Was the crime reported? Global estimates have also documented substantial sexual abuse among boys. Child sexual abuse is predominantly seen as a social evil and crime against humanity, but it is equally a serious public health problem. Yet our response understandably revolves around the perpetrator. Has the accused been arrested? Will the prosecution succeed? What punishment will follow?
Approximately one in eight girls/women, experienced rape or sexual assault before turning 18, according to UNICEF 2024 estimates.
The first contact with the healthcare system is crucial. Depending on the nature and timing of the assault, the child may require treatment for physical injuries, testing and treatment for sexually transmitted infections, and assessment of the risk of HIV. Hepatitis B and HPV vaccination, STI prophylaxis or treatment and pregnancy-related care may also be required. This is why medical examination after sexual assault cannot become merely an exercise in collecting evidence for a criminal case. Evidence matters, but the survivor is also simultaneously a patient sitting in front of the doctor. others may develop post-traumatic stress disorder (PTSD), depression, anxiety, nightmares, intrusive memories, hypervigilance or dissociation While some children recover with family support and appropriate care. Self-harm, suicidal thoughts, eating disorders, substance misuse and behavioural problems can also occur. Longer-term difficulties may involve self-worth, emotional regulation, trust, intimacy and relationships. Experiencing trauma does not automatically mean developing a psychiatric disorder. Outcomes vary with age, developmental stage, duration of abuse, relationship with the perpetrator and support following disclosure. This is why every survivor should receive a baseline mental health assessment covering mood, sleep, behaviour, schooling, relationships, self-harm and suicidality. Its purpose is not to label the child as mentally ill, but to establish a clinical reference point from which recovery or emerging difficulties can be followed. Treatment must be individualised. Supportive psychotherapy and counselling may be sufficient for some. Children with significant symptoms require assessment by trained mental health professionals. Cognitive behavioural therapy helps identify connections between thoughts, emotions and behaviour and develops healthier ways of responding to distress. For children and adolescents with post-traumatic stress symptoms or PTSD, trauma-focused cognitive behavioural therapy, or TF-CBT, is an important evidence-based option. It can teach skills to manage anxiety, gradually and safely process traumatic memories, challenge beliefs such as self-blame and help restore normal functioning. Other interventions, including interpersonal psychotherapy for appropriate emotional disorders and EMDR for PTSD, may have a role depending on clinical assessment. The principle is that every survivor deserves an assessment and access to care, but not every survivor needs the same treatment. Eventually, the success of our response cannot be measured only by whether justice was set in motion: it is whether the infection was prevented, whether reproductive healthcare was provided, whether the child’s mental health was assessed, whether treatment was available when needed, whether the family knew how to support the child, whether the child returned to school and, ultimately, whether that child was able to move forward.
When indicated, HIV post-exposure prophylaxis should be started as early as possible and within 72 hours. Emergency contraception can be offered to girls at risk of pregnancy who present within 120 hours.
