What constitutes sexual abuse? What’s the first step to take if you suspect that your child has been abused?

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 questionable situation is to have your child examined by a sexual abuse specialist. Most children's hospitals have a sexual abuse team, or will be able to refer you to a specialist in your area.

A sexual abuse examination is comprised of two basic elements. First, and perhaps most important, your child would be interviewed by an expert who very gently elicits information from her about what might have happened. The interviewer will let your child 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. Samples may be sent for STD testing and/or DNA testing (if there is evidence of bodily secretions present). In at least half of the cases of child abuse that are confessed by the abuser, there are no findings on physical exam.