Doctor describes horrors of sex abuse

A child you know likely will be abused; you can help prevent it.

***This article includes graphic details***

As a medical resident, I saw a 4-year-old girl with a large tear in her vagina that required surgery to put it back together. I couldn’t image what had happened. The family said she fell on the top of a plunger. The examination (and common sense) said otherwise. The mother’s boyfriend was eventually prosecuted for sexual abuse.

I’ve seen many more cases during my time as a pediatrician. I’ve collected evidence from young victims’ bodies, scraping their mouths and privates with cotton swabs, pulling hair from their heads and pubic areas, and taking pictures of marks and bruises. I’ve tested children for gonorrhea, chlamydia, syphilis and HIV. I’ve testified in court and worried if what I said would do more harm than good.

Sex abuse is an incredibly harsh reality in our society. According to the Nation Crime Victims Survey, one in every five girls and one in every 10 boys will be sexually abused in their lifetime. It’s likely you know a child who has been or will be abused.

Just as startling is that most perpetrators start at a young age — more than one-third of all sexual crimes against children are committed by juveniles. Adult offenders report their first criminal act occurred at the average age of 14.

What’s even scarier is this epidemic goes largely undetected. Only 5 to 15 percent of children ever tell anyone the abuse is happening. Most perpetrators will never be caught because no one will ever expose them. It’s even difficult to tell from a medical perspective as a very small percentage of child sex abuse victims have any abnormalities during physical exams.

This is why parents and caregivers must know the warnings signs. Sex abuse often happens because most adults don’t know what to look for and don’t want to believe it.

The perpetrators aren’t stupid. They target specific children, families, job opportunities and communities where they have access to a large number of children. They gain trust of the family so if a child ever tells on them it will be incredibly hard for someone to believe the child. They begin slowly exposing children to physical touching such as “wrestling, hugging, tickling, massages and backrubs” then begin sexualized talk, exposure to nudity and eventually physical sexual encounters.

Child sexual abuse is usually not just a single event but occurs over time. Perpetrators look to fill voids a child or family has, such as single parents, uninvolved parents or children with lack of boundaries. They may shower a child with attention, affection, special privileges or gifts.

Children may drop hints of sex abuse. For example, a child may say “Joey (her older brother) is bothering me at night.” If a parent asks more questions, she may then say “He’s coming into my room at night and touching me.”

Parents must be open, caring and nonjudgmental. Always believe the child and get help — the instances of children making up sex abuse stories is extremely small.

Tips on how to prevent sex abuse:

1. Use appropriate language when you talk about your children’s genitalia, such as vagina, breasts and penis instead of private areas.
2. Talk about how it’s not OK for someone to ask to see, touch or take pictures of your child’s genitals.
3. If you find your children looking at each other’s genitals or they have searched pictures on the internet, stay calm. Ask open-ended questions and have a discussion about it.
4. Set age-appropriate limits for TV, radio, music, games and internet access.
5. Monitor your child’s social media and internet use. Consider not allowing your child to have internet access alone in their bedroom.
6. Be aware of any adult who seems more interested in your child than you.
7. Check the sex offender registry.

Signs of sex abuse in a child:

1. Increased sexualized behaviors, such as acting seductively or sexually through dolls or toys
2. More sexual knowledge beyond normal level of development
3. Sleep problems and eating disorders, such as bulimia, anorexia or overeating
4. Bowel problems, such as soiling oneself or genital/rectal pain or bleeding
5. Sudden or unexplained personality changes, including aggression, fear and depression
6. Thoughts or talking about suicide
7. Drop in school performance
8. Drug use
9. Running away from home
10. Resistance to spending time with a certain adult or asking to spend more time with them due to gifts and attention

All Kentuckians are required to report suspected child abuse. Call (877) KY-SAFE1. For more information, visit or call (800) CHILDREN.