Introduction There has been an 85% increase in the total number of police-recorded sexual offences against children and young people (CYP) in the UK, between 2010/11 and 2014/15. Many children delay disclosure, raising a question as to the clinical yield from anogenital examination in historic cases, as much research has focussed on findings following acute assessment of child sexual abuse (CSA). We sought to identify the clinical and CSA– related characteristics in children presenting non-acutely to a specialised historic CSA clinic.
Methods CYP under 17 completed years presenting with a suspicion or historic allegation of CSA (one week to one year after the alleged episode) between October 2009 and November 2014 were included. Prospective data included referrer, perpetrator, type of abuse including penetrative or non-penetrative, disability, family history of CSA/domestic violence, and physical findings. Full history and examination including colposcopy (with dual reporting) were recorded on a standardised proforma.
Results Among the 249 children (80% girls), most referrals originated from Social Care (56.5%), and the remainder from paediatricians (24%), primary care (9%), police (7%) and others (1%). Ages ranged from 0 –17 years (median 7, standard deviation 4.3). In 14% (36/249) cases, the child had a reported disability. There was a history of CSA in the mother in 17% (26/153) and domestic violence in 8% (12/153). Among the 70% (190/249) of cases with an alleged perpetrator, 66% (126/190) were from the victim’s family environment. Average age was significantly higher in those presenting with alleged penetration (p<0.001). Anogenital examination was carried out in 232/249 (93%) cases; seven refused, and nine had a prior examination. Anogenital findings supportive of CSA were found in 18 (7%) children, all of who were female, and had alleged penetration (p<0.001); 12/18 (66%) were over 13 years old. There were three children with sexually transmitted infections (STI).
Conclusion There was a large portion of alleged intrafamilial perpetrators of historic CSA. Significant numbers of children had anogenital findings supportive of CSA and STIs were present, despite the historic nature of presentation. These findings reiterate the clinical and forensic importance of a comprehensive clinical examination, even in historical allegations.
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