbances A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are test ...
, and
dissociative Dissociatives are a class of hallucinogen which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of such action, dissociatives ...

dissociative
and
anxiety disorder Anxiety disorders are a cluster of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such feat ...
s including
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi r ...
. While children may exhibit regressive behaviours such as
thumb sucking A bonnet macaque thumb sucking Thumb sucking is a behavior found in humans, chimpanzees The chimpanzee (''Pan troglodytes''), also known as the common chimpanzee, robust chimpanzee, or simply chimp, is a species of great ape The Homini ...
or bedwetting, the strongest indicator of sexual abuse is sexual
acting out In the psychology Psychology is the science of mind and behavior. Psychology includes the study of consciousness, conscious and Unconscious mind, unconscious phenomena, as well as feeling and thought. It is an academic discipline of immense ...
and inappropriate sexual knowledge and interest.Understanding child sexual abuse: education, prevention, and recovery.
''
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologist A psychologist is a professional A professional is a member of a profession or any person who earns a living from a speci ...
'' Retrieved 30 October 2012
Victims may withdraw from school and social activities and exhibit various learning and behavioural problems including
cruelty to animals Cruelty to animals, also called animal abuse, animal neglect or animal cruelty, is the infliction by omission (neglect) or by commission by humans of suffering Suffering, or pain in a broad sense, may be an experience of unpleasantness and a ...
,
attention deficit/hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, or excessive activity and impulsivity, which are otherwise not Developmental psychology, appropriate for a person's age. Some indivi ...
(ADHD),
conduct disorder Conduct disorder (CD) is a mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may ...
, and
oppositional defiant disorder Oppositional defiant disorder (ODD) is listed in the DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5) is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomy ...
(ODD).
Teenage pregnancy Teenage pregnancy, also known as adolescent pregnancy, is pregnancy Pregnancy, also known as gestation, is the time during which one or more offspring In biology, offspring are the young born of living organism, organisms, produced eithe ...
and risky sexual behaviors may appear in adolescence. Child sexual abuse victims report almost four times as many incidences of self-inflicted harm. A well-documented, long-term negative effect is repeated or additional victimization in adolescence and adulthood. A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including
crime In ordinary language, a crime is an unlawful act punishable by a state State may refer to: Arts, entertainment, and media Literature * ''State Magazine'', a monthly magazine published by the U.S. Department of State * The State (newspaper ...

crime
and
suicide Suicide is the act of intentionally causing one's own death (1906) Death is the permanent, Irreversible process, irreversible cessation of all biological process, biological functions that sustain a living organism. Brain death is some ...

suicide
, also published in in addition to alcoholism and drug abuse. Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting. A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former. Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems, and emotional problems than their peers. A specific characteristic pattern of symptoms has not been identified, and there are several hypotheses about the causality of these associations. Studies have found that 51% to 79% of sexually abused children exhibit psychological symptoms. The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used. The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force. The social stigma of child sexual abuse may compound the psychological harm to children, and adverse outcomes are less likely for abused children who have supportive family environments.


Posttraumatic stress disorder

Child abuse Child abuse or child maltreatment is , , and/or maltreatment or of a child or children, especially by a parent or a caregiver. Child abuse may include any act or by a parent or a caregiver that results in actual or potential harm to a chil ...

Child abuse
, including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent. Recent research showed that females with high exposure to child sexual abuse (CSA) suffer PTSD symptoms that are associated with poor social functioning, which is also supported by prior research studies. The feeling of being “cut-off” from peers and “emotional numbness” are both results of CSA and highly inhibit proper social functioning. Furthermore, PTSD is associated with higher risk of substance abuse as a result of the “self-medication hypothesis” and the “high-risk and susceptibility hypothesis." Prolonged exposure therapy (PE) was found to decrease PTSD and depressive symptoms in female methadone using CSA survivors. Besides
dissociative identity disorder Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is a mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes signif ...

dissociative identity disorder
(DID),
posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental Mental may refer to: * of or relating to the mind Films * Mental (2012 film), ''Mental'' (2012 film), an Australian comedy-drama * Mental (2016 film), ''Mental'' (2016 film), a Bangladeshi r ...
(PTSD), and
complex post-traumatic stress disorder Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to exposure to an extremely traumatic event or series of events in a context in which the individual p ...
(C-PTSD), child sexual abuse survivors may present
borderline personality disorder Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that c ...
(BPD) and eating disorders such as
bulimia nervosa Bulimia nervosa, also known as simply bulimia, is an eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eatin ...
.


Research factors

Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse, some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse. In a 1998 review of related literature, Martin and Fleming state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects." Other studies have found an independent association of child sexual abuse with adverse psychological outcomes. Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the
effect size In , an effect size is a number measuring the strength of the relationship between two variables in a population, or a sample-based estimate of that quantity. It can refer to the value of a statistic calculated from a sample of , the value of a p ...
of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins. A 1998 meta-analysis by Bruce Rind et al. generated controversy by suggesting that child sexual abuse does not always cause pervasive harm, that girls were more likely to be psychologically harmed than boys, that some college students reported such encounters as positive experiences and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual." The study was criticized for flawed methodology and conclusions. The US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.


Physical


Injury

Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause internal lacerations and
bleeding Bleeding, also known as a hemorrhage, haemorrhage, or simply blood loss, is blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible fluid In physics, a fluid is a substan ...

bleeding
. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.


Infections

Child sexual abuse may cause infections and
sexually transmitted disease Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal disease, are infection An infection is the invasion of an organism's body tissues by disease-causing agents, th ...
s. Due to a lack of sufficient
vaginal fluid Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina In mammals, the vagina is the elastic, muscular part of the female genital tract ...

vaginal fluid
, chances of infections can heighten depending on the age and size of the child.
Vaginitis Vaginitis, also known as vulvovaginitis, is inflammation of the vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vulva to the cervix. The outer vaginal opening is normall ...

Vaginitis
has also been reported.


Neurological damage

Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;" Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects; Anderson et al. (2002) recorded abnormal transverse relaxation time in the cerebellar vermis of adults sexually abused in childhood; Teicher et al. (1993) found that child sexual abuse was associated with a reduced
corpus callosum The corpus callosum (Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of the ...

corpus callosum
area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse; and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children. Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped
limbic system The limbic system, also known as the paleomammalian cortex, is a set of structures located on both sides of the , immediately beneath the medial of the primarily in the .Schacter, Daniel L. 2012. ''Psychology''.sec. 3.20 It supports a variety ...
. Teicher et al. (1993) used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected. Navalta et al. (2006) found that the self-reported math
Scholastic Aptitude Test The SAT ( ) is a standardized test A standardized test is a test Test(s), testing, or TEST may refer to: * Test (assessment), an educational assessment intended to measure the respondents' knowledge or other abilities Arts and entertainme ...
scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects' verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short-term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.


Incest

Incest between a child or adolescent and a related adult is known as child incestuous abuse, and has been identified as the most widespread form of child sexual abuse with a highly significant capacity to damage the young person. One researcher stated that more than 70% of abusers are immediate family members or someone very close to the family. Another researcher stated that about 30% of all perpetrators of sexual abuse are related to their victim, 60% of the perpetrators are family acquaintances, like a neighbor, babysitter or friend and 10% of the perpetrators in child sexual abuse cases are strangers. A child sexual abuse offense where the perpetrator is related to the child, either by blood or marriage, is a form of
incest Incest ( ) is between family members or close . This typically includes sexual activity between people in (blood relations), and sometimes those related by ( or ), adoption, or . The is one of the most widespread of all cultural s, both in ...
described as ''intrafamilial child sexual abuse''. The most-often reported form of incest is father–daughter and stepfather–daughter incest, with most of the remaining reports consisting of mother/stepmother–daughter/son incest. Father–son incest is reported less often; however, it is not known if the actual prevalence is less or it is under-reported by a greater margin. Similarly, some argue that sibling incest may be as common, or more common, than other types of incest: Goldman and Goldman reported that 57% of incest involved siblings; Finkelhor reported that over 90% of
nuclear family A nuclear family, elementary family or conjugal family is a family In , family (from la, familia) is a of people related either by (by recognized birth) or (by marriage or other relationship). The purpose of families is to maintain the ...
incest involved siblings; while Cawson et al. show that sibling incest was reported twice as often as incest perpetrated by fathers/stepfathers. Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates state that 20 million Americans have been victimized by parental incest as children.


Types

Child sexual abuse includes a variety of sexual offenses, including: * ''
sexual assault Sexual assault is an act in which one intentionally sexually touches another person without that person's consent Consent occurs when one person voluntarily agrees to the proposal or desires of another. It is a term of common speech, with spe ...
'' – a term defining offenses in which an adult uses a minor for the purpose of sexual gratification; for example,
rape Rape is a type of sexual assault Sexual assault is an act in which one intentionally sexually touches another person without that person's consent Consent occurs when one person voluntarily agrees to the proposal or desires of another. ...

rape
(including
sodomy Sodomy () or buggery (British English British English (BrE) is the standard dialect of the English language English is a West Germanic languages, West Germanic language first spoken in History of Anglo-Saxon England, early medieval ...
), and sexual penetration with an object. Most U.S. states include, in their definitions of sexual assault, any penetrative contact of a minor's body, however slight, if the contact is performed for the purpose of sexual gratification. * ''
sexual exploitation Sexual slavery and sexual exploitation is attaching the right of ownership over one or more people with the intent of coercing or otherwise forcing them to engage in sexual activities. This includes forced labor, reducing a person to a serv ...
'' – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child,
live streaming sexual abuse Cybersex trafficking, or live streaming sexual abuse is a cybercrime involving sex trafficking and the live streaming Livestreaming refers to online streaming media simultaneously recorded and broadcast in real-time. It is often referred to sim ...
, and creating or trafficking in child pornography. *'' sexual grooming'' – a term defining the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online
chat room The term chat room, or chatroom (and sometimes group chat; abbreviated as GC), is primarily used to describe any form of synchronous conferencing, occasionally even asynchronous conferencing. The term can thus mean any technology ranging from rea ...
.


Commercial sexual exploitation

Commercial sexual exploitation of children (CSEC) is defined by the Declaration of the First World Congress against Commercial Sexual Exploitation of Children, held in Stockholm in 1996, as "sexual abuse by an adult accompanied by remuneration in cash or in kind to the child or third person(s)." CSEC usually takes the form of
child prostitution Child prostitution is prostitution Prostitution is the business or practice of engaging in sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express ...
or
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography Pornography (often shortened to porn) is the portrayal of Human sexual activity, sexual subject matter for the exclusive purpo ...
, and is often facilitated by
child sex tourism Child sex tourism (CST) is tourism at the archaeological site of Chichén Itza. in Vienna. Tourism is travel for pleasure or business; also the theory and practice of touring (disambiguation), touring, the business of attracting, accommodati ...
. CSEC is particularly a problem in developing countries of
Asia Asia () is 's largest and most populous , located primarily in the and . It shares the continental of with the continent of and the continental landmass of with both Europe and . Asia covers an area of , about 30% of Earth's total lan ...

Asia
. In recent years, new innovations in technology have facilitated the trade of Internet child pornography. In the United Kingdom, the term ''child sexual exploitation'' covers any form of sexual abuse which includes an exchange of a resource for sexual activity with a child. Prior to 2009, the term commonly used to describe child sexual exploitation was ''child prostitution''. The term ''child sexual exploitation'' first appeared in government guidance in 2009 as part of an attempt to promote an understanding that children involved in exploitation were victims of abuse rather than criminals. Because early definitions of child sexual exploitation were created to foster a move away from use of the term ''child prostitution'', the concept of exchange, which made child sexual exploitation different from child sexual abuse, referred to financial gain only. However, in the years since the birth of the concept of child sexual exploitation, the notion of exchange has been widened to include other types of gain, including love, acquisition of status and protection from harm.


Disclosure

Children who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support. In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse. Negative social reactions to disclosure have been found to be harmful to the survivor's well-being. One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, post traumatic stress disorder symptoms, and dissociation. Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse. Non-validating and otherwise non-supportive responses to disclosure by the child's primary attachment figure may indicate a relational disturbance predating the sexual abuse that may have been a risk factor for the abuse, and which can remain a risk factor for its psychological consequences. The
American Academy of Child and Adolescent Psychiatry The American Academy of Child and Adolescent Psychiatry (AACAP) is a 501(c)(3) A 501(c)(3) organization is a corporation, trust, unincorporated association, or other type of organization exempt from federal income tax under section 501(c)(3) of T ...
provides guidelines for what to say to the victim and what to do following the disclosure. Asa Don Brown has indicated: "A minimization of the trauma and its effects is commonly injected into the picture by parental caregivers to shelter and calm the child. It has been commonly assumed that focusing on children’s issues too long will negatively impact their recovery. Therefore, the parental caregiver teaches the child to mask his or her issues." In many jurisdictions, abuse that is suspected, not necessarily proven, requires reporting to
child protection Child protection is the safeguarding of children from violence, exploitation, abuse, and neglect. Article 19 of the UN Convention on the Rights of the Child provides for the protection of children in and out of the home. One of the ways to e ...
agencies, such as the Child Protection Services in the United States. Recommendations for healthcare workers, such as
primary care provider Image:Jericho Health Centre 20050326.jpg, Primary care may be provided in community health centres. Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of ...
s and
nurse Nursing is a profession within the health care Healthcare is the maintenance or improvement of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential value'' or ''qual ...

nurse
s, who are often suited to encounter suspected abuse are advised to firstly determine the child's immediate need for safety. A private environment away from suspected abusers is desired for interviewing and examining. Leading statements that can distort the story are avoided. As disclosing abuse can be distressing and sometimes even shameful, reassuring the child that he or she has done the right thing by telling and that they are not bad and that the abuse was not their fault helps in disclosing more information.
Anatomically correct doll An anatomically correct doll or anatomically precise doll is a doll A doll is a physical model, model typically of a human or humanoid character, often used as a toy for little girls. Dolls have also been used in traditional religious rituals t ...
s are sometimes used to help explain what happened, although some researchers consider the dolls too explicit and overstimulating, which might contribute to non-abused children behaving with the dolls in one or more ways that suggest they were sexually abused. For the suspected abusers, it is also recommended to use a nonjudgmental, nonthreatening attitude towards them and to withhold expressing shock, in order to help disclose information.


Treatment

The initial approach to treating a person who has been a victim of sexual abuse is dependent upon several important factors: *Age at the time of presentation *Circumstances of presentation for treatment *Co-morbid conditions The goal of treatment is not only to treat current mental health issues, and
trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic injur ...
related symptoms, but also to prevent future ones.


Children and adolescents

Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from child welfare agencies. The three major modalities for therapy with children and adolescents are
family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology that works with families In human society, family (from la, familia) is a Socia ...
,
group therapy Group psychotherapy or group therapy is a form of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a ...
, and
individual therapy Psychotherapy (also psychological therapy or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction with adults, to help a person change behavior and overcome prob ...
. Which course is used depends on a variety of factors that must be assessed on a case-by-case basis. For instance, treatment of young children generally requires strong parental involvement and can benefit from family therapy. Adolescents tend to be more independent; they can benefit from individual or group therapy. The modality also shifts during the course of treatment; for example, group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing. In a 2012 systematic review,
cognitive behavior therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health Mental health, defined by the World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the U ...
showed potential in treating the adverse consequences of child sexual abuse. Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child's family of origin. Roland C. Summit, a medical doctor, defined the different stages the victims of child sexual abuse go through, called child sexual abuse accommodation syndrome. He suggested that children who are victims of sexual abuse display a range of symptoms that include secrecy, helplessness, entrapment, accommodation, delayed and conflicted disclosure and recantation.


Adults

Adults who have been sexually abused as children often present for treatment with a secondary mental health issue, which can include
substance abuse Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods which are harmful to the individual or others. It is a form of substance-related disorder Substance-related disorders, also known as substance use disorde ...
,
eating disorders An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's health, physical or mental health, mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders i ...
,
personality disorders Personality disorders (PD) are a class of mental disorder A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Su ...

personality disorders
,
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
, and conflict in romantic or interpersonal relationships. Generally, the approach is to focus on the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person's specific issues. For instance, a person with a history of sexual abuse suffering from severe depression would be treated for
depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
. However, there is often an emphasis on
cognitive restructuring Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortion A cognitive distortion is an exaggerated or irrational thought pattern involved in t ...
due to the deep-seated nature of the trauma. Some newer techniques such as
eye movement desensitization and reprocessing #REDIRECT Eye movement desensitization and reprocessing Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy Psychotherapy (also psychological therapy or talking therapy) is the use of psychological methods, particu ...
(EMDR) have been shown to be effective. Although there is no known cure for pedophilia, there are . Some of the treatments focus on attempting to change the sexual preference of pedophiles, while others focus on keeping pedophiles from committing child sexual abuse, or on keeping child sexual abusers from committing child sexual abuse again.
Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (e.g ...
(CBT), for example, aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use
cognitive restructuring Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortion A cognitive distortion is an exaggerated or irrational thought pattern involved in t ...
to change views on sex with children. The most common form of this therapy is
relapse prevention Relapse prevention (RP) is a cognitive-behavioral approach to relapse In internal medicine Internal medicine or general internal medicine (in Commonwealth of Nations, Commonwealth nations) is the medical specialty dealing with the prevention, di ...
, where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions. The evidence for cognitive behavioral therapy is mixed. A 2012
Cochrane Review Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based Evidence-based practice (EBP) is the idea that occupation ...
of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders. Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism. There is debate over whether non-randomized studies should be considered informative. More research is needed. Sexual abuse is associated with many sub-clinical behavioral issues as well, including
re-victimization Victimisation ( or victimization) is the process of being victimised or becoming a victim Victim may refer to: Films and television * ''The Victim'' (1916 film), an American silent film by the Fox Film Corporation starring vamp Valeska Suratt * ...
in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and
distorted thinking A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological states, such as Depression (mood), depression and anxiety. Psychiatrist Aaron T. Beck laid the groundwork for the st ...
on the subject of sexual abuse (for instance, that it is common and happens to everyone). When first presenting for treatment, the patient can be fully aware of their abuse as an event, but their ''appraisal'' of it is often distorted, such as believing that the event was unremarkable (a form of isolation). Frequently, victims do not make the connection between their abuse and their present pathology.


Prevention

Child sexual abuse prevention programmes were developed in the United States of America during the 1970s. Some programme are delivered to children and can include one-to-one work and group work. Programmes delivered to parents were developed in the 1980s and took the form of one-off meetings, two to three hours long. In the last 15 years, web-based programmes have been developed. School-based education programs were evaluated in 2015 by Cochrane that demonstrated improvements in protective behaviors and knowledge among children.


Offenders


Demographics

Offenders are more likely to be relatives or acquaintances of their victim than strangers. A 2006–07 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%). More offenders are male than female, though the percentage varies between studies. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%. Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% to 43% of female offenders. Maletzky (1993) found that, of his sample of 4,402 convicted child sex offenders, 0.4% were female. According to research conducted in Australia by Kelly Richards on child sexual abuse, 35.1% of female victims were abused by another male relative and 16.4% of male victims were abused by another male relatives. Male relatives were found to be the most relevant predators in the case of both gender. In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28". According to C.E. Dettmeijer-Vermeulen, Dutch national spokeswoman on human traffic and sexual violence against children, in the Netherlands, 3% of the convicted perpetrators are women, 14.58% of the victims are boys and "most victims were abused by a family member, friend or acquaintance." One in six perpetrators are underage.


Typology

Early research in the 1970s and 1980s began to classify offenders based on their motivations and traits. Groth and Birnbaum (1978) categorized child sexual offenders into two groups, "fixated" and "regressed". Fixated were described as having a primary attraction to children, whereas regressed had largely maintained relationships with other adults, and were even married. This study also showed that adult
sexual orientation Sexual orientation is an enduring pattern of or (or a combination of these) to persons of the opposite or , the same sex or gender, or to both sexes or more than one gender. These attractions are generally subsumed under , , and , while (the ...
was not related to the sex of the victim targeted, e.g. men who molested boys often had adult relationships with women. Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles. They are divided as follows: *Situational – does not prefer children, but offend under certain conditions. **''Regressed'' – Typically has relationships with adults, but a stressor causes them to seek children as a substitute. **''Morally Indiscriminate'' – All-around sexual deviant, who may commit other sexual offenses unrelated to children. **''Naive/Inadequate'' – Often mentally disabled in some way, finds children less threatening. *Preferential – has true sexual interest in children. **''Mysoped'' – Sadistic and violent, target strangers more often than acquaintances. **''Fixated'' – Little or no activity with own age, described as an "overgrown child".


Causal factors

Causal factors of child sex offenders are not known conclusively. The experience of sexual abuse as a child was previously thought to be a strong risk factor, but research does not show a causal relationship, as the vast majority of sexually abused children do not grow up to be adult offenders, nor do the majority of adult offenders report childhood sexual abuse. The US
Government Accountability Office The U.S. Government Accountability Office (GAO) is a government agency that provides ing, , and investigative services for the . It is the of the . It identifies its core "mission values" as: accountability, integrity, and reliability. It is ...
concluded, "the existence of a cycle of sexual abuse was not established." Before 1996, there was greater belief in the theory of a "cycle of violence", because most of the research done was retrospective—abusers were asked if they had experienced past abuse. Even the majority of studies found that most adult sex offenders said they had ''not'' been sexually abused during childhood, but studies varied in terms of their estimates of the percentage of such offenders who had been abused, from 0 to 79 percent. More recent prospective
longitudinal Longitudinal is a geometric term of location which may refer to: * Longitude ** Line of longitude, also called a meridian (geography), meridian * Longitudinal engine, an internal combustion engine in which the crankshaft is oriented along the long ...
research—studying children with documented cases of sexual abuse over time to determine what percentage become adult offenders—has demonstrated that the cycle of violence theory is not an adequate explanation for why people molest children. Offenders may use
cognitive distortion A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological Psychopathology is the study of abnormal cognitions, behaviour and experiences which differs according to social ...
s to facilitate their offenses, such as
minimization Minimisation or minimization may refer to: * Minimisation (psychology), downplaying the significance of an event or emotion * Minimisation (clinical trials) * Minimisation (code) or Minification, removing unnecessary characters from source code * S ...
of the abuse,
victim blaming Victim blaming occurs when the victim of a crime In ordinary language, a crime is an unlawful act punishable by a state or other authority. The term ''crime'' does not, in modern criminal law, have any simple and universally accepted defini ...
, and excuses.


Pedophilia

Pedophilia is a condition in which an adult or older adolescent is primarily or exclusively attracted to prepubescent children, whether the attraction is acted upon or not. A person with this attraction is called a ''pedophile''. In
law enforcement File:CBP female officers going aboard a ship.jpg, upU.S. Customs and Border Protection officers boarding a ship 'Law enforcement'' is the activity of some members of government who act in an organized manner to enforce the law by discovering, dete ...

law enforcement
, the term ''pedophile'' is sometimes used to describe those accused or convicted of child sexual abuse under sociolegal definitions of ''child'' (including both prepubescent children and adolescents younger than the local
age of consent The age of consent is the age at which a person is considered to be legally competent In United States and Canadian law, competence concerns the mental capacity of an individual to participate in legal proceedings or transactions, and the ...
); however, not all child sexual offenders are pedophiles and not all pedophiles engage in sexual abuse of children. For these reasons, researchers recommend against imprecisely describing all child molesters as ''pedophiles''. The term ''pedocriminality'' (: ''Pädokriminalität''; : ''pédocriminalité'') is a controversial term which originated in the 1980s and has been used by organisations such as
UNICEF UNICEF, also known as the United Nations Children's Fund, is a United Nations The United Nations (UN) is an intergovernmental organization that aims to maintain international peace and international security, security, develop friendly ...

UNICEF
,
UNHRC The United Nations Human Rights Council (UNHRC), CDH is a United Nations The United Nations (UN) is an intergovernmental organization that aims to maintain international peace and international security, security, develop friendly rel ...
, the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations United Nations Specialized Agencies are autonomous organizations working with the United Nations and each other through the co-ordinating machinery of the Unit ...
and the
Council of Europe The Council of Europe (CoE; french: Conseil de l'Europe, ) is an international organization, international organisation founded in the wake of World War II to uphold European Convention on Human Rights, human rights, democracy and the Law in Eu ...

Council of Europe
to refer to child sexual abuse and sexual violence used against children, Adolf Gallwitz, Manfred Paulus 2009: ''Pädokriminalität weltweit: sexueller Kindesmissbrauch, Kinderhandel, Kinderprostitution und Kinderpornographie''. VDP, Verl. Dt. Polizeiliteratur, .
child prostitution Child prostitution is prostitution Prostitution is the business or practice of engaging in sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express ...
, child trafficking and the use of
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography Pornography (often shortened to porn) is the portrayal of Human sexual activity, sexual subject matter for the exclusive purpo ...
. The term "cyber-pedocriminality" has been used to refer to the activities of viewers of child pornography online.


Recidivism

Recidivism rates for sex offenders are lower than for the general criminal population. Estimated rates among child sex offenders vary. One study found that 42% of offenders re-offended (either a sex crime, violent crime, or both) after they were released. Risk for re-offense was highest in the first 6 years after release, but continued to be significant even 10–31 years later, with 23% offending during this time. A study done in California in 1965 found an 18.2% recidivism rate for offenders targeting the opposite sex and a 34.5% recidivism rate for same-sex offenders after 5 years. Because recidivism is defined and measured differently from study to study, one can arrive at inaccurate conclusions being made based on comparison of two or more studies that are not conducted with similar methodology.


Other children

When a prepubescent child is sexually abused by one or more other children or adolescent youths, and no adult is directly involved, it is defined as child-on-child sexual abuse. The definition includes any sexual activity between children that occurs without consent, without equality, or due to coercion, whether the offender uses physical force, threats, trickery or psychological manipulation, emotional manipulation to compel cooperation. When sexual abuse is perpetrated by one sibling upon another, it is known as "intersibling abuse", a form of
incest Incest ( ) is between family members or close . This typically includes sexual activity between people in (blood relations), and sometimes those related by ( or ), adoption, or . The is one of the most widespread of all cultural s, both in ...
. Unlike research on adult offenders, a strong causal relationship has been established between child and adolescent offenders and these offenders' own prior victimization, by either adults or other children.


Teachers

According to a 2010
UNICEF UNICEF, also known as the United Nations Children's Fund, is a United Nations The United Nations (UN) is an intergovernmental organization that aims to maintain international peace and international security, security, develop friendly ...

UNICEF
report, 46% of Congolese schoolgirls confirmed that they had been victims of sexual harassment, abuse, and violence committed by their teachers or other school personnel. In Mozambique, a study by the Ministry of Education found that 70 percent of female respondents reported knowing teachers who use sexual intercourse as a necessary condition to advance students to the next grade. A survey by Promundo found that 16% of girls in North Kivu said they had been forced to have sex with their teachers. According to UNICEF, teachers in Mali are known to use "La menace du bic rouge" ("the threat of the red pen") or bad marks if girls do not accept sexual advances. According to Plan International, 16% of children in Togo, for instance, named a teacher as responsible for the pregnancy of a classmate.


Prevalence


Global

Based on Self-report study, self-disclosure data, a 2011 meta-analysis of 217 studies estimated a global prevalence of 12.7%–18% for girls and 7.6% for boys. The rates of self-disclosed abuse for specific continents were as follows: A 2009 meta-analysis of 65 studies from 22 countries found a global prevalence of 19.7% for females and 7.9% for males. In that analysis, Africa had the highest prevalence rate of child sexual abuse (34.4%), primarily because of high rates in South Africa; Europe showed the lowest prevalence rate (9.2%); and America and Asia had prevalence rates between 10.1% and 23.9%.


Africa

A ten-country school-based study in southern Africa in 2007 found 19.6% of female students and 21.1% of male students aged 11–16 years reported they had experienced forced or coerced sex. Rates among 16-year-olds were 28.8% in females and 25.4% in males. Comparing the same schools in eight countries between 2003 and 2007, age-standardised on the 2007 Botswana male sample, there was no significant decrease between 2003 and 2007 among females in any country and inconsistent changes among males. The prevalence of child sexual abuse in Africa is compounded by the virgin cleansing myth that sexual intercourse with a virgin will cure a man of HIV or AIDS. The myth is prevalent in South Africa, Zimbabwe, Zambia and Nigeria and is being blamed for the high rate of sexual abuse against young children. Sexual violence in the Democratic Republic of the Congo, Child rape is on the rise in the war-ravaged eastern Democratic Republic of the Congo. Aid workers blame combatants on all sides, who operate with much impunity, for a culture of sexual violence. South Africa has some of the highest incidences of child rape (including the rape of babies) in the world (also see sexual violence in South Africa). A survey by CIET found around 11% of boys and 4% of girls admitted to forcing someone else to have sex with them. In a related Statistical survey, survey conducted among 1,500 schoolchildren, a quarter of all the boys interviewed said that "jackrolling", a term for gang rape, was fun. More than 67,000 cases of rape and sexual assaults against children were reported in 2000 in South Africa, compared to 37,500 in 1998. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. The largest increase in attacks was against children under seven. The virgin cleansing myth is especially common in South Africa, which has the highest number of HIV-positive citizens in the world. Eastern Cape social worker Edith Kriel notes that "child abusers are often relatives of their victims – even their fathers and providers."'' South African Men Rape Babies as "Cure" for AIDS,''
Jane Flanagan, ''Daily Telegraph (UK),'' November 11, 2001.
A number of high-profile baby rapes appeared since 2001 (including the fact that they required extensive reconstructive surgery to rebuild urinary, genital, abdominal, or tracheal systems). In 2001, a 9-month-old was raped and likely lost consciousness as the pain was too much to bear. In February 2002, an 8-month-old infant was reportedly gang-raped by four men. One has been charged. The infant has required extensive reconstructive surgery. The 8-month-old infant's injuries were so extensive, increased attention on prosecution has occurred.


Asia

In Afghanistan, some boys are forced to participate in Bacha bazi , sexual activities with men. They are also termed 'dancing boys'. The custom is connected to sexual slavery and child prostitution. In Bangladesh, child prostitutes are known to take the drug Dexamethasone, Oradexon, an over-the-counter steroid, usually used by farmers to fatten cattle, to Prostitution in Bangladesh, make child prostitutes look larger and older. Charities say that 90% of prostitutes in the country's legalized brothels use the drug. According to social activists, the steroid can cause diabetes and high blood pressure and is highly addictive. In 2007, the Ministry of Women and Child Development (India), Ministry of Women and Child Development published the "Study on Child Abuse: India 2007." It sampled 12447 children, 2324 young adults and 2449 stakeholders across 13 states. It looked at different forms of child abuse: physical abuse, sexual abuse and psychological abuse, emotional abuse and girl child neglect in five evidence groups, namely, children in a family environment, children in school, children at work, children on the street and children in institutions. The study's main findings included: 53.22% of children reported having faced sexual abuse. Among them, 52.94% were boys and 47.06% girls. Andhra Pradesh, Assam, Bihar and Delhi reported the highest percentage of sexual abuse among both boys and girls, as well as the highest incidence of sexual assaults. 21.90% of child respondents faced severe forms of sexual abuse, 5.69% had been sexually assaulted and 50.76% reported other forms of sexual abuse. Children on the street, at work and in institutional care reported the highest incidence of sexual assault. The study also reported that 50% of abusers are known to the child or are in a position of trust and responsibility and most children had not reported the matter to anyone. Despite years of lack of any specific child sexual abuse laws in India, which treated them separately from adults in case of sexual offense, the 'Protection of Children Against Sexual Offences Bill, 2011' was passed the Indian parliament on May 22, 2012, which came into force from 14 November 2012. In Pakistan, sexual abuse of children is a problem in some Madrassas in Pakistan, madrassas. The Kasur child sexual abuse scandal, which involved forced sex, forced sex acts and an estimated 280 to 300 children, was termed the largest child abuse scandal in Pakistan's history. In 2019, Pakistan's Human Rights Minister, Shirin Mazari has said that Pakistan was ranked as the country with the largest numbers of
child pornography Child pornography (also called CP, child sexual abuse material, CSAM, child porn, or kiddie porn) is pornography Pornography (often shortened to porn) is the portrayal of Human sexual activity, sexual subject matter for the exclusive purpo ...
viewers. Geo Pakistan, the Federal Investigation Agency, cyber-crime chief has said, "Child pornography is a business . . with those involved in the crime linked to international child pornography rings." In Taiwan, a survey of adolescents reported 2.5% as having experienced childhood sexual abuse. In Uzbekistan, the UK Ambassador Craig Murray wrote that the government, under president Islam Karimov, used child rape to force false confessions from prisoners.


Pacific

According to UNICEF, nearly half of Sexual violence in Papua New Guinea, reported rape victims in Papua New Guinea are under 15 years of age and 13% are under 7 years of age while a report by ChildFund Australia citing former Parliamentarian Dame Carol Kidu stated 50% of those seeking medical help after rape are under 16, 25% are under 10 and 10% are under 8. Additionally, a study found that men with a history of victimization, especially having been raped or otherwise sexually coerced themselves, were more likely than otherwise to have participated in both single-perpetrator and gang rape, multiple-perpetrator non-partner rape. 57·5% (587/1022) of men who raped a non-partner committed their first rape as teenagers.


United States and Europe

Child sexual abuse occurs frequently in Western society, although the rate of prevalence can be difficult to determine. Research in North America has concluded that approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. In the UK, a 2010 study estimated prevalence at about 5% for boys and 18% for girls (not dissimilar to a 1985 study that estimated about 8% for boys and 12% for girls). More than 23,000 incidents were recorded by the UK police between 2009 and 2010. Girls were six times more likely to be assaulted than boys with 86% of attacks taking place against them. Barnardo's Charitable organization, charity estimates that two thirds of victims in the United Kingdom are girls and one third are boys. Barnardo's is concerned that boy victims may be overlooked. A firm of solicitors that acts in many cases of child abuse has published a list of over twenty Children's Homes and group actions that they have an interest in or for which they are lead solicitors. The estimates for the United States vary widely. A literature review of 23 studies found rates of 3% to 37% for males and 8% to 71% for females, which produced an average of 17% for boys and 28% for girls, while a statistical analysis based on 16 cross-sectional studies estimated the rate to be 7.2% for males and 14.5% for females. The US Department of Health and Human Services reported 83,600 substantiated reports of sexually abused children in 2005, while state-level child protective services reported 63,527 sexual abuse incidents in 2010. Including incidents which were not reported would make the total number even larger. According to Emily M. Douglas and David Finkelhor, "Several national studies have found that African American, black and Non-Hispanic Whites, white children experienced near-equal levels of sexual abuse. Other studies, however, have found that both blacks and Hispanic and Latino Americans, Latinos have an increased risk for sexual victimization". Surveys have shown that one fifth to one third of all women reported some sort of childhood sexual experience with a male adult. A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year-old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse. The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative." Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered. A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease ... Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview." It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.
Child marriage Child marriage is a or , formal or informal, between a under - typically age 18 - and an or another child. * * * * The vast majority of child marriages are between a girl and a man or older boy, and are rooted in . Although the (legal adu ...
is often considered to be another form of child sexual abuse. Over 200,000 marriages involving minors were allowed between 2000 and 2015 in the US. These marriages were most often between an adult male and female minor. Child marriage in the United States is allowed in the majority of states as long as parental consent or judicial approval (typically for pregnancy) is given. In US schools, according to the United States Department of Education,Shakeshaft, C,
Educator Sexual Misconduct: A Synthesis of the Literature
, U.S. Department of Education, 2004
"nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%. In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18 to 28% of reported cases, depending on the study" Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex stereotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys. Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female–female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports. This underreporting has been attributed to cultural denial of female-perpetrated child sex abuse, because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female." Journalist Cathy Young writes that under-reporting is contributed to by the difficulty of people, including jurors, in seeing a male as a "true victim". In the United Kingdom, reported child sex abuse has increased, but this may be due to greater willingness to report. Police need more resources to deal with it. Also parents and schools need to give children and adolescents regular advice about how to spot abuse and about the need to report abuse. Software providers are urged to do more to police their environment and make it safe for children.


International law

Child sexual abuse is outlawed nearly everywhere in the world, generally with severe criminal penalties, including in some jurisdictions, Life sentence, life imprisonment or capital punishment. An adult's sexual intercourse with someone below the legal
age of consent The age of consent is the age at which a person is considered to be legally competent In United States and Canadian law, competence concerns the mental capacity of an individual to participate in legal proceedings or transactions, and the ...
is defined as statutory rape, based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be Legal consent#Sex, legal consent. The United Nations Convention on the Rights of the Child (CRC) is an international treaty that legally obliges states to protect children's rights. Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the child pornography, exploitation of children in creating pornography. States are also required to prevent the abduction, sale, or trafficking of children. As of November 2008, 193 countries are bound by the CRC,United Nations Treaty Collection.
Convention on the Rights of the Child
''. Retrieved on 26 November 2008.
including every member of the United Nations except the United States and South Sudan. The Council of Europe has adopted the Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse in order to prohibit child sexual abuse that occurs within home or family. In the European Union, child sexual abuse is subject to a Directive (European Union), directive. This directive deals with several forms of sexual abuse of children, especially commercial sexual exploitation of children.


History

Child sexual abuse has gained public attention since the 1970s and has become one of the most high-profile crimes. While sexual use of children by adults has been present throughout history, public interest in prevention has tended to fluctuate. Initially, concern centered around children under the age of ten, but over time, advocates have attracted attention toward the sexual abuse of children between the ages of 11 and 17. Up until the 1930s, the psychological impact of sexual abuse was not emphasized, instead emphasis was placed on the physical harm or the child's reputation. Widespread public awareness of children's sexual abuse did not occur until the 1970s in the West.


Early writings

The first published work dedicated specifically to child sexual abuse appeared in France in 1857: ''Medical-Legal Studies of Sexual Assault'' ''(Etude Médico-Légale sur les Attentats aux Mœurs)'', by Auguste Ambroise Tardieu, the noted French pathologist and pioneer of forensic medicine.


Public concern

Child sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time, sexual abuse remained rather secretive and socially unspeakable. Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the Child Abuse Prevention and Treatment Act in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically. Finally, the National Abuse Coalition was created in 1979 to create pressure in congress to create more sexual abuse laws. Second wave feminism brought greater awareness of child sexual abuse and violence against women, and made them public, political issues. Judith Lewis Herman, Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement. Her second book ''Trauma and Recovery'' coined the term
complex post-traumatic stress disorder Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to exposure to an extremely traumatic event or series of events in a context in which the individual p ...
and included child sexual abuse as a cause. In 1986, Congress passed the Child Abuse Victims' Rights Act, giving children a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abusers. During the 1970s a large transition began in the legislature related to child sexual abuse. Megan's Law which was enacted in 1996 gives the public access to knowledge of sex offenders nationwide. Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one of history's largest social revolutions." According to John Jay College of Criminal Justice professor B.J. Cling,
"By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism ... As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma ... depends on the support of a political movement.'"


Civil lawsuits

In the United States growing awareness of child sexual abuse has sparked an increasing number of civil lawsuits for monetary damages stemming from such incidents. Increased awareness of child sexual abuse has encouraged more victims to come forward, whereas in the past victims often kept their abuse secret. Some states have enacted specific laws lengthening the applicable statutes of limitations so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority. Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, or daycare was charged with supervising the child but failed to do so with child sexual abuse resulting, making the individual or institution liable. In the Catholic sex abuse cases the various Roman Catholic Diocese in the United States have paid out approximately $1 billion settling hundreds of such lawsuits since the early 1990s. There have also been lawsuits involving the American Christian Religious Right. Crimes have allegedly gone unreported and victims were pressured into silence. As lawsuits can involve demanding procedures there is a concern that children or adults who file suit will be re-victimized by defendants through the legal process, much as
rape Rape is a type of sexual assault Sexual assault is an act in which one intentionally sexually touches another person without that person's consent Consent occurs when one person voluntarily agrees to the proposal or desires of another. ...

rape
victims can be re-victimized by the accused in criminal rape trials. The child sexual abuse plaintiff's attorney Thomas A. Cifarelli has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process. In June 2008 in Zambia the issue of teacher-student sexual abuse and sexual assault was brought to the attention of the High Court of Zambia where a landmark case decision, with presiding Judge Philip Musonda, awarded $45million Zambian kwacha (US$13,000) to the plaintiff, a 13-year-old girl for sexual abuse and rape by her school teacher. This claim was brought against her teacher as a "person of authority" who, as Judge Musonda stated, "had a moral superiority (responsibility) over his students" at the time. A 2000 World Health Organization – Geneva report, “World Report on Violence and Health (Chap 6 – Sexual Violence)” states, “Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools.”World Health Organization Report on Sexual Violence
2002


See also


References


Further reading

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External links

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American Academy of Child and Adolescent Psychiatry Facts for Families: Child Sexual AbuseMen who molest their sexually immature daughters: Is a special explanation required?
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2017 child sexual abuse statistics
from Darkness to Light {{DEFAULTSORT:Child Sexual Abuse Child sexual abuse, Human sexuality Adverse childhood experiences