The sexual abuse of children is a widespread problem across the world. Sexual abuse during childhood refers to any kind of sexual relations that occur between a child and an immediate family member, caregiver, any other adult, or another child or teen. These interactions can range from inappropriate touching of the genitals and other body parts to forced sexual behaviors, such as vaginal, oral, or anal penetration. While only a few studies have been successfully conducted (largely due to the hesitancy of children to discuss this taboo subject), statistics indicate that a large percentage (8-12%) of children all over the world have experienced sexual abuse.³

International Prevalence of Childhood Sexual Abuse (CSA)

In Australia from 2009-2010, there were 286,437 notifications of child sexual abuse.¹³  Of all forms of abuse and maltreatment of children, sexual abuse accounted for 12.7%.¹³ In a study conducted on English students ranging from 9-16 years of age in 2008, 19% reported they were sexually abused, were almost sexually abused, or were abducted from their homes at some time in their lives.¹⁵  More female-identified students than male-identified students were assaulted (10.4% vs. 4.2% respectively).¹⁵  Most of the perpetrators were male-identified (88.2%), and although 79.9% of students disclosed their experience, only 33.3% reported to the police.¹⁵

In 2002, the United Nations studied violence against children.  One of their findings was that 150 million female-identified children and 73 million male-identified children under the age of 18 had experienced sexual violence, including forced sexual intercourse.¹⁸

Of all children subjected to maltreatment in the United States, which is almost 50%, 9.5% of them are sexually abused.¹⁵

Perpetrators and Difficulty with Disclosure

Before the age of 18, one in six female-identified children and one in twenty male-identified children will be sexually abused.¹⁹ However, much of this abuse goes unreported. It is difficult to determine the true frequency of CSA due to the power dynamics between the perpetrator and the survivor. Often, the perpetrator is in a position of power, is much older or more mature, or utilizes force or trickery.¹⁷ Thus, the perpetrator often makes the survivor feel shame and fear. This shame is towards themselves, as the survivor may start blaming themselves for the abuse that occurred.

The perpetrator may also use grooming tactics, which can make the child feel special and indebted towards them. Grooming can be shown in the form of special gifts or special outings with the child. The perpetrator may extend these tactics to the family to create a relationship or an emotional connection.

The perpetrator may be a trusted friend of the family, or a family member. The child may feel like telling someone is not an option because they are convinced they will not be believed, or that they brought the abuse upon themselves. Additionally, they may feel afraid of their perpetrator due to the possible retaliation or future punishment that disclosing their CSA may bring on if the perpetrator were to find out. A perpetrator’s coercive or manipulative tactics may also reduce the likelihood that a child discloses their abuse.³

Physical Effects

STIs

During the abuse, many perpetrators do not use barrier methods of protection. This includes male and female condoms. Other birth control methods (hormonal), such as oral contraceptives, the implant, or an IUD, would not protect against STIs. This leads CSA survivors to be susceptible to contracting sexually transmitted infections (STIs). Many STIs are treatable, however, children may not have access to proper healthcare and are often too young to know the signs of an STI. If left untreated, an STI may have lifelong physical effects on personal health and affect pregnancy.

Pregnancy

CSA often occurs during a period of time when children have not been introduced to birth control, or contraceptives. Therefore, most children are at a disadvantage since they do not have access to birth control and often cannot disclose the abuse to their caretakers in order to access it. 

If a child has started menstruating, then they are able to get pregnant and give birth. This leads to a high risk of pregnancy for CSA survivors, and studies have shown that survivors “tend to become pregnant at a younger age.”⁶ When survivors of CSA become pregnant, they must decide at a very young age whether to have a full-term pregnancy or to have an abortion. They may not have access to comprehensive healthcare, childcare, or be able to disclose their abuse to their caretakers. Under this pressure, they are not able to make a fully informed decision. 

Lack of Sleep 

Survivors of CSA tend to have difficulty sleeping. This includes:

• waking up often
• night terrors 
• bedwetting
• difficulty falling asleep

In a study of survivors of CSA in preschool, researchers found that children had significant difficulty with sleep following immediately after the abuse, as well as a year later.⁷ This is a common issue shared by survivors of CSA later in life.⁷

Substance Abuse

Survivors of CSA may turn to substances such as alcohol or drugs in order to numb the pain. While they may feel like they have this substance use under control, it can quickly lead to substance abuse that creates difficulty with everyday functioning, impairs their relationships, and affects their employment opportunities. Taking unprescribed medication or drugs is not recommended for dealing with sexual abuse.

Other

Some effects of CSA are not directly traceable. Survivors may experience pain or discomfort that they are not able to explain. Survivors of CSA have been more likely to experience “medically unexplained symptoms” than adults who are not survivors of CSA.⁸ These may include symptoms such as irritable bowel syndrome (IBS). Survivors of CSA have also been shown to have a higher chance of “bodily pain and migraine headaches.”⁸ The physical effects of CSA may not always be apparent but being aware of what other survivors of CSA experience may be beneficial for understanding symptoms. 

Mental Effects

The long-term impact for every survivor of sexual abuse is different. Some survivors may never develop mental disorders or issues. However, the risk of developing a mental disorder is doubled by experiencing CSA.⁵

Survivors may have issues that impact their everyday functioning. The most commonly reported issues are chronic PTSD, self-esteem issues, emotional distress, anxiety, depression, dissociation/depersonalization, substance abuse, and suicidal ideation.³ As a result of shame and stigma following the CSA, survivors may not seek help for their mental health. Talking to a doctor, a therapist, or a trusted friend may help the survivor feel less alone, but disclosure is not necessary in order for mental health to improve.

Depression

Survivors of CSA may experience depression. Depression is characterized by feelings of helplessness or hopelessness, difficulty sleeping, loss of interest in activities, and sadness. This is a mental health disorder that may make daily life difficult and lead to suicidal thoughts or ideation. If a survivor is experiencing suicidal thoughts or ideation, it is important for them to seek help. Many survivors use therapy or medication in order to regulate their depression.

PTSD

Survivors of CSA may experience post-traumatic stress disorder, or PTSD. PTSD develops in response to a traumatic experience, or a series of traumatic experiences. Those who experience PTSD can have flashbacks, difficulty sleeping, and recall the events that caused their PTSD.⁴ Survivors may have triggers that cause them to slip back into those memories. While they are recalling the events, they may not be as responsive or aware of the outside world. 

While it is normal for survivors to experience triggers or vividly recall traumatic events, these symptoms do not typically last for more than three months. If they do, it is a sign that the survivor may have PTSD.⁴

There is also a correlation between PTSD and sexual dysfunction.⁴ Survivors may experience erectile dysfunction or have difficulty with getting lubricated sufficiently. In these cases, it is important to talk about consent and communicate effectively. A “safe word” may be helpful for the survivor during sexual acts or everyday life in order to communicate that they are experiencing discomfort.

Dissociation/Depersonalization

Survivors of CSA may experience dissociation or depersonalization. Dissociation includes symptoms that can be described as a disconnection or alienation from surroundings.⁹ Depersonalization symptoms can include feeling detached from oneself, whether that be feeling detached from their body or from their identity.⁹ In both dissociation and depersonalization, people do not feel as if they are in the present. The purpose of dissociation and depersonalization is to help cope with traumatic, or incredibly stressful, events.

Survivors as young as preschoolers have been shown to experience dissociative symptoms.⁷ Adult survivors do not usually dissociate during sex more than non-CSA survivors, however, they do tend to experience more dissociative symptoms than non-CSA survivors throughout their daily lives.¹⁰

CSA survivors may have difficulty with sexual arousal, as they may feel detached from their bodies or disconnected from the present moment. However, not all survivors will experience sexual dysfunction. Survivors of CSA who experience depersonalization tend to have lower sexual arousal functioning, while those who experience derealization (feeling detached from reality) tend to have higher sexual arousal functioning.¹⁰

Body Image

Survivors of CSA may feel discomfort when they are in close proximity to other people.¹¹ This is due to their personal space not being respected during the CSA. They may also have negative feelings towards their own bodies. In addition, the survivor may feel objectified (or treated like an object) by the perpetrator. This may cause the survivor to feel a sense of shame. This may also be difficult to deal with during sexual relationships with new partners. 

A study exploring the dynamics of the self and the body tried contrasting the effects of CSA on those who identify as male or female. Their study found that there are “more similarities than differences” between these two genders in regard to the effects of CSA.¹¹

Houselessness

Many survivors of CSA have become houseless or have been “placed in accommodation where they did not feel safe or supported.”² This often occurs when the child runs away from home in an effort to physically remove themselves from the abuse, because the perpetrators are often a member of the family or a trusted friend of the family. Housing instability may also emerge later in life, causing difficulty with securing employment.²

Difficulty During Pregnancy 

Survivors may experience difficulty during pregnancy because their mental health, comfort with parenting, and relationship with their child can be affected by their history of CSA.⁶ CSA survivors tend to become pregnant at a younger age and they may not be ready to become a parent.⁶ In addition, survivors who give birth may be at an increased risk of depression in the period before birth, and their hormones may not be regulated properly during pregnancy.⁶ Being pregnant may also contribute to feelings of dissociation or to feeling a lack of control over their own bodies. Other survivors may feel overprotective towards their child or feel distress when they come into physical contact with them.⁶

It is important to be aware of these possible factors that come with being a parent who is a survivor of CSA. If these factors do become unmanageable during the pregnancy, or if survivors have concerns, they should consult their doctors. There are a variety of interventions during the perinatal period that may provide relief. These can be specifically geared towards survivors of CSA.

While these factors do influence the experience of raising a child, survivors can be excellent parents and often do give their children the care and support that they need. Children of survivors of CSA can also live very happy lives. This is a mutually beneficial relationship because having a child can contribute to the empowerment of a survivor, which can lead to increased feelings of “competence and control.”⁶ In this way, being a parent can contribute to the healing process. For those who have experienced prior difficulty with creating close connections with people, it can increase confidence.⁶Having a child can provide a fresh start for creating lifelong, healthy relationships.

Indicators

Sexual abuse indicators in children are different depending on the age of the child and may manifest physically or behaviorally. For example, a child may seem listless and withdrawn from their peers. Their anger towards their abuser may also show itself in unchecked aggression towards their peers. In addition, they may start experiencing sleep issues. Check out this article for more information on sexual abuse indicators in children.

Statute of Limitations (U.S.A.)

In the United States, each individual state has different laws in which a child is old enough to give consent (an active and clear communication between two partners that can be revoked at any time) for sexual relations. For example, in California, the age for consent is eighteen. The survivor may choose to file against their perpetrator if they were below the legal age limit at the time that the CSA occurred, or if they were above the age limit and were manipulated or pressured into giving consent.

Due to the nature of CSA, many survivors may not choose to disclose for years. This is due to mental health issues, the trauma they experienced, feeling triggered, or the memory loss associated with coping with trauma as a child. Thus, by the time survivors choose to file a claim, they may not be able to because the statute of limitations has passed. 

A statute of limitations is a set time period that determines how long a criminal can be held responsible for the crimes they committed.¹² In cases of CSA, the statute of limitations can  conserve the amount of data and evidence that can be used in a court of law. The longer that time passes, the less physical evidence there is and the more the survivor’s memory of the event declines. 

In the United States, different states have vastly different statutes of limitations for CSA. For example, Alabama requires the survivor to bring forth their claim within two years of the date of injury, while Delaware does not enforce a statute of limitations for claims regarding CSA.¹² These two states are on different ends of the spectrum, however, they highlight the confusion that may result from the inconsistencies between the states. 

One policy that favors survivors is not counting the years of the statute of limitations until the survivor turns eighteen. However, this can create stress for the survivor because they are in a race against the clock to decide to disclose and file a claim.¹² In a state such as Alabama, survivors do not have as much time to make a well-reasoned decision.

Healing After Childhood Sexual Abuse

Healing after CSA is a different process for everyone. Survivors of childhood sexual abuse may choose to disclose to their loved ones, however, this is a personal choice that many may not feel comfortable with. If survivors feel comfortable disclosing, they may choose to disclose and seek legal action against their abuser. Others may not find that this method brings them peace. They may find groups or therapists within their community where they can find comfort. There is a feeling of solidarity when a survivor understands that they are not alone. If survivors do not feel comfortable disclosing, they may find it useful to use introspection to explore the effects CSA had on their mental/physical health, educate themselves about triggers, and prioritize self-care. Survivors may be discouraged by their progress (or lack of it), however, there is no right answer for how to heal or how long it should take to heal. 

Concluding Remarks

Childhood sexual abuse affects many people around the world. This article highlights some of the effects CSA has on mental and physical health. Every survivor’s story and method for coping is different. Survivors may choose to disclose the information about their abuse to their loved ones or to the relevant authorities, but this may not be the right choice for everyone. For further information on CSA, check out our articles on sexual abuse indicators in children, survivors of childhood sexual abuse, and myths and facts on childhood sexual abuse.

References

1. “Sexual Abuse in Childhood” from Chapter 3.3: Sexual Abuse in Childhood on the Johns Hopkins University Website, December 1999. 
2. Independent Inquiry Into Child Sexual Abuse. “Victim and Survivor Voices from the Truth Project.” IICSA Independent Inquiry into Child Sexual Abuse, 27 Nov. 2017.
3. Hanson, Rochelle F, and Cristin S Adams. “Childhood Sexual Abuse: Identification, Screening, and Treatment Recommendations in Primary Care Settings.” Primary Care, U.S. National Library of Medicine, June 2016.
4. Richard J. McNally, Alexandre Heeren & Donald J. Robinaugh (2017) A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse, European Journal of Psychotraumatology, 8:sup3, 1341276.
5. Rapsey, Charlene M., et al. “Childhood Sexual Abuse, Poly-Victimization and Internalizing Disorders across Adulthood and Older Age: Findings from a 25-Year Longitudinal Study.” Journal of Affective Disorders, vol. 244, 2019, pp. 171–179.
6. Stephenson, Lucy A., et al. “Perinatal Interventions for Mothers and Fathers Who Are Survivors of Childhood Sexual Abuse.” Child Abuse & Neglect, vol. 80, 2018, pp. 9–31.
7. Hébert, Martine, et al. “Sleep Problems and Dissociation in Preschool Victims of Sexual Abuse.” Journal of Trauma & Dissociation, 2016, pp. 1–15.
8. Easton, Scott D., and Jooyoung Kong. “Mental Health Indicators Fifty Years Later: A Population-Based Study of Men with Histories of Child Sexual Abuse.” Child Abuse & Neglect, vol. 63, 2017, pp. 273–283.
9. Dearden, Joanna, and Nick Medford. “Functional Neurological Symptoms Following Childhood Sexual Abuse: the Role of Depersonalisation.” Journal of Neurology, Neurosurgery & Psychiatry, vol. 88, no. 8, 2017, doi:10.1136/jnnp-2017-bnpa.25.
10. Bird, Elizabeth R., et al. “Dissociation During Sex and Sexual Arousal in Women With and Without a History of Childhood Sexual Abuse.” Archives of Sexual Behavior, vol. 43, no. 5, 2013, pp. 953–964.
11. Talmon, Anat, and Karni Ginzburg. “‘Body Self’ in the Shadow of Childhood Sexual Abuse: The Long-Term Implications of Sexual Abuse for Male and Female Adult Survivors.” Child Abuse & Neglect, vol. 76, Feb. 2018, pp. 416–425.
12. Ovrom, Theodore R.A. “Reasonable for Whom? Developing a More Sensible Approach to the Discovery Rule in Civil Actions Based on Childhood Sexual Abuse.” Iowa Law Review, 24 Apr. 2018.
13. Alister Lamont. “How Many Reports are Made to Child Protection Services in Australia Each Year?” Table 1. Sept 2011.
14. Gallagher, Bernard, et al. “Attempted and Completed Incidents of Stranger-Perpetrated Child Sexual Abuse and Abduction.” Child Abuse & Neglect, vol. 32, no. 5, 2008, pp. 517–528.
15. Hopper, Jim. “Child Abuse Statistics.” Jim Hopper, PH.D., May 2010,
16. Gaudiosi, John. “Child Maltreatment 2009.” Figures3-1 and 3-4. 2009.
17. Sauda Burch and Staci Haines. “Adult Survivors of Child Sexual Abuse.” Support for Survivors: Training for Sexual Assault Counselors.
18. “World Health Organization Says Violence against Children Can and Must Be Prevented.” World Health Organization, World Health Organization, 8 Dec. 2010,
19. “California Megan’s Law Website State of California Department of Justice Office of the Attorney General.” California Megans Law, 11 May 2015.

Last Updated: 22 November 2019