Recognizing signs of sexual assault in teens
Sexual abuse among adolescents and young adults is very common and occurs in all social and economic groups. “Adolescents and young adults suffer the highest rates of sexual abuse, and adolescents who have disabilities or who are lesbian, gay, or bisexual have even higher rates,” said Tonya Chaffee, MD, MPH, FAAP, director, Teen and Young Adult Health Center, Zuckerberg San Francisco General Hospital, and clinical professor, Pediatrics, University of California, San Francisco.
In her presentation “On and off campus: Care of the adolescent after sexual assault,” held on Monday, October 24, Chaffee emphasized the key role pediatricians play in recognizing the signs of sexual assault in their patients and provided them with information on how to respond.
Data show that 10% to 18% of high school/middle school students have been forced to have sex, and that lesbian/gay/bisexual (LGB) persons suffer higher rates than heterosexuals (18% vs 5%, respectively). Data also show that adolescents with disabilities are 1.5 to 2 times more likely to be victims, with those with cognitive disabilities suffering the highest rates. In addition, 1 in 4 women are sexually abused during college, with most of the assaults not reported.
In recognizing the signs of sexual abuse, Chaffee spoke on both acute and later signs for which pediatricians should be aware. Acute signs include insomnia, anorexia, urinary or vaginal symptoms, or physical injuries. Later signs include denial/suppression of feelings, withdrawal from peers, mistrust of friends, anger/outbursts, cutting, or eating disorders.
Chaffee emphasized that some victims will seek services (such as testing for sexually transmitted diseases or pregnancy) or present with various symptoms, but not disclose the sexual assault. If sexual assault is suspected, she stressed the importance of asking the patient and provided guidance on good ways to do this. She also talked about issues with disclosure (ie, how to validate and respond to a disclosure, as well as the rules and processes of mandatory reporting) and the importance of working with multidisciplinary teams (such as a Sexual Assault Response Team [SART]).
The presentation also included discussion of the role pediatricians can play in helping to prevent sexual assault as well as supporting families of victims.
“Community pediatricians often are unaware of both the acute and long-term physical and emotional consequences of sexual violence in adolescents and young adults,” Chaffee said. “By understanding these consequences and knowing their local resources, pediatricians play a key role in responding and assisting adolescents and young adults who are victims of sexual assault.”