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EVERY emergency physician has been confronted with similar cases of suspected child abuse. However, recognition of child sexual abuse by professionals did not occur consistently until the 1980s. Child sexual abuse is defined as involvement in sexual activities by a dominant or more powerful person with a dependent, developmentally immature child or adolescent for the dominant person’s own sexual stimulation, or for the gratification of other persons, as in child pornography or prostitution. The sexual activities include exhibitionism, inappropriate viewing of the child, allowing the child to view inappropriate sexual material, taking sexually related photographs of the child, sexualized kissing, fondling, masturbation, digital or object penetration of the vagina or anus, and oral-genital, genital-genital, and anal-genital contact. These sexual activities are imposed on the child, since the child cannot provide informed consent, because of his or her age or developmental stage.1,2 Child sexual abuse is a distinct form of victimization and differs from adult sexual assault in several important respects. (See Table 1.) These distinctions are not absolute, and there is some overlap between what is typically seen as child and adolescent sexual abuse and adult sexual assault.2-5 Emergency physicians play a vital role in the outcome of an alleged abuse case, as they are often the first professionals to hear the disclosure and to evaluate the child. It is critical that the opportunity to elicit a disclosure, evaluate for injuries, and perform a forensic examination not be missed. Often there is only one opportunity to collect this information, which can ultimately serve to identify the abuser and protect the child.


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