The following is (mostly) a summary on the above article from the Singapore Medical Association publication (p.5-7). It was written by Eirliani Abdul Rahman. (She won BMW Foundation Responsible Leaders Award in 2015 and maintained entries on the The Huffington Post, India).
Child sexual abuse (CSA, which counts incest as a subset), has various potential impacts. In the immediate timeframe, there is risk of:
‘…fearfulness, acute stress disorder, hostility and aggression, depression, low self-esteem, guilt and shame, eating and sleeping disorders, acting out, cognitive disability, developmental delay and inappropriate sexual behaviour.
Consequently, in the long run, the adult inclinations exhibited possibly are:
- emotional shutdown/lockdown
- self punishment emotionally and physically
- being perturbed around children due to confusion about what constitutes proper physical contact
Doctors may be the first to discover such abuse and affirm the child (as the non-offending) adult in the event of disclosure of the abuse. It could then prevent aggravation of the earlier mentioned outcomes.
How the abuse happens is when the adult gets close to the target such as through common interests. This could take up to years. Gradually, the offender crosses different stages from sexual jokes, playing, then to ‘accidentally’ touching the child to achieve desensitisation (or also in my interpretation Pavlovian conditioning). (Apparently), it is not rare for abusers to explicitly inform the children they are to blame for causing the abuse.
One indicator is physically on the body:
- bleeding, swelling, itching in genitals
- trouble in standing/walking
- repeated yeast/urinary tract infections
- stained/bloody/torn underwear
Another relates to actions:
- bed wetting at age 11 i.e. going back to younger days (‘regression’)
- sexual information beyond age group generalisations (typically, a child up to 4 years could display interest in private parts; while from 5 to 9, there is discussion about the private areas but the child has comprehension that the areas are restricted to him/herself or appropriate persons; then puberty etc.)
- abrupt withdrawal/seclusion
- fear of family member/friend/specific person
- weight gain/loss
- bathe unnecessarily/ remain dirty
- self multilation
- night terrors
- avoid physical contact
The doctor involved has the option to verify the abuse with guardian/parent(s). This is precluded if the carers are the suspects. The medical professional has then to check with the child. The author mentions it is imperative to ‘respect what your child patient wants you to do…’ and ‘…first explain to the child any decisions that you make.’
If the decision of the child is to expose the abuse, the parent(s)/guardian(s), assuming they are the innocent parties, need to be informed. Contact with the offender(s) is to be cut off.
The doctor can thereafter report to the Child Protective Service Helpline: 1800-777 0000 (or as directed by the Ministry of Social and Family Development, the Police Divisional HQ or the nearest Neighbourhood Police Post).