Peter Winterbottom considers the implications for healthcare professionals of the distressing consequences of child sexual abuse

Sexual abuse of children is an ‘epidemic’: in the United Kingdom in 1995 there were 9,200 cases of sexually-abused children on ‘at risk’ registers, an increase of 250 per cent since 1989 (Department of Health 1996). Sexual abuse poses a risk of infection to children and its occurrence might only become apparent when the child presents at a clinic with a sexually-transmitted disease (Anderson 1995, Cohen et al 1993). Additionally, the nature of some common practices associated with sexual abuse, e.g. anal penetration, in addition to the fragile lining of immature mucosal barriers in children, add to the risk of transmission of HIV.