Zusammenfassung
10–15% der Kinder einer kinder- und jugendgynäkologischen Sprechstunde werden unter dem Verdacht des sexuellen Missbrauchs vorgestellt. Die sorgfältige Untersuchung und Dokumentation aller Auffälligkeiten ist wichtig. Der sichere Beweis gelingt nur selten (anogenitale Verletzungen mit eindeutiger Anamnese, Nachweis von Spermien- /Ejakulatflüssigkeit und Schwangerschaft). Die Untersuchung sollte so gestaltet werden, dass sie vom potenziellen Opfer nicht erneut als Traumatisierung empfunden wird.
Vom Normalbefund sind unspezifische (z. B. Vulvovaginitis), spezifische (z. B. sexuell übertragbare Erkrankungen) und beweisende Befunde zu trennen. Das Opfer muss von erfahrenen Ärzten, Psychologen und Sozialarbeitern betreut werden. Die wichtigsten präventiven Maßnahmen sind: Stärkung der Autonomie und des Selbstbewusstseins der Kinder, die Sensibilisierung der Öffentlichkeit, Aufklärungsarbeit in Schulen und anderen kinderbetreuenden Einrichtungen und das Erkennen von Risikokonstellationen.
Abstract
From 10–15% of children presenting at a pediatric gynecologist are referred for the determination of possible sexual abuse. In such cases, the careful examination and documentation of all suspicious findings is of extreme importance. Obvious evidence of sexual abuse, such as anogenital injuries without other explanations, the presence of semen or seminal plasma or a pregnancy, is rarely found. The gynecological examination needs to be performed without retraumatizing the potential victim.
The physician should be trained to differentiate between normal physiological, non-specific/specific findings and evidence of sexual abuse. An interdisciplinary assessment of the case should be performed.
The most important preventive measures are the strengthening of the child's autonomy, the careful identification of family related risk and the systematic cooperation with schools and social organizations.
Literatur
Frauennotruf München (2001) Eigene Statistik. S 10–11
Balogh R, Bretherton K, Whibley S et al. (2001) Sexual abuse in children and adolescents with intellectual disability. J Intellect Disabil Res 45: 194–201
Carlstedt A, Forsman A Soderstrom H (2001) Sexual child abuse in a defined Swedish area 1993–97: a population-based survey. Arch Sex Behav 30: 483–493
Tutsch-Bauer E, Rauch E Penning R (1998) Rechtsmedizinische Aspekte bei Verdacht auf sexuellen Mißbrauch. Dtsch Ärztebl 95: A-1027–1032
Navratil F (2002) Diagnostik und Befunderhebung bei Verdacht auf sexuellen Mißbrauch. Kinder- undJugendgynäkologie 257–269
Navratil F (1997) The genital examination in suspected child sexual abuse. A diagnostic dilemma. Ann N Y Acad Sci 816: 414–421
Lowy G (1992) Sexually transmitted diseases in children. Pediatr Dermatol 9: 329–334
Hadlich SF Kohl PK (1998) Sexually transmitted diseases in children. A practical approach. Dermatol Clin 16: 859–861, xvi
Siegel RM, Schubert CJ, Myers PA Shapiro RA (1995) The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics 96: 1090–1094
Gardner JJ (1992) Comparison of the vaginal flora in sexually abused and nonabused girls. J Pediatr 120: 872–877
Robinson AJ, Watkeys JE Ridgway GL (1998) Sexually transmitted organisms in sexually abused children. Arch Dis Child 79: 356–358
Hammerschlag MR (1998) Sexually transmitted diseases in sexually abused children: medical and legal implications. Sex Transm Infect 74: 167–174
Bump RC Buesching WJ 3rd (1988) Bacterial vaginosis in virginal and sexually active adolescent females: evidence against exclusive sexual transmission. Am J Obstet Gynecol 158: 935–939
Ingram DL, Everett VD, Lyna PR, White ST Rockwell LA (1992) Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse. Pediatr Infect Dis J 11: 945–950
Ingram DM, Miller WC, Schoenbach VJ, Everett VD Ingram DL (2001) Risk assessment for gonococcal and chlamydial infections in young children undergoing evaluation for sexual abuse. Pediatrics 107: E73
Ross JD, Scott GR Busuttil A (1993) Trichomonas vaginalis infection in pre-pubertal girls. Med Sci Law 33: 82–85
zur Hausen H (1986) Intracellular surveillance of persisting viral infections. Human genital cancer results from deficient cellular control of papillimavirus gene expression. Lancet I: 489–491
Syrjanen S Puranen M (2000) Human papillomavirus infections in children: the potenzial role of maternal transmission. Crit Rev Oral Biol Med 11: 259–274
de Jesus LE, Cirne Neto OL, Monteiro do Nascimento LM, Costa Araujo R, Agostinho Baptista A (2001) Anogenital warts in children: sexual abuse or unintentional contamination? Cad Saude Publica 17: 1383–1391
Pitche P, Kombate K, Gbadoe AD, Tchangai-Walla K (2001) [Anogenital warts in young children in hospital consultation in Lome (Togo). Role of transmission by sexual abuse]. Med Trop 61: 158–162
Gross G (1992) Condylomata acuminata in childhood—a sign for sexual abuse. Dermatologist 43: 120–125
Wachter I (2002) Sexual assault and sexual abuse in childhood and adolescence. Gynäkologe 35: 372–378
Bussen S, Rehn M, Haller A, Weichert K Dietl J (2001) Genital findings in sexually abused prepubertal girls. Zentralbl Gynakol 123: 562–567
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Anthuber, S., Anthuber, C., Haerty, A. et al. Sexueller Missbrauch von Kindern und Jugendlichen. Gynäkologe 36, 10–17 (2003). https://doi.org/10.1007/s00129-002-1313-2
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DOI: https://doi.org/10.1007/s00129-002-1313-2