Children's use of sexual body part terms in witness interviews about sexual abuse

Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed?

When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors ("children"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or "endosex" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from "cosmetic" labiaplasty to medicalized ritual "pricking" of the vulva, insofar as the procedure is not strictly necessary to protect the child's physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child's privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter's sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.

Initial Medical Assessment of Possible Child Sexual Abuse: History, History, History

Primary care professionals (PCPs) can play a valuable role in the initial assessment of possible child sexual abuse (CSA), an all too prevalent problem. PCPs, however, are often reluctant to conduct these assessments. The goal of this paper is to help PCPs be more competent and comfortable playing a limited but key role. This is much needed as there may be no need for further assessment and also because of a relative paucity of medical experts in this area. While some children present with physical problems, the child's history is generally the critical information. This article therefore focuses on practical guidance regarding history-taking when CSA is suspected, incorporating evidence from research on forensic interviewing. We have been mindful of the practical constraints of a busy practice and the role of the public agencies in fully investigating possible CSA. The approach also enables PCPs to support children and their families.

Attorneys' Questions and Children's Responses Referring to the Nature of Sexual Touch in Child Sexual Abuse Trials

Eliciting clear descriptions of sexual body parts and abusive touch in child sexual abuse trials is challenging because of children's immaturity and embarrassment. This study examined references to sexual body part knowledge and sexual touch in attorneys' questions and 5- to 10-year-old children's responses (N = 2,247) in 113 child sexual abuse trials. Regardless of children's age, attorneys and children primarily used unclear colloquialisms to refer to sexual body parts. Questions asking children to name sexual body parts elicited more uninformative responses than questions about the function of sexual body parts. In turn, questions about the function of sexual body parts were more likely to increase the specificity of body part identifications than questions about the location of sexual body parts. Attorneys predominantly used option-posing (yes-no and forced choice) questions to ask about sexual body part knowledge, the location of touch, the method or manner of touching, skin-to-skin contact, penetration, and how the touching felt. Generally, wh- questions were no more likely than option-posing questions to elicit uninformative responses, and consistently elicited more child-generated information. The results question the legal assumption that children's uninformative responses when testifying about sexual abuse should be overcome by asking option-posing questions.

Imprecision About Body Mechanics When Child Witnesses Are Questioned About Sexual Abuse

In child sexual abuse cases, a central part of the child's testimony is their description of the abuse episode. However, it is often difficult for children to describe the body mechanics of abuse, and miscommunications are likely to occur. In the present study, we examined questions about the mechanics of abuse in trial transcripts (N = 63) to identify sources of miscommunication (N = 130) between attorneys and children (5-12 years old, M age at trial = 9.44, SD = 1.97). We found that both attorneys and children used imprecise language, which led to miscommunication. Specifically, the imprecise use of sexual terminology and the word "touch," polarity items, broad open-ended questions, anaphora and elliptical questions, and "how" questions led to imprecision in attorneys' questions. Imprecise attorney questions often elicited underinformative answers from children, including misinterpretations of the grain size (i.e., level of detail) requested. In response to these underinformative answers, attorneys at times asked highly focused and leading questions, which led to further miscommunications. Implications and recommendations for future research on how best to elicit details about the mechanics of abuse from children are discussed.

Raising the Awareness of Students in a Child Development Department regarding the Prevention of Child Sexual Abuse

The purpose of this study was to evaluate the effectiveness of the training given to raise awareness of child sexual abuse among students at a Turkish University. For this study, a quasi-experimental method, the single group pretest posttest model, was used. The data were collected using a questionnaire that was distributed to students in the Department of Child Development before and after relevant training. The study sample consisted of 87 participants. In this study, increased awareness was indicted by the participants' understanding of good and bad touching following the instruction. In addition, the attitudes of the participants regarding the use of correct anatomical names when teaching about the genitals and their knowledge of the special regions of the body increased (p <.05). The findings of the study showed that the "awareness training" was an effective program for increasing sensitivity regarding the prevention of sexual abuse. Consequently, it is recommended that lessons on child abuse should be included in the university educational curriculum, and that programs promoting sensitivity to this issue should be promoted. It is also recommended that similar studies, with larger samples, should be carried out in the fields of educational science and health science.

Gender and generation perspectives in the narratives of sexually abused women in childhood

Objective:

to analyze the narratives of sexually abused women in childhood, identifying issues related to gender and generation.

Method:

descriptive research with a qualitative approach, based on 214 reports selected from the Brazilian campaign #primeiroassedio (first harassment), which took place on Twitter social network, collected from a structured instrument. Thematic content analysis was used.

Results:

girls were the main victims of sexual abuse. The perpetrators were mostly male and people they knew. Five categories emerged from the narratives: Sexual abuse in the aggressors’ discourse; The child as the object of sexual pleasure; Violated childhood; Victims’ guilty feelings; and Repercussions of sexual abuse experienced in childhood.

Conclusion:

sexual abuse often occurs in the family context and, even if sometimes veiled, the submission of girls’ power in gender relations and of children in generation relationships is evident. Analyzing sexual abuse under the categories of gender and generation contributes to an in-depth understanding of the phenomenon, directing practices more effectively to their coping.