Peer-reviewed article

Child Sexual Abuse

Daley SF, Gutovitz S · 31 Jan 2026

Abstract

According to the World Health Organization (WHO), child sexual abuse (CSA) involves children in sexual activity they do not fully comprehend, cannot consent to, are not developmentally prepared for, or behavior that violates societal laws or social taboos. Historical records indicate that CSA has occurred for centuries, with increasing societal awareness of and response to the problem in modern times. Ancient texts from the Byzantine Empire over a thousand years ago document rapes under the guise of premature marriages, child prostitution, sexual exploitation of boys by men, and incest, despite strict legal and religious prohibitions against such acts. Perpetrators are most often individuals known to the child, with the majority being family or household members, including parents, stepparents, older siblings, or nonrelated adults residing in the home. Abusers include neighbors, teachers, coaches, religious leaders, clinicians, and other adults who exploit their position of responsibility, authority, or trust for their own sexual gratification. CSA encompasses a range of abusive behaviors, including exposure to sexually explicit materials, oral-genital contact, genital-to-genital contact, genital-to-anal contact, and genital fondling, without necessarily involving penetration. Clinicians must distinguish CSA from normal "sexual play," when children of similar ages or developmental levels view or touch their genitalia out of curiosity in the absence of coercion. CSA is a significant global public health issue, with millions of cases annually, mostly unreported. While children from all backgrounds can be affected, those experiencing family dysfunction, including exposure to substance abuse, domestic violence, or intimate partner violence, and those living with nonbiologically related adults are at heightened risk. Clinicians play a pivotal role in recognizing and addressing CSA by employing a trauma-informed approach to care to ensure they conduct history-taking, physical examinations, and documentation with sensitivity, accuracy, and respect for the child's well-being. Most cases of CSA present without physical findings, often necessitating laboratory evaluation for sexually transmitted infections (STIs) and pregnancy, with prophylactic treatment provided when indicated. Additionally, clinicians must consider differential diagnoses, as genital injuries, infections, and dermatologic conditions can mimic abuse. Comprehensive care involves close medical and psychological follow-up to address the potential lifelong effects of CSA on mental and physical health. Effective collaboration with an interprofessional healthcare team and legal professionals is crucial for accurate diagnosis, timely intervention, and ensuring a child's safety and recovery following CSA.