Recognizing Sexual Abuse

How can I recognize sexual abuse if it happened to my three-and-a-half-year-old daughter? About a month ago she told me a friend of ours touched her vagina. Since that time she has said nothing else and on gentle questioning she said it did not happen. There are no behavioral changes and her behavior towards the man in question has not changed at all. They’ve always had great times together. I have no idea why she said this and my feeling is that it is completely innocent. She is also at the stage where she is very interested in what a penis is and what a vagina is – she occasionally can be found on the floor probing her vagina. But, is there anything I should be concerned about and how do I recognize real abuse of a child?
Palo Alto, California

Recognizing Sexual Abuse

Dr. Greene’s Answer:

Some of the most poignant episodes of my pediatric training were long visits with children victimized by sexual abuse. I vividly remember sitting with tears streaming down my face after hearing how children had been scarred by those they trusted.

How sad that we need to be discussing this subject for a three-and-a-half-year-old! Unfortunately, there is no age at which a child is exempt from sexual abuse. About one third of cases occur in kids younger than six years of age, about one third in children ages six to twelve, and one third in children ages twelve to eighteen.

Sexual abuse includes any activity with a child for the sexual gratification of an adult or significantly older child (more than about 4 years older). Children’s intense need for affection and nurturance from older figures makes them vulnerable. Adults and older children hold a position of tremendous power in their lives. It is the abuse of this power, and the abuse of children’s trust, that is so damaging.

Sexual abuse falls into three different categories:

  1. molestation, which is defined as the touching or fondling of the genitals of a child, or asking a child to touch or fondle an adult’s genitals, or using a child to enhance pleasure from sexual acts or pornography;
  2. sexual intercourse, which includes vaginal, oral, or rectal penetration;
  3. rape.

Most abuse begins with innocent physical contact. A needy adult then makes this a routine. Once a routine is developed, it is not uncommon to progress to intercourse.

The most common perpetrator of sexual abuse is either a family member or a close friend of the family. Sexual abuse by a stranger is quite uncommon.

Sexual abuse commonly comes to light through the child’s disclosing the incident of sexual contact to a trusted adult. Historically, a child’s word was not taken seriously. Over the last twenty years the pendulum swung to the opposite extreme; if a child described sexual contact it was considered a fact, and the volunteering of such information was considered very strong legal evidence. Recently, the pendulum has returned to a more balanced position: take it very seriously whenever a child mentions sexual contact, but understand that not everything said necessarily mirrors physical reality.

The best way to clarify a situation such as you have described is to have your child examined by a sexual abuse specialist in. Most children’s hospitals have a sexual abuse team, or will be able to refer you to a specialist in your area. (The two hospitals that offer this service in your area are Santa Clara Valley Medical Center in San Jose and the Keller Center at San Mateo Medical Center.)

A sexual abuse examination is comprised of two basic elements. First, and perhaps most important, your daughter would be interviewed by an expert who very gently elicits information from her about what might have happened. Efforts are made to minimize the number of times a child has to tell the story and the number of people visibly present during the interview. The interviewer will let your daughter set the pace and will use pictures or dolls to draw her out, without suggesting to her what might have occurred.

This is generally followed by a physical examination of the external genitals, checking for any sign of trauma, laxity, or discharge. Sometimes this will be done with magnification, using an instrument called a colposcope. Note that a physical examination cannot in and of itself confirm or rule out sexual abuse. In at least half of the cases of child abuse that are confessed by the abuser, there are no findings on physical exam.

Children who have actually been abused will often recant their initial statement because they are afraid of their abuser or because their abuser convinces them that this is “their little secret.” And, children who have never been sexually abused will, based on normal child development, go through phases of curiosity and misunderstandings about their genitals and about sexual activity.

Several clues are associated with sexual abuse as opposed to normal development (but many children give no clues except what they say):

  • Genital infections, redness, or discharge
  • Burning with urination
  • Urinary tract infection
  • The new onset of either bed-wetting or stool problems
  • Sudden increased sexuality with peers, animals, or objects
  • Seductive behavior
  • Age-inappropriate sexual knowledge
  • Regression
  • Other dramatic behavior changes

Hopefully, nothing significant happened to your little girl, but if my daughter came to me with the same story I would not let the situation go uninvestigated. The scenario you have described is the most frequent way actual abuse is detected.

Whatever turns out to be true, we must prepare our children to protect themselves against sexual abuse. Begin by teaching them the proper names and significance of their private parts as soon as they are able to understand (about age 3). Then they will be ready to understand the three key messages:

  1. Say no if somebody tries to touch your nipples, rectum, or genitals.
  2. Tell a trusted adult if someone tries to touch you.
  3. Don’t keep secrets — If somebody tells you to keep a secret, let your parents know right away.


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Dr. Alan Greene

Dr. Greene is the founder of (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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  1. Busisiwe

    My 2year old was staying her grandma (my mom) and my brother. I took her now she’s staying with me. When I bathe her she’s doesn’t want me to wash her vagina and when I didn’t know much about babies. She’s my first baby, so I’m planning to take her to de medical professional for examination. I’m so worried I’m even shaking.

  2. Dee

    When my daughter was between the ages of 2 and 5 she consistently reported that her father was putting red things in her butt, which she could not explain what they were at the time. My ex and I were going through a divorce/custody battle at the time. My attorney told me to bring her into the hospital for an exam the first time she reported it to me, which at the age of 2.5 was inconclusive.

    The court had a field day with the allegation. Her allegations continued and we were in the store one day and she yelled out “Twizzlers,” which I was confused about her blurting this out. She then stated, “that was what daddy was putting in my butt.” I immediately called CPS again and they did a 15 minute interview with my daughter, called the police and then gave her father THREE days notice and told him what they were coming for and exactly what for.

    This was in October — the police found not one piece of candy in the house. Fast forward four years later and she recants by saying, “Do you remember when I told you about the red things — that never happened.” Dad has since had people living in his household and as far as I know, nothing has happened since. Obviously, there is a little more to this story, but this is the gist.

    Do you think that a child could indicate such things and then recant like this? The entire situation has never sat well with me and I still worry every day, because her father is an abusive man with extreme addictive behaviors.

  3. D C

    I am trying not to over react and trying not to under react either.

    My youngest is 2 and last week she was having her diaper changed and was playing with a stuffed cat which she tried putting in her diaper (not in a suggestive way) and I said don’t put the kitty by your dirty bum. She then made like the kitty was licking her dirty bum.

    I called my mom panicking. My mom said that she and her twin brother always walk around like kitties and lick at people, arms, knee, hand or face. And we were talking about kitties and bums and it was likely nothing. No one has access to my children. My husband myself and my grandmother are the main care providers. I spoke to my husband when I was so upset about it, he too was shook up. My mom calmed us both down some. She said if it happened a bunch of times then worry about it. Not to make a huge deal out of it, which I admit I probably overreacted.

    The next morning we were snuggling. And she was watching YouTube on my cell phone. And I looked over and she was watching the show where there were people pooping things like that it’s called doodie man (totally inappropriate). And I recalled that my three-year-old had found the same show a few days before on her own. I will admit that we have been very negligent in monitoring what they’re watching on YouTube, which I feel absolutely horrible about. I wrongly assumed graphic content wouldn’t make its way on there. Anyway later that day my two-year-old licked her dolls butt. When I said that’s gross where did you learn that? She told me the bum was dirty, see? And she pointed to the (writing it was a Cabbage Patch doll) we refer to poopy pants as dirty bums.

    My gut tells me she saw something on YouTube, it was all within the three-day span of that. If you go to that cartoon I was referring to, the links that are below it that you can just touch and move to are all inappropriate. I sat through some of the doodie man, never saw the actual poop licking, but did she poop eating and various other things like that, so I wouldn’t be surprised if it was in there.

    I just can’t subject myself to hours of footage to try and find the one they may have seen. And I cannot see anyone in our life doing that. I cannot see my husband, or anyone else. But I don’t want to overlook something, yet I don’t want to over react as well.

    Please help. I feel like a $h!tty parent for letting them have youtube access, but they were watching kid stuff, and now I got complacent and I am paying for it :(

  4. J

    If you ask a 2/3 year old leading questions about someone touching them, like did such and such do this, is that a good way to do it. Furthermore, what if this is someone that normally changes and takes care of the child?

  5. sarah

    My 3yr goes to visitation at her dads/grandmother’s house 4x week with her almost 2yr brother. My daughter has come home several times with red, sore,and swollen genitals! My son came home with red and sore penis once! Each time it’s only their genitals and not the surrounding area. My daughter has been saying for about a week and a half her 7yr cousins touched her! Tonight she told me again and I asked her where they touched her? She said at Daddy’s. I asked her to touch herself where they touched her and she immediately put her hand to her genitals. She then told me her but too and they tickle her butt! I asked her if her 11yr cousin touched her? She said no, she touched brother (my son) and made him cry. I then asked her if she could show me were the cousin touched her brother, she pointed to my son’s penis. She then climbed on top of my son in the bathtub and started like humping him and making what I would call see noises. I’m worried and scared! I don’t know what to do or who to contact? Do I need to be concerned? My daughter also has tried sticking things in her vagina, stick her finger inside her butt, while sitting on the potty non stop playing with her self down there.

    • Hanna

      Get the child away from ALL those involved, seek legal advice and medical too. DO NOT ALLOW them to GO NEAR your ex or his mother or cousins or uncles or whomever.

      Protect YOUR CHILDREN. If you have these concerns, GO TO THE POLICE! S/S and or a GP. Just doing NOTHING is exactly that, doing NOTHING!!! These innocent children need YOU to protect them! She’s telling you abuse is happening to them both for, goodness sake!

      • sarah

        I have been to the police, dss and the hospital! I am being forced to send them into evil! I tried a restraining order and judge shot that down!! That whole side of family is very evil and have heavy mental illness. All reports I have made to the police or dss state it’s an ugly custody battle!

        What can I do to protect them/get something done!? I am just sick that no one will help or believe!!!!! My daughter tells me almost daily that @#÷×% and i_^::! Took her clothes off and her britches (what we call diapers/pull ups) and touched her butt and she touches her vagina. She will whisper we have to be very quiet and don’t tell! She keeps telling me s@&&€% takes her brothers clothes and britches off and touches him. My son is not yet 2 and he says s@&&€% plays Dr with him. My daughter keeps telling that i-^::! Nickel her brother down and held him down and refused to let him up! She gets very upset while telling it.

        I do believe the ex and his mom know what has happened! The ex’s family never call any of the kids by name ever it’s the boys, twins, the baby and little man. My daughter has said KIDS! DONT YOU EVER TOUCH EMMY LIKE THAT AGAIN! (Emmy is what she calls herself). It is court ordered that he gets the kids 2 days a week for 4 hrs and 2 days for 2hrs. The ex is majorly addicted to weed. He smokes it the minute he wakes up and continues to smoke it all day until he goes to bed. Unfortunately we live in a legal marijuana state so that is completely acceptable and he is back to drinking as well.

        I am at a loss and would love any and all help or advice to protect my kids and keep them safe! I want to protect them without the threat of losing my kids! I’ve been told if I don’t send them to evil then I will get contempt and he will get the kids! I am at a total loss! I have tried the legal ways to get help just to fail. The court facilitator is always trying to find a way to give my ex more time with the kids! I have been reporting to dss about my kids coming home bruised up, diaper rash to the point of blistering and bleeding, my daughter getting a very bad 2 degree burn to half her hand etc. And they say what do you want us to do about it? I am just at a total loss!!!

        • sarah

          The police told me that my daughter is acting out what she has heard or saw! I can honestly say my kids DO NOT see or hear this stuff with me!!!! My TV is 99% of the time on Disney Channel, the 1% on the on the little couple (my kids love Will and Zoe)! I am very careful what my kids watch in my care! And I strongly believe kids come before a boyfriend (honest opinion, kids first, then furkids, then a man!) My only hope is that their counselor can do something! She has most definitely seen major detrimental changes to BOTH my kids!!!!

  6. liezl

    I feel like I’m going crazy. My 2 year old told my the past Thursday that @#££% put his fingers in her did. For the life of me I can not recall the name. I got such a fright. I can still hear the name but also not hear it at the same time. I took her to a gp who suggested I work with her and try and get her to tell me the name again. I am trying. But she is mentioning all kinds of names. Please advise. I really need help.

  7. heather

    So if i have a feeling my husband could be doing things to my 4 yr old daughter there are places that i can call to talk to someone about it? I know something is going on cause she is so clingy she wont let me leave her alone nor him. She has her legs open so much i havent seen children do that it seems she makes his arm or hand go between her legs sometimes thats very odd to me. He wont stop taking showers with her she still doesnt wipe her own butt even though she is potty trained im just so worried.

    • Mandy medina

      Please stop letting him take showers with her! Why are you letting him do that? With all these concerns why would you allow that? Please be her protector and DO NOT ALLOW IT get some help for you and her. Find out! For sure!

      • Audrey

        Also, your daughter is 4 and that is extremely inappropriate for the father to be taking a shower with his daughter. EXTREMELY. If he’s telling you he’s the father and it’s okay, you’re overreacting, HE’S LYING. Are you isolated too?

        Are you so removed from others with children that you feel like your expectations and desires regarding how he treats your daughter seem unreasonable? You might be in an abusive relationship. No reasonable grown man would take a shower with his 4 year old daughter and expose himself like that. It’s gross, unacceptable, and completely INAPPROPRIATE.

    • Hanna

      You HAVE TO GET your DAUGHTER AWAY from that man. You should in NO WAY ALLOW abuse to be going on! You say you ‘have a feeling’ and that ‘you have evidence’ then for your daughters’ sake, PROTECT HER!!!!!!!!!!!!! I cannot believe some of these comments. Children are our responsibility. If you allow this to happen you are as bad as the abuser! How will she feel in 10-30 years from now that you just stood by and allowed this to happen. Get out and get her some help!


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