Child sexual abuse

{{Short description|Form of child abuse}}
{{redirect|Child sex offender|sex crimes committed by minors|Juvenile sex crimes}}
{{redirect|Child exploitation|non-sexual exploitation of children|Child labour}}
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{{Criminal law}}
{{Sex and the law}}
'''Child sexual abuse''' ('''CSA'''), also called '''child molestation''', is a form of [[child abuse]] in which an adult or older adolescent uses a [[child]] for [[sexual stimulation]].<ref name=medline2008>{{cite web|url=https://www.nlm.nih.gov/medlineplus/childsexualabuse.html |title=Child Sexual Abuse |work=Medline Plus|date = 2008-04-02 |publisher=U.S. National Library of Medicine}}</ref><ref name="APA Guidelines">{{Cite journal|title=Guidelines for psychological evaluations in child protection matters. Committee on Professional Practice and Standards, APA Board of Professional Affairs|url=https://archive.org/details/sim_american-psychologist_1999-08_54_8/page/586|journal=The American Psychologist |volume=54 |issue=8 |pages=586–593|date=August 1999|pmid=10453704 |doi=10.1037/0003-066X.54.8.586 |quote='''Abuse, sexual (child)''': generally defined as contacts between a child and an adult or other person significantly older or in a position of [[Abusive power and control|power or control]] over the child, where the child is being used for sexual stimulation of the adult or other person.}}</ref> Forms of child sexual abuse include engaging in [[Human sexual activity|sexual activities]] with a child (whether by asking or pressuring, or by other means), [[indecent exposure]], [[child grooming]], and [[child sexual exploitation]],<ref name="Williams discussion">{{cite web |last1=Williams |first1=Mike |title=The NSPCC's Protect & Respect child sexual exploitation programme: a discussion of the key findings from programme implementation and service use |date=2019 |url=https://learning.nspcc.org.uk/media/1699/a-discussion-key-findings-from-programme-implementation-service-use.pdf |website=National Society for the Prevention of Cruelty to Children |access-date=29 March 2019 |archive-url=https://web.archive.org/web/20190329145421/https://learning.nspcc.org.uk/media/1699/a-discussion-key-findings-from-programme-implementation-service-use.pdf |archive-date=29 March 2019}}</ref><ref name ="Williams one">{{cite web |last1=Williams |first1=Mike |title=Evaluation of the NSPCC's Protect & Respect child sexual exploitation one-to-one work |date=March 2019 |url=https://learning.nspcc.org.uk/media/1702/protect-respect-evaluation-one-to-one.pdf |website=National Society for the Prevention of Cruelty to Children |access-date=29 March 2019}}</ref><ref name ="Williams group">{{cite web |last1=Williams|first1=Mike |title=Evaluation of the NSPCC's Protect & Respect Child Sexual Exploitation Group Work Service |date=March 2019 |url=https://learning.nspcc.org.uk/media/1703/protect-respect-evaluation-group-work.pdf |website=National Society for the Prevention of Cruelty to Children |access-date=29 March 2019}}</ref> such as using a child to produce [[child pornography]].<ref name=medline2008/><ref name=nspcc/>

Child sexual abuse can occur in a variety of settings, including home, school, or work (in places where [[child labor]] is common). [[Child marriage]] is one of the main forms of child sexual abuse; [[UNICEF]] has stated that child marriage "represents perhaps the most prevalent form of sexual abuse and exploitation of girls".<ref name=":1">{{cite web|url=http://www.unicef.org/chinese/protection/files/Child_Marriage.pdf|title=UNICEF|website=unicef.org|access-date=2014-01-03|archive-date=2019-10-10|archive-url=https://web.archive.org/web/20191010153612/https://www.unicef.org/chinese/protection/files/Child_Marriage.pdf}}</ref> The effects of child sexual abuse can include [[Depression (mood)|depression]],<ref name="Roosa"/> [[post-traumatic stress disorder]],<ref name="widom"/> [[anxiety]],<ref name="levitan"/> [[complex post-traumatic stress disorder]],<ref>{{cite journal |doi=10.1002/jts.2490100403 |title=Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for posttraumatic stress disorder |url=https://archive.org/details/sim_journal-of-traumatic-stress_1997-10_10_4/page/539 |year=1997|last1=Roth |first1=Susan |last2=Newman |first2=Elana |last3=Pelcovitz |first3=David |last4=Van Der Kolk |first4=Bessel|last5=Mandel |first5=Francine S.|journal=Journal of Traumatic Stress |volume=10 |issue=4 |pages=539–55 |pmid=9391940}}</ref>{{Not in body|date=August 2023}} propensity to further [[victimization]] in adulthood,<ref name="Messman-Moore"/> and physical injury to the child, among other problems.<ref name="dinw"/> Sexual abuse by a family member is a form of [[incest]] and can result in more serious and long-term [[psychological trauma]], especially in the case of [[parental incest]].<ref name=Courtois>{{Cite book|last=Courtois |first=Christine A. |title=Healing the incest wound: adult survivors in therapy |url=https://archive.org/details/healingincestwou00cour |publisher=Norton |location=New York |year=1988 |page=[https://archive.org/details/healingincestwou00cour/page/208 208] |isbn=978-0-393-31356-7}}</ref>

One study found an estimated 19.7% of females and 7.9% of males experienced some form of child sexual abuse prior to the age of 18.<ref name="pereda" /> Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles, or cousins;<ref>{{Cite web|url=https://www.nsopw.gov/en-US/Education/FactsStatistics?AspxAutoDetectCookieSupport=1|title=Raising Awareness About Sexual Abuse: Facts and Statistics|website=NSOPW|access-date=18 October 2017|archive-url=https://web.archive.org/web/20190310222140/https://www.nsopw.gov/en-US/Education/FactsStatistics|archive-date=2019-03-10}}</ref>{{Not in body|date=August 2023}} around 60% are other acquaintances, such as "friends" of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases.<ref name=Whealin/> Most child sexual abuse is committed by men; studies on female child molesters show that women commit 14% to 40% of offenses reported against boys and 6% of offenses reported against girls.<ref name=Whealin/><ref name="Finkelhor1994"/><ref>{{Cite journal |vauthors=Dube SR, Anda RF, Whitfield CL, etal |title=Long-term consequences of childhood sexual abuse by gender of victim|url=https://archive.org/details/sim_american-journal-of-preventive-medicine_2005-06_28_5/page/430 |journal=American Journal of Preventive Medicine|volume=28 |issue=5 |pages=430–438|date=June 2005|pmid=15894146 |doi=10.1016/j.amepre.2005.01.015|citeseerx=10.1.1.189.5033}}</ref>{{Not in body|date=August 2023}}

The word ''[[pedophile]]'' is commonly applied indiscriminately to anyone who sexually abuses a child,<ref name="ames"/> but child sexual offenders are not pedophiles unless they have a strong sexual interest in [[prepubescent]] children.<ref name="barbaree-seto"/><ref name=Oxford>{{Cite book|last1=Blaney|first1=Paul H.|last2=Millon|first2=Theodore|title=Oxford Textbook of Psychopathology (Oxford Series in Clinical Psychology)|edition=2nd|year=2009|publisher=Oxford University Press, US|quote=Some cases of child molestation, especially those involving incest, are committed in the absence of any identifiable deviant erotic age preference. |isbn= 978-0-19-537421-6 |page=528}}</ref>{{Not in body|date=August 2023}} Under the law, ''child sexual abuse'' is often used as an [[umbrella term]] describing criminal and civil offenses in which an adult engages in sexual activity with a [[Minor (law)|minor]] or exploits a minor for the purpose of sexual gratification.<ref name=nspcc>{{cite web|url=https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/child-sexual-abuse/what-is-csa/?_t_id=1B2M2Y8AsgTpgAmY7PhCfg%3d%3d&_t_q=child+sexual+abuse&_t_tags=language%3aen%2csiteid%3a7f1b9313-bf5e-4415-abf6-aaf87298c667&_t_ip=130.113.202.161&_t_hit|title=What is sexual abuse?|work=NSPCC|access-date=12 January 2016|archive-url=https://web.archive.org/web/20160124182516/https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/child-sexual-abuse/what-is-csa/?_t_id=1B2M2Y8AsgTpgAmY7PhCfg%3d%3d&_t_q=child+sexual+abuse&_t_tags=language%3aen%2csiteid%3a7f1b9313-bf5e-4415-abf6-aaf87298c667&_t_ip=130.113.202.161&_t_hit|archive-date=24 January 2016}}</ref><ref>[http://www.sp2.upenn.edu/~restes/CSEC_Files/CSEC_Bib_August_2001.pdf The Sexual Exploitation of Children] {{webarchive |url=https://web.archive.org/web/20091122123053/http://www.sp2.upenn.edu/~restes/CSEC_Files/CSEC_Bib_August_2001.pdf |date=November 22, 2009 }}, ''Chart 1: Definitions of Terms Associated With the Sexual Exploitation (SEC) and Commercial Sexual Exploitation of Children (CSEC)'' (p. 4), [[University of Pennsylvania]] Center for Youth Policy Studies, U.S. [[National Institute of Justice]], August 2001.</ref>{{Not in body|date=August 2023}} The [[American Psychological Association]] states that "children cannot consent to sexual activity with adults", and condemns any such action by an adult: "An adult who engages in sexual activity with a child is performing a criminal and immoral act which never can be considered normal or socially acceptable behavior."<ref name="delay">{{cite press release|title=APA Letter to the Honorable Rep. DeLay (R-Tx)|publisher=[[American Psychological Association]]|date=June 9, 1999|archive-url=https://web.archive.org/web/19991010055703/http://www.apa.org/releases/delay.html |archive-date=October 10, 1999|url=http://www.apa.org/releases/delay.html |access-date=2009-03-08}}</ref>{{Not in body|date=August 2023}}
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==Effects==

===Psychological===
Child sexual abuse can result in both short-term and long-term harm, including [[psychopathology]] in later life.<ref name="dinw">{{Cite journal |vauthors=Dinwiddie S, Heath AC, Dunne MP, etal |title=Early sexual abuse and lifetime psychopathology: a co-twin-control study|journal=Psychological Medicine|volume=30 |issue=1 |pages=41–52|date=January 2000|pmid=10722174 |doi=10.1017/S0033291799001373|s2cid=15270464}}</ref><ref name="twin">{{Cite journal |vauthors=Nelson EC, Heath AC, Madden PA, etal |title=Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study|journal=Archives of General Psychiatry|volume=59 |issue=2 |pages=139–145|date=February 2002|pmid=11825135 |doi=10.1001/archpsyc.59.2.139|doi-access=free}}</ref> Indicators and effects include [[Major depressive disorder|depression]],<ref name="Roosa">{{Cite journal|vauthors=Roosa MW, Reinholtz C, Angelini PJ|title=The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups|url=https://archive.org/details/sim_journal-of-abnormal-child-psychology_1999-02_27_1/page/65|journal=Journal of Abnormal Child Psychology|volume=27 |issue=1 |pages=65–76|date=February 1999|pmid=10197407}}</ref><ref name=Widom2007>{{Cite journal|vauthors=Widom CS, DuMont K, Czaja SJ|title=A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up|journal=Archives of General Psychiatry|volume=64 |issue=1 |pages=49–56|date=January 2007|pmid=17199054 |doi=10.1001/archpsyc.64.1.49 |doi-access=free}}
*{{cite press release |date=January 3, 2007 |title=Child Abuse And Neglect Associated With Increased Risk Of Depression Among Young Adults |website=[[ScienceDaily]] |url=https://www.sciencedaily.com/releases/2007/01/070102092229.htm}}</ref><ref name=Arnow/> [[anxiety]],<ref name="levitan">{{Cite journal|vauthors=Levitan RD, Rector NA, Sheldon T, Goering P|title=Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity|journal=Depression and Anxiety|volume=17 |issue=1 |pages=34–42|year=2003|pmid=12577276 |doi=10.1002/da.10077|s2cid=26031006|doi-access=free}}</ref> [[eating disorders]],<ref name=Walsh2011/> poor [[self-esteem]],<ref name=Walsh2011>{{Cite book|last1=Walsh|first1=K.|last2=DiLillo|first2=D.|editor1-last=Paludi|editor1-first=Michael A.|chapter=Child sexual abuse and adolescent sexual assault and revictimization|title=The psychology of teen violence and victimization|volume=1 |publisher=Praeger|location=Santa Barbara, CA|year=2011|pages=203–216|isbn=978-0-313-39375-4}}</ref> [[somatization]],<ref name=Arnow>{{Cite journal|author=Arnow BA|title=Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization|journal=The Journal of Clinical Psychiatry|volume=65|pages=10–15|year=2004|issue=Suppl 12 |pmid=15315472|url=http://article.psychiatrist.com/?ContentType=START&ID=10000983|access-date=2010-03-16|archive-url=http://arquivo.pt/wayback/20160516194224/http://article.psychiatrist.com/?ContentType=START&ID=10000983|archive-date=2016-05-16}}</ref> [[sleep disorder|sleep disturbances]],<ref>{{Cite journal |author=Noll, J. G. |author2=Trickett, P. K. |author3=Susman, E. J. |author4=Putnam, F. W.|title=Sleep disturbances and childhood sexual abuse|journal=Journal of Pediatric Psychology|volume=31 |issue=5 |pages=469–480|year=2006|doi=10.1093/jpepsy/jsj040|pmid=15958722|doi-access=free}}</ref><ref>{{Cite journal|vauthors=Steine IM, Krystal JH, Nordhus IH, Bjorvatn B, Harvey AG, Eid J, Grønli J, Milde AM, Pallesen S |title=Insomnia, nightmare frequency, and nightmare distress in victims of sexual abuse: The role of perceived social support and abuse characteristics|journal=Journal of Interpersonal Violence|volume=27|issue=9 |pages=51827–51843|year=2012|doi=10.1177/0886260511430385|pmid=22204947|s2cid=20268989}}</ref> and [[Dissociative identity disorder|dissociative]] and [[anxiety disorder]]s including [[post-traumatic stress disorder]].<ref name="widom">{{Cite journal|author=Widom CS|title=Posttraumatic stress disorder in abused and neglected children grown up|journal=The American Journal of Psychiatry|volume=156 |issue=8 |pages=1223–1229|date=August 1999|pmid=10450264 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10450264 |doi=10.1176/ajp.156.8.1223|s2cid=7339542 }}</ref><ref name=Treichel>{{Cite journal|url=http://pn.psychiatryonline.org/cgi/content/full/40/15/34-a|archive-url=https://web.archive.org/web/20060303063148/http://pn.psychiatryonline.org/cgi/content/full/40/15/34-a|archive-date=2006-03-03|title=Dissociation Often Precedes PTSD In Sexually Abused Children|first1=Joan|last1=Arehart-Treichel|journal=Psychiatric News|date=2005-08-05|volume=40|page=34|publisher=American Psychiatric Association|issue=15|doi=10.1176/pn.40.15.00400034a}}</ref> While children may exhibit regressive behaviours such as [[thumb sucking]] or [[Nocturnal enuresis|bedwetting]], the strongest indicator of sexual abuse is sexual [[acting out]] and inappropriate sexual knowledge and interest.<ref name=APA2012>[https://web.archive.org/web/20141231094025/http://apa.org/pi/families/resources/understanding-child-abuse.aspx Understanding child sexual abuse: education, prevention, and recovery.] ''[[American Psychological Association]]'' Retrieved 30 October 2012</ref><ref name=Faller>{{Cite book|last=Faller |first=Kathleen Coulborn |title=Child Sexual Abuse: Intervention and Treatment Issues |publisher=Diane Publishing |year=1993 |page=6 |isbn=978-0-7881-1669-8}}</ref>  Victims may withdraw from school and social activities<ref name=APA2012/> and exhibit various learning and behavioural problems including [[cruelty to animals]],<ref>{{cite journal |doi=10.2752/089279303786992116 |title=Cruelty to animals in normative, sexually abused, and outpatient psychiatric samples of 6- to 12-year-old children: Relations to maltreatment and exposure to domestic violence |year=2003 |last1=Ascione |first1=Frank R. |last2=Friedrich |first2=William N. |last3=Heath |first3=John |last4=Hayashi |first4=Kentaro |journal=Anthrozoös|volume=16 |issue=3 |pages=194–212|s2cid=145018287 }}</ref><ref>{{cite book |last=Ascione |first=Frank R. |year=2005 |chapter=Child sexual abuse |chapter-url=https://books.google.com/books?id=DPyAML4cGxcC&pg=PA46 |page=46 |title=Children and Animals: Exploring the Roots of Kindness and Cruelty |publisher=Purdue University Press |isbn=978-1-55753-383-8}}</ref><ref>{{cite journal |doi=10.1016/0145-2134(95)00087-O |pmid=8556438 |title=Clinical characteristics related to severity of sexual abuse: A study of seriously mentally ill youth |url=https://archive.org/details/sim_child-abuse-neglect_1995-10_19_10/page/1245 |year=1995 |last1=McClellan |first1=Jon |last2=Adams |first2=Julie |last3=Douglas |first3=Donna |last4=McCurry |first4=Chris |last5=Storck |first5=Mick |journal=Child Abuse & Neglect |volume=19 |issue=10 |pages=1245–1254}}</ref><ref>{{cite journal |doi=10.1093/jpepsy/11.1.47 |title=Behavior Problems in Sexually Abused Young Children |year=1986 |last1=Friedrich |first1=William N. |last2=Urquiza |first2=Anthony J. |last3=Beilke |first3=Robert L. |journal=Journal of Pediatric Psychology |volume=11 |pages=47–57 |pmid=3958867 |issue=1}}</ref> [[Attention deficit hyperactivity disorder|attention deficit/hyperactivity disorder]] (ADHD), [[conduct disorder]], and [[oppositional defiant disorder]] (ODD).<ref name=Walsh2011/> [[Teenage pregnancy]] and risky sexual behaviors may appear in adolescence.<ref name=Tyler2002>{{Cite journal|author=Tyler, K.A. |title=Social and emotional outcomes of childhood sexual abuse: A review of recent research |journal=Aggression and Violent Behavior |volume=7|issue=6 |pages=567–589 |year=2002 |doi=10.1016/S1359-1789(01)00047-7}}</ref> Child sexual abuse victims report almost four times as many incidences of [[Self-harm|self-inflicted harm]].<ref name=SelfHarm2003>{{Cite journal|author=J. G. Noll |title=Revictimization and self-harm in females who experienced childhood sexual abuse: Results from a prospective study|url=https://archive.org/details/sim_journal-of-interpersonal-violence_2003-12_18_12/page/1452 |journal=Journal of Interpersonal Violence|volume=18|issue=12|pages=1452–1471|year=2003|doi=10.1177/0886260503258035|pmid=14678616|s2cid=38994688|display-authors=etal}}</ref> Sexual assault among teenagers has been shown to lead to an increase in mental health problems, social exclusion and worse school performance.<ref>{{Cite journal |date=2022-09-23 |title=Sexual assault has lasting effects on teenagers' mental health and education |website=National Institute for Health and Care Research |url=https://evidence.nihr.ac.uk/alert/sexual-assault-lasting-effects-teenagers-mental-health-education/ |language=en |doi=10.3310/nihrevidence_53533|s2cid=252516636 }}</ref><ref>{{Cite journal |last1=Clarke |first1=Venetia |last2=Goddard |first2=Andrea |last3=Wellings |first3=Kaye |last4=Hirve |first4=Raeena |last5=Casanovas |first5=Marta |last6=Bewley |first6=Susan |last7=Viner |first7=Russell |last8=Kramer |first8=Tami |last9=Khadr |first9=Sophie |date=2021-08-09 |title=Medium-term health and social outcomes in adolescents following sexual assault: a prospective mixed-methods cohort study |journal=Social Psychiatry and Psychiatric Epidemiology |volume=58 |issue=12 |pages=1777–1793 |language=en |doi=10.1007/s00127-021-02127-4 |pmid=34370051 |pmc=10627884 |s2cid=236953714 |issn=0933-7954|doi-access=free }}</ref>

[[File:NIH child sex abuse disorders graph.svg|right|400px|thumb|A study funded by the US [[National Institute of Drug Abuse]] found that "Among more than 1,400 adult females, childhood sexual abuse was associated with increased likelihood of drug dependence, alcohol dependence, and psychiatric disorders. The associations are expressed as [[odds ratio]]s: for example, women who experienced nongenital sexual abuse in childhood were 2.83 times more likely to develop drug dependence as adults than were women who were not abused."<ref name=NIDA17/>]]

A well-documented, long-term negative effect is repeated or additional victimization in adolescence and adulthood.<ref name="Messman-Moore">{{Cite journal|doi=10.1177/088626000015005003 |title=Child Sexual Abuse and Revictimization in the Form of Adult Sexual Abuse, Adult Physical Abuse, and Adult Psychological Maltreatment|url=https://archive.org/details/sim_journal-of-interpersonal-violence_2000-05_15_5/page/489 |year=2000|last1=Messman-Moore|first1=T. L.|last2=Long|first2=P. J.|journal=Journal of Interpersonal Violence|volume=15 |pages=489–502|issue=5|s2cid=145761598}}</ref><ref name=Polusny>{{Cite journal|title=Long-term correlates of child sexual abuse: Theory and review of the empirical literature|author1=Melissa A. Polusny|author2=Victoria M. Follette|publisher=Elsevier Ltd.|journal=Applied and Preventive Psychology|volume= 4 |issue= 3|year=1995|pages=143–166|doi=10.1016/s0962-1849(05)80055-1}}</ref> A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including [[crime]] and [[suicide]],<ref name=Whealin>{{cite web|url=http://www.ptsd.va.gov/public/pages/child-sexual-abuse.asp |archive-url=https://web.archive.org/web/20090730101002/http://www.ptsd.va.gov/public/pages/child-sexual-abuse.asp |archive-date=2009-07-30 |title=Child Sexual Abuse |author=Julia Whealin |publisher=National Center for Post Traumatic Stress Disorder, US Department of Veterans Affairs |date=2007-05-22 }}</ref><ref name="science-freyd">{{Cite journal|vauthors=Freyd JJ, Putnam FW, Lyon TD |title=Psychology. The science of child sexual abuse |journal=Science |volume=308 |issue=5721 |page=501 |date=April 2005 |pmid=15845837 |doi=10.1126/science.1108066|s2cid=70752683 |display-authors=etal}}</ref><ref name="Dozier">{{Cite book |vauthors=Dozier M, Stovall KC, Albus K |year=1999 |chapter=Attachment and Psychopathology in Adulthood |editor1=J. Cassidy |editor2=P. Shaver |title=Handbook of Attachment |pages=497–519 |location=NY |publisher=Guilford Press |isbn=978-1-57230-826-8}}</ref><ref name="Kendall">{{Cite journal|vauthors=Kendall-Tackett KA, Williams LM, Finkelhor D |s2cid=2512368 |title=Impact of sexual abuse on children: a review and synthesis of recent empirical studies |url=https://archive.org/details/sim_psychological-bulletin_1993-01_113_1/page/164 |journal=Psychological Bulletin |volume=113 |issue=1 |pages=164–80 |date=January 1993 |pmid=8426874 |doi=10.1037/0033-2909.113.1.164}} also published in {{Cite book|title=Annual progress in child psychiatry and child development 1994 |first=Margaret E. |last=Hertzig |author2=Ellen A. Farber |year=1994 |publisher=Psychology Press |pages=321–56 |isbn=978-0-87630-744-1}}</ref><ref>{{Cite journal|vauthors=Gauthier L, Stollak G, Messé L, Aronoff J |title=Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning |url=https://archive.org/details/sim_child-abuse-neglect_1996-07_20_7/page/549 |journal=Child Abuse & Neglect |volume=20 |issue=7 |pages=549–59 |date=July 1996 |pmid=8832112 |doi=10.1016/0145-2134(96)00043-9}}</ref><ref name="johnbriere">{{Cite journal |author=Briere J |title=Methodological issues in the study of sexual abuse effects |journal=Journal of Consulting and Clinical Psychology |volume=60 |issue=2 |pages=196–203 |date=April 1992 |pmid=1592948 |doi=10.1037/0022-006X.60.2.196 |url=http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf |archive-url=https://web.archive.org/web/20080911152635/http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf |archive-date=2008-09-11 }}</ref> in addition to alcoholism and drug abuse.<ref name=NIDA17>{{Cite journal|title=Childhood Sex Abuse Increases Risk for Drug Dependence in Adult Women |journal=NIDA Notes |publisher=National Institute of Drug Abuse |volume=17 |issue=1 |date=April 2002 |first=Patrick |last=Zickler |doi=10.1151/v17i1CSAIRDDAW |page=5 }}</ref><ref name= Polusny/><ref>{{Cite journal|author=Brown D |title=(Mis) representations of the long-term effects of childhood sexual abuse in the courts |journal=Journal of Child Sexual Abuse |volume=9 |issue=3–4 |pages=79–107 |year=2000 |pmid=17521992 |doi=10.1300/J070v09n03_05|s2cid=20874393 }}</ref> Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting.<ref name=APA2012/> A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former.<ref name=Arnow/><ref name="pmid18204885">{{Cite journal|vauthors=Bonomi AE, Anderson ML, Rivara FP |title=Health care utilization and costs associated with childhood abuse |journal=Journal of General Internal Medicine |volume=23 |issue=3 |pages=294–9 |date=March 2008 |pmid=18204885 |pmc=2359481 |doi=10.1007/s11606-008-0516-1|display-authors=etal}}</ref> Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems, and emotional problems than their peers.<ref name=Parenting2004>{{cite journal |doi=10.1016/j.chiabu.2003.07.006 |pmid=15159068 |title=The effects of child sexual abuse in later family life; mental health, parenting and adjustment of offspring |url=https://archive.org/details/sim_child-abuse-neglect_2004-05_28_5/page/525 |year=2004 |last1=Roberts |first1=Ron |last2=o'Connor |first2=Tom |last3=Dunn |first3=Judy |last4=Golding |first4=Jean |journal=Child Abuse & Neglect |volume=28 |issue=5 |pages=525–545}}</ref>

A specific characteristic pattern of symptoms has not been identified,<ref name="Fergusson">{{Cite book|author1=Fergusson, D.M.  |author2=Mullen, P.E. |year=1999 |title=Childhood sexual abuse: An evidence based perspective |url=https://archive.org/details/childhoodsexuala00ferg  |location=Thousand Oaks, California |publisher=Sage Publications |isbn=978-0-7619-1136-4}}{{Page needed|date=September 2010}}</ref> and there are several hypotheses about the causality of these associations.<ref name="Roosa"/><ref name="pmid11015813"/><ref>{{Cite journal|vauthors=Briere J, Elliott DM |title=Sexual abuse, family environment, and psychological symptoms: on the validity of statistical control |url=https://archive.org/details/sim_journal-of-consulting-and-clinical-psychology_1993-04_61_2/page/284 |journal=Journal of Consulting and Clinical Psychology |volume=61 |issue=2 |pages=284–8; discussion 289–90 |date=April 1993 |pmid=8473582 |doi=10.1037/0022-006X.61.2.284}}</ref>

Studies have found that 51% to 79% of sexually abused children exhibit psychological symptoms.<ref name="Kendall" /><ref>{{Cite journal|doi=10.1177/107906328900200102 |title=The Impact of Child Sexual Abuse On Victims' Adjustment |year=1989 |last1=Caffaro-Rouget |first1=A. |last2=Lang |first2=R. A. |last3=Van Santen |first3=V. |journal=Sexual Abuse: A Journal of Research and Treatment |volume=2 |pages=29–47|s2cid=145389337 }}</ref><ref>{{Cite journal|vauthors=Mannarino AP, Cohen JA |title=A clinical-demographic study of sexually abused children |journal=Child Abuse & Neglect |volume=10 |issue=1 |pages=17–23 |year=1986 |pmid=3955424 |doi=10.1016/0145-2134(86)90027-X}}</ref><ref>{{Cite journal|vauthors=Tong L, Oates K, McDowell M |title=Personality development following sexual abuse |url=https://archive.org/details/sim_child-abuse-neglect_1987_11_3/page/371 |journal=Child Abuse & Neglect |volume=11 |issue=3 |pages=371–83 |year=1987 |pmid=3676894 |doi=10.1016/0145-2134(87)90011-1}}</ref><ref>{{Cite journal|doi=10.1177/088626058700200404 |title=The Effects of Sexual Abuse on Children: A Multidimensional View |year=1987 |last1=Conte |first1=J. R. |last2=Schuerman |first2=J. R. |journal=Journal of Interpersonal Violence |volume=2 |pages=380–390|issue=4|s2cid=143952913 }}</ref> The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used.<ref>{{Cite journal|vauthors=Bulik CM, Prescott CA, Kendler KS |title=Features of childhood sexual abuse and the development of psychiatric and substance use disorders |journal=The British Journal of Psychiatry |volume=179 |issue= 5|pages=444–9 |date=November 2001 |pmid=11689403 |doi=10.1192/bjp.179.5.444|doi-access=free }}</ref> The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force.<ref name="dinw" /><ref name="twin" /><ref name=Beitchman>{{Cite journal|vauthors=Beitchman JH, Zucker KJ, Hood JE, daCosta GA, Akman D, Cassavia E |title=A review of the long-term effects of child sexual abuse |url=https://archive.org/details/sim_child-abuse-neglect_1992_16_1/page/101 |journal=Child Abuse Negl |volume=16 |issue=1 |pages=101–18 |year=1992 |pmid=1544021 |doi=10.1016/0145-2134(92)90011-F}}</ref><ref name=pmid3704036>{{Cite journal|vauthors=Browne A, Finkelhor D |title=Impact of child sexual abuse: a review of the research |url=https://archive.org/details/sim_psychological-bulletin_1986-01_99_1/page/66 |journal=Psychological Bulletin |volume=99 |issue=1 |pages=66–77 |date=January 1986 |pmid=3704036 |doi=10.1037/0033-2909.99.1.66|hdl=10983/681 }}</ref> The social stigma of child sexual abuse may compound the psychological harm to children,<ref name=pmid3704036/><ref>{{Cite journal|doi=10.1016/S1359-1789(02)00101-5 |title=The 'sexually abused child': Potential mechanisms of adverse influences of such a label |year=2003 |last1=Holguin |first1=G |journal=Aggression and Violent Behavior |volume=8 |pages=645–670|issue=6|last2=Hansen|first2=David J.|url=http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1026&context=psychfacpub }}</ref> and adverse outcomes are less likely for abused children who have supportive family environments.<ref>{{Cite journal|vauthors=Romans SE, Martin JL, Anderson JC, O'Shea ML, Mullen PE |title=Factors that mediate between child sexual abuse and adult psychological outcome |url=https://archive.org/details/sim_psychological-medicine_1995-01_25_1/page/127 |journal=Psychological Medicine |volume=25 |issue=1 |pages=127–42 |date=January 1995 |pmid=7792348 |doi=10.1017/S0033291700028154|s2cid=7585679 }}</ref><ref>{{Cite journal|vauthors=Spaccarelli S, Kim S |title=Resilience criteria and factors associated with resilience in sexually abused girls |url=https://archive.org/details/sim_child-abuse-neglect_1995-09_19_9/page/1171 |journal=Child Abuse & Neglect |volume=19 |issue=9 |pages=1171–82 |date=September 1995 |pmid=8528822 |doi=10.1016/0145-2134(95)00077-L}}</ref>

====Posttraumatic stress disorder====
{{Main|Dissociation (psychology)|Posttraumatic stress disorder}}
[[Child abuse]], including sexual abuse, especially chronic abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories.<ref name=chu>{{Cite journal|vauthors=Chu JA, Frey LM, Ganzel BL, Matthews JA |title=Memories of childhood abuse: dissociation, amnesia, and corroboration |journal=The American Journal of Psychiatry |volume=156 |issue=5 |pages=749–55 |date=May 1999 |pmid=10327909 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=10327909 |doi=10.1176/ajp.156.5.749|s2cid=24262943 }}</ref>  When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.<ref name=draijer>{{Cite journal|vauthors=Draijer N, Langeland W |title=Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients |url=https://archive.org/details/sim_american-journal-of-psychiatry_1999-03_156_3/page/379 |journal=The American Journal of Psychiatry |volume=156 |issue=3 |pages=379–85 |date=March 1999 |pmid=10080552 |doi=10.1016/j.biopsych.2003.08.018|s2cid=14670794 }}</ref> Recent research showed that females with high exposure to child sexual abuse (CSA) develop PTSD symptoms that are associated with poor social functioning, which is also supported by prior research studies.<ref>{{cite journal | last1 = McLean | first1 = CP | last2 = Rosenbach | first2 = SB | last3 = Capaldi | first3 = S | last4 = Foa | first4 = EB | year = 2013 | title = Social and academic functioning in adolescents with child sexual abuse-related PTSD | journal = Child Abuse & Neglect | volume = 37 | issue = 9| pages = 675–678 | doi = 10.1016/j.chiabu.2013.03.010 | pmid = 23623621 | pmc = 3740087 }}</ref> The feeling of being "cut-off" from peers and "emotional numbness" are both results of CSA and highly inhibit proper social functioning. Furthermore, PTSD is associated with higher risk of substance abuse as a result of the "self-medication hypothesis" and the "high-risk and susceptibility hypothesis".<ref name="auto">{{cite journal | last1 = Schiff | first1 = M | last2 = Nacasch | first2 = N | last3 = Levit | first3 = S | last4 = Katz | first4 = N | last5 = Foa | first5 = EB | year = 2015 | title = Prolonged exposure for treating PTSD among female methadone patients who were survivors of sexual abuse in Israel | journal = Social Work & Health Care | volume = 54 | issue = 8| pages = 687–707 | doi = 10.1080/00981389.2015.1058311 | pmid = 26399489 | s2cid = 9288531 }}</ref>

Besides [[dissociative identity disorder]] (DID), [[posttraumatic stress disorder]] (PTSD), and [[complex post-traumatic stress disorder]] (C-PTSD), child sexual abuse survivors may present [[borderline personality disorder]] (BPD) and eating disorders such as [[bulimia nervosa]].<ref name="Honor2010">{{Cite journal|author=Hornor, G. |title=Child sexual abuse: Consequences and implications |journal=Journal of Pediatric Health Care |volume=24|issue=6 |pages=358–364 |year=2010 |doi=10.1016/j.pedhc.2009.07.003|pmid=20971410}}</ref>

====Research factors====
Because child sexual abuse often occurs alongside other possibly confounding variables, such as poor family environment and physical abuse,<ref>{{Cite journal|vauthors=Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP |title=The long-term impact of the physical, emotional, and sexual abuse of children: a community study |url=https://archive.org/details/sim_child-abuse-neglect_1996-01_20_1/page/7 |journal=Child Abuse & Neglect |volume=20 |issue=1 |pages=7–21 |date=January 1996 |pmid=8640429 |doi=10.1016/0145-2134(95)00112-3}}</ref> some scholars argue it is important to control for those variables in studies which measure the effects of sexual abuse.<ref name="twin" /><ref name="pmid11015813">{{Cite journal|vauthors=Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA |title=Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis |journal=Archives of General Psychiatry |volume=57 |issue=10 |pages=953–9 |date=October 2000 |pmid=11015813 |doi=10.1001/archpsyc.57.10.953|doi-access=free }}</ref><ref>{{Cite journal|first1=Harrison G. |last1=Pope |first2=James I. |last2=Hudson |title=Does childhood sexual abuse cause adult psychiatric disorders? Essentials of methodology |journal=Journal of Psychiatry & Law |volume=23 |issue=3 |date=Fall 1995 |pages=363–81|doi=10.1177/009318539502300303 |s2cid=81434466 }}</ref><ref>{{Cite journal|vauthors=Levitt EE, Pinnell CM |title=Some additional light on the childhood sexual abuse-psychopathology axis |url=https://archive.org/details/sim_international-journal-of-clinical-experimental-hypnosis_1995-04_43_2/page/145 |journal=The International Journal of Clinical and Experimental Hypnosis |volume=43 |issue=2 |pages=145–62 |date=April 1995 |pmid=7737760 |doi=10.1080/00207149508409958}}</ref> In a 1998 review of related literature, Martin and Fleming state "The hypothesis advanced in this paper is that, in most cases, the fundamental damage inflicted by child sexual abuse is due to the child's developing capacities for trust, intimacy, agency and sexuality, and that many of the mental health problems of adult life associated with histories of child sexual abuse are second-order effects."<ref>{{Cite journal|vauthors=Fleming J, Mullen PE, Sibthorpe B, Bammer G |title=The long-term impact of childhood sexual abuse in Australian women |url=https://archive.org/details/sim_child-abuse-neglect_1999-02_23_2/page/145 |journal=Child Abuse & Neglect |volume=23 |issue=2 |pages=145–59 |date=February 1999 |pmid=10075184 |doi=10.1016/S0145-2134(98)00118-5}}</ref> Other studies have found an independent association of child sexual abuse with adverse psychological outcomes.<ref name="levitan" /><ref name="twin" /><ref name="pmid11015813"/>

Kendler et al. (2000) found that most of the relationship between severe forms of child sexual abuse and adult psychopathology in their sample could not be explained by family discord, because the [[effect size]] of this association decreased only slightly after they controlled for possible confounding variables. Their examination of a small sample of CSA-discordant twins also supported a causal link between child sexual abuse and adult psychopathology; the CSA-exposed subjects had a consistently higher risk for psychopathologic disorders than their CSA non-exposed twins.<ref name="pmid11015813"/>

A 1998 [[Rind et al. controversy|meta-analysis by Bruce Rind et al.]] generated controversy by suggesting that child sexual abuse does not always cause pervasive harm, that girls were more likely to be psychologically harmed than boys, that some college students reported such encounters as positive experiences and that the extent of psychological damage depends on whether or not the child described the encounter as "consensual".<ref>{{Cite journal|doi=10.1080/00224499709551891 |title=A meta-analytic review of findings from national samples on psychological correlates of child sexual abuse |url=https://archive.org/details/sim_journal-of-sex-research_1997_34_3/page/237 |year=1997 |last1=Rind |first1=Bruce |last2=Tromovitch |first2=Philip |journal=Journal of Sex Research |volume=34 |pages=237–255|issue=3}}</ref> The study was criticized for flawed methodology and conclusions.<ref name="LC Dallam">{{Cite journal|vauthors=Dallam SJ, Gleaves DH, Cepeda-Benito A, Silberg JL, Kraemer HC, Spiegel D | title=The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998) |url=https://archive.org/details/sim_psychological-bulletin_2001-11_127_6/page/715 |journal=Psychological Bulletin |volume=127 |issue=6 |pages=715–33 |date=November 2001 |pmid=11726068 |doi=10.1037/0033-2909.127.6.715}}</ref><ref>{{Cite book|last1=Oltmanns |first1=Thomas F. |last2=Emery |first2=Robert E. |title=Abnormal Psychology |publisher=Prentice Hall |year=2001 |location=Upper Saddle River, NJ |isbn=978-0-13-187521-0}}{{Page needed|date=September 2010}}</ref> The US Congress condemned the study for its conclusions and for providing material used by pedophile organizations to justify their activities.<ref name="congress">{{cite web|author=US Congress|year=1999|title=Whereas no segment of our society is more critical to the future of human survival than our children|work=106th Congress, Resolution 107|url=http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_bills&docid=f:hc107enr.txt.pdf}}</ref>

===Physical===

====Injury====
Depending on the age and size of the child, and the degree of force used, child sexual abuse may cause internal lacerations and [[bleeding]]. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.<ref>{{Cite journal|doi=10.1080/08884310420001679386 |title=Child Sexual Abuse: A Public Health Issue |year=2004 |last1=Anderson |first1=James |last2=Mangels |first2=Nancie |last3=Langsam |first3=Adam |journal=The Justice Professional |volume=17 |pages=107–126|s2cid=144058326 }}</ref>

====Infections====
Child sexual abuse may cause infections and [[sexually transmitted disease]]s.<ref name="jong">{{Cite journal|author=De Jong AR |title=Vaginitis due to Gardnerella vaginalis and to Candida albicans in sexual abuse |journal=Child Abuse & Neglect |volume=9 |issue=1 |pages=27–9 |year=1985 |pmid=3872154 |doi=10.1016/0145-2134(85)90088-2}}</ref> Due to a lack of sufficient [[Vaginal lubrication|vaginal fluid]], chances of infections can heighten depending on the age and size of the child. [[Vaginitis]] has also been reported.<ref name="jong" />

====Neurological damage====
Research has shown that traumatic stress, including stress caused by sexual abuse, may cause notable changes in brain functioning and development.<ref>Developing Mind, Daniel Siegel, Guilford Press, 1999{{Page needed|date=September 2010}}</ref><ref>{{Cite book|author1=Maia Szalavitz |author2=Perry, Bruce |title=The boy who was raised as a dog: and other stories from a child psychiatrist's notebook: what traumatized children can teach us about loss, love and healing |publisher=Basic Books |location=New York |year=2006 |isbn=978-0-465-05652-1}}{{Page needed|date=September 2010}}</ref> Various studies have suggested that severe child sexual abuse may have a deleterious effect on brain development. Ito et al. (1998) found "reversed hemispheric asymmetry and greater left hemisphere coherence in abused subjects;"<ref>{{Cite journal|vauthors=Ito Y, Teicher MH, Glod CA, Ackerman E |title=Preliminary evidence for aberrant cortical development in abused children: a quantitative EEG study |journal=The Journal of Neuropsychiatry and Clinical Neurosciences |volume=10 |issue=3 |pages=298–307 |year=1998 |pmid=9706537|doi=10.1176/jnp.10.3.298 }}</ref> Teicher et al. (1993) found that an increased likelihood of "ictal temporal lobe epilepsy-like symptoms" in abused subjects;<ref name="epi">{{Cite journal|vauthors=Teicher MH, Glod CA, Surrey J, Swett C |title=Early childhood abuse and limbic system ratings in adult psychiatric outpatients |journal=The Journal of Neuropsychiatry and Clinical Neurosciences |volume=5 |issue=3 |pages=301–6 |year=1993 |pmid=8369640|doi=10.1176/jnp.5.3.301 }}</ref> Anderson et al. (2002) recorded abnormal [[Relaxation (NMR)|transverse relaxation]] time in the cerebellar vermis of adults sexually abused in childhood;<ref>{{Cite journal|vauthors=Anderson CM, Teicher MH, Polcari A, Renshaw PF |title=Abnormal T2 relaxation time in the cerebellar vermis of adults sexually abused in childhood: potential role of the vermis in stress-enhanced risk for drug abuse |journal=Psychoneuroendocrinology |volume=27 |issue=1–2 |pages=231–44 |year=2002 |pmid=11750781 |doi=10.1016/S0306-4530(01)00047-6|s2cid=38238017 }}</ref> Teicher et al. (1993) found that child sexual abuse was associated with a reduced [[corpus callosum]] area; various studies have found an association of reduced volume of the left hippocampus with child sexual abuse;<ref name="scars">{{Cite journal|author=Teicher MH |title=Scars that won't heal: the neurobiology of child abuse |url=https://archive.org/details/sim_scientific-american_2002-03_286_3/page/68 |journal=Scientific American |volume=286 |issue=3 |pages=68–75 |date=March 2002 |pmid=11857902 |doi=10.1038/scientificamerican0302-68|bibcode=2002SciAm.286c..68T }}</ref> and Ito et al. (1993) found increased electrophysiological abnormalities in sexually abused children.<ref>{{Cite journal|vauthors=Ito Y, Teicher MH, Glod CA, Harper D, Magnus E, Gelbard HA |title=Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse |journal=The Journal of Neuropsychiatry and Clinical Neurosciences |volume=5 |issue=4 |pages=401–8 |year=1993 |pmid=8286938 |doi=10.1176/jnp.5.4.401}}</ref>

Some studies indicate that sexual or physical abuse in children can lead to the overexcitation of an undeveloped [[limbic system]].<ref name="scars" /> Teicher et al. (1993)<ref name="epi" /> used the "Limbic System Checklist-33" to measure ictal temporal lobe epilepsy-like symptoms in 253 adults. Reports of child sexual abuse were associated with a 49% increase to LSCL-33 scores, 11% higher than the associated increase of self-reported physical abuse. Reports of both physical and sexual abuse were associated with a 113% increase. Male and female victims were similarly affected.<ref name="epi" /><ref>{{Cite journal |first1=Joan |last1=Arehart-Treichel |date=March 2001 |title=Psychological Abuse May Cause Changes in Brain |journal=Psychiatric News |volume=36 |issue=5 |page=36 |url=http://pn.psychiatryonline.org/content/36/5/36.full |archive-url=https://web.archive.org/web/20110320035637/http://pn.psychiatryonline.org/content/36/5/36.full |archive-date=2011-03-20 |doi=10.1176/pn.36.5.0036 }}</ref>

Navalta et al. (2006) found that the self-reported math [[Scholastic Aptitude Test]] scores of their sample of women with a history of repeated child sexual abuse were significantly lower than the self-reported math SAT scores of their non-abused sample. Because the abused subjects' verbal SAT scores were high, they hypothesized that the low math SAT scores could "stem from a defect in hemispheric integration." They also found a strong association between short-term memory impairments for all categories tested (verbal, visual, and global) and the duration of the abuse.<ref name="navalta">{{Cite journal|vauthors=Navalta CP, Polcari A, Webster DM, Boghossian A, Teicher MH|title=Effects of childhood sexual abuse on neuropsychological and cognitive function in college women |journal=The Journal of Neuropsychiatry and Clinical Neurosciences |volume=18 |issue=1 |pages=45–53 |year=2006 |pmid=16525070 |doi=10.1176/appi.neuropsych.18.1.45}}</ref>

==Incest==
{{Main|Incest}}
Incest between a child or adolescent and a related adult is known as '''child incestuous abuse''',<ref>{{cite web |last=Trusiani|first=Jessica|title=Working with Survivors of Child Incestuous Abuse|website=Rutgers University|url=http://socialwork.rutgers.edu/Libraries/VAWC/Trusiani_presentation.sflb.ashx|access-date=2014-04-04|archive-url=https://web.archive.org/web/20141101063712/http://socialwork.rutgers.edu/Libraries/VAWC/Trusiani_presentation.sflb.ashx|archive-date=2014-11-01}}</ref> and has been identified as the most widespread form of child sexual abuse with a highly significant capacity to damage the young person.<ref name=Courtois /> One researcher stated that more than 70% of abusers are immediate family members or someone very close to the family.<ref>{{cite web|url=http://www.aaets.org/article31.htm |title=Sexual Abuse:Surviving the Pain |author1=Barabara E. Bogorad |others=Sexual Abuse Recovery Program Unit South Oaks Hospital, New York |publisher=The American Academy of Experts in Traumatic Stress, Inc.}}</ref> Another researcher stated that about 30% of all perpetrators of sexual abuse are related to their victim, 60% of the perpetrators are family acquaintances, like a neighbor, babysitter or friend and 10% of the perpetrators in child sexual abuse cases are strangers.<ref name=Whealin/> A child sexual abuse offense where the perpetrator is related to the child, either by blood or marriage, is a form of [[incest]] described as ''intrafamilial child sexual abuse''.<ref>{{Cite journal|doi=10.1177/088740349000400304 |title=Decision-Making Of The District Attorney: Diverting Or Prosecuting Intrafamilial Child Sexual Abuse Offenders |year=1990 |last1=Fridell |first1=L. A. |journal=Criminal Justice Policy Review |volume=4 |pages=249–267|issue=3|s2cid=145654768 }}</ref>

The most-often reported form of incest is father–daughter and stepfather–stepdaughter incest, with most of the remaining reports consisting of mother/stepmother–daughter/son incest.<ref name=Turner>{{Cite book |last=Turner |first=Jeffrey S. |title=Encyclopedia of relationships across the lifespan |publisher=Greenwood Press |location=Westport, Conn |year=1996 |page=[https://archive.org/details/encyclopediaofre0000turn/page/92 92] |isbn=978-0-313-29576-8 |url=https://archive.org/details/encyclopediaofre0000turn/page/92 }}</ref> Father–son incest is reported less often; however, it is not known if the actual prevalence is less or it is under-reported by a greater margin.<ref>{{cite web|url=http://williamapercy.com/wiki/images/Father-son_incest_a_review.pdf|title=Williamapercy.com|website=williamapercy.com|access-date=2014-05-10|archive-date=2016-03-04|archive-url=https://web.archive.org/web/20160304071829/http://williamapercy.com/wiki/images/Father-son_incest_a_review.pdf|url-status=dead}}</ref><ref>{{Cite journal |hdl = 1811/51174|title = Father-Son Incest: Underreported Psychiatric Problem?|url = https://archive.org/details/sim_american-journal-of-psychiatry_1978-07_135_7/page/835|year = 1978|last1 = Calestro|first1 = Kenneth|last2 = Arnold|first2 = L. Eugene|last3 = Dixon|first3 = Katharine N.|journal = The American Journal of Psychiatry|volume = 135|issue = 7|pages = 835–8|pmid = 665796|doi = 10.1176/ajp.135.7.835|hdl-access = free}}</ref><ref>{{Cite book|last1=Meyer |first1=Isabel Denholm |last2=Dorais |first2=Michel |title=Don't tell: the sexual abuse of boys |url=https://archive.org/details/donttellsexualab0000dora |publisher=McGill-Queen's University Press |location=Montreal |year=2002 |page=[https://archive.org/details/donttellsexualab0000dora/page/24 24] |isbn=978-0-7735-2261-9}}</ref><ref>{{Cite book|last=Courtois |first=Christine A. |title=Healing the incest wound: adult survivors in therapy |url=https://archive.org/details/healingincestwou00cour |publisher=Norton |location=New York |year=1988 |isbn=978-0-393-31356-7}}{{Page needed|date=September 2010}}</ref> Similarly, some argue that sibling incest may be as common, or more common, than other types of incest: Goldman and Goldman<ref>{{Cite journal|vauthors=Goldman JD, Padayachi UK |title=The prevalence and nature of child sexual abuse in Queensland, Australia |url=https://archive.org/details/sim_child-abuse-neglect_1997-05_21_5/page/489 |journal=Child Abuse & Neglect |volume=21 |issue=5 |pages=489–98 |date=May 1997 |pmid=9158908 |doi=10.1016/S0145-2134(97)00008-2}}</ref> reported that 57% of incest involved siblings; Finkelhor reported that over 90% of [[nuclear family]] incest involved siblings;<ref>Finkelhor, D. (1979). Sexually [[victimised]] children. New York: Free Press</ref> while Cawson et al. show that sibling incest was reported twice as often as incest perpetrated by fathers/stepfathers.<ref>{{Cite book|first1=Pat |last1=Cawson |first2=Corinne |last2=Wattam |first3=Sue |last3=Brooker |title=Child Maltreatment in the United Kingdom: A Study of the Prevalence of Child Abuse and Neglect |publisher=National Society for the Prevention of Cruelty to Children |location=London |year=2000 |isbn=978-1-84228-006-5}}{{Page needed|date=September 2010}}</ref>

Prevalence of parental child sexual abuse is difficult to assess due to secrecy and privacy; some estimates state that 20 million Americans have been victimized by parental incest as children.<ref name=Turner />

==Types==
Child sexual abuse includes a variety of sexual offenses, including:
* ''[[sexual assault]]'' – a term defining offenses in which an adult uses a minor for the purpose of sexual gratification; for example, [[rape]] (including [[sodomy]]), and sexual penetration with an object.<ref>{{Cite journal|first1=David |last1=Finkelhor |first2=Richard |last2=Ormrod |url=http://www.ncjrs.gov/pdffiles1/ojjdp/187238.pdf |title=Child Abuse Reported to the Police |journal=Juvenile Justice Bulletin |publisher=U.S. Office of Juvenile Justice and Delinquency Prevention |date=May 2001}}</ref> Most U.S. states include, in their definitions of sexual assault, any penetrative contact of a minor's body, however slight, if the contact is performed for the purpose of sexual gratification.<ref>[http://www.childwelfare.gov/systemwide/laws_policies/statutes/defineall.pdf ''Definitions of Child Abuse and Neglect, Summary of State Laws,''] {{Webarchive|url=https://web.archive.org/web/20071025174014/http://www.childwelfare.gov/systemwide/laws_policies/statutes/defineall.pdf |date=2007-10-25 }} National Clearinghouse on Child Abuse and Neglect Information, U.S. Department of Health and Human Services.</ref>
* ''[[Commercial sexual exploitation of children|sexual exploitation]]'' – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child,<ref>{{Cite journal|first1=David |last1=Finkelhor |first2=Richard |last2=Ormrod |url=http://www.ncjrs.gov/html/ojjdp/203946/contents.html |title=Prostitution of Juveniles: Patterns From NIBRS |journal=Juvenile Justice Bulletin |publisher=U.S. Office of Juvenile Justice and Delinquency Prevention |date=June 2004}}</ref> [[live streaming sexual abuse]],<ref>{{cite news|url=https://www.reuters.com/article/us-philippines-trafficking-children/philippines-child-slavery-survivors-fight-to-heal-scars-of-abuse-idUSKBN1H400E|title=Philippines child slavery survivors fight to heal scars of abuse|newspaper=Reuters|date=April 8, 2020}}</ref> and creating or trafficking in child pornography.<ref>[http://www.ncjrs.gov/txtfiles/exploit.txt ''Child Sexual Exploitation: Improving Investigations and Protecting Victims,''] Massachusetts Child Exploitation Network, U.S. Office of Juvenile Justice and Delinquency Prevention, January 1995.</ref>
*''[[Child grooming|sexual grooming]]'' – a term defining the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online [[chat room]].<ref>{{Cite web|url=https://www.zdnet.com/|title=Technology News, Analysis, Comments and Product Reviews for IT Professionals|website=ZDNet}}</ref>

===Commercial sexual exploitation===
{{Main|Commercial sexual exploitation of children}}

Commercial sexual exploitation of children (CSEC) is defined by the Declaration of the First World Congress against Commercial Sexual Exploitation of Children, held in Stockholm in 1996, as "sexual abuse by an adult accompanied by remuneration in cash or in kind to the child or third person(s)."<ref>{{cite web|url=http://www.unicef.org/eapro/Fact_sheet_SexualExploitation.pdf|title=UNICEF|website=unicef.org|access-date=2014-02-07|archive-date=2016-03-03|archive-url=https://web.archive.org/web/20160303232214/http://www.unicef.org/eapro/Fact_sheet_SexualExploitation.pdf|url-status=dead}}</ref> CSEC usually takes the form of [[child prostitution]] or [[child pornography]], and is often facilitated by [[child sex tourism]]. CSEC is particularly a problem in developing countries of [[Asia]].<ref>{{Cite web|url=http://www.unescap.org/pmd/documents/me/Sexual%20abuse.pdf|archive-url=https://web.archive.org/web/20140222151144/http://www.unescap.org/pmd/documents/me/Sexual%20abuse.pdf|title=Unescap.org|archive-date=February 22, 2014}}</ref><ref>{{cite web|url=http://www.unicef.org/rosa/commercial.pdf|title=UNICEF|website=unicef.org|access-date=2014-02-07|archive-date=2016-03-03|archive-url=https://web.archive.org/web/20160303233833/http://www.unicef.org/rosa/commercial.pdf|url-status=dead}}</ref> In recent years, new innovations in technology have facilitated the trade of Internet child pornography.<ref>{{cite web|url=http://www.unicef.org/eapro/activities_3757.html|title=What we do – Commercial sexual exploitation of children|work=unicef.org|access-date=23 March 2015|archive-date=6 April 2015|archive-url=https://web.archive.org/web/20150406042943/http://www.unicef.org/eapro/activities_3757.html|url-status=dead}}</ref>

In the United Kingdom, the term ''child sexual exploitation'' covers any form of sexual abuse which includes an exchange of a resource for sexual activity with a child.<ref name="Williams discussion" /><ref>{{cite web |title=Child sexual exploitation Definition and a guide for practitioners, local leaders and decision makers working to protect children from child sexual exploitation |website=Human Trafficking Search |url=https://humantraffickingsearch.org/resource/child-sexual-exploitation-definition-and-a-guide-for-practitioners-local-leaders-and-decision-makers-working-to-protect-children-from-child-sexual-exploitation/ |date=February 2017 }}</ref> Prior to 2009, the term commonly used to describe child sexual exploitation was ''child prostitution''.<ref>{{cite book |last1=Phoenix |first1=Jo |title=Out of place: The policing and criminalisation of sexually exploited girls and young women. |date=2012 |publisher=The Howard League for Penal Reform |location=London |url=https://howardleague.org/wp-content/uploads/2016/04/Out-of-place.pdf}}</ref><ref>{{cite book |last1=Hallet |first1=Sophie |title=Making sense of child sexual exploitation: exchange, abuse and children and young people. |date=2017 |publisher=Policy Press |location=Bristol }}</ref> The term ''child sexual exploitation'' first appeared in government guidance in 2009 as part of an attempt to promote an understanding that children involved in exploitation were victims of abuse rather than criminals.<ref>{{cite web |last1=DCSF |title=Safeguarding Children and Young People from Sexual Exploitation |date=2009 |url=http://www.haringeylscb.org/sites/haringeylscb/files/safeguarding_cpy_from_sexual_exploitation_1_.pdf |archive-url=https://web.archive.org/web/20160831193125/http://www.haringeylscb.org/sites/haringeylscb/files/safeguarding_cpy_from_sexual_exploitation_1_.pdf |archive-date=2016-08-31 |url-status=unfit |access-date=29 March 2019}}</ref><ref name="Words Matter">{{cite book |last1=Beckett |first1=Helen |last2=Walker |first2=Joanna |editor-last1=Beckett |editor-first1=Helen |editor-last2=Pearce |editor-first2=Jenny |title=Understanding and Responding to Child Sexual Exploitation |publisher=Routledge |location=London |pages=9–23 |date=2018 |chapter=Words Matter}}</ref> Because early definitions of child sexual exploitation were created to foster a move away from use of the term ''child prostitution'', the concept of exchange, which made child sexual exploitation different from child sexual abuse, referred to financial gain only. However, in the years since the birth of the concept of child sexual exploitation, the notion of exchange has been widened to include other types of gain, including love, acquisition of status and protection from harm.<ref name="Words Matter"/>

==Disclosure==
Children who received supportive responses following disclosure had less traumatic symptoms and were abused for a shorter period of time than children who did not receive support.<ref>{{cite journal | doi = 10.1300/J070v09n01_03 | last1 = Gries | first1 = L. | last2 = Goh | first2 = D. | last3 = Andrews | first3 = M. | last4 = Gilbert | first4 = J. | last5 = Praver | first5 = F. | last6 = Stelzer | first6 = D. | year = 2000 | title = Positive reaction to disclosure and recovery from child sexual abuse | url = https://archive.org/details/sim_journal-of-child-sexual-abuse_2000_9_1/page/29 | journal = Journal of Child Sexual Abuse | volume = 9 | issue = 1| pages = 29–51 | s2cid = 144064563 }}</ref><ref>{{cite journal | doi = 10.1300/J070v14n02_02 | last1 = Kogan | first1 = S. | year = 2005 | title = The Role of Disclosing Child Sexual Abuse on Adolescent Adjustment and Revictimization | url = https://archive.org/details/sim_journal-of-child-sexual-abuse_2005_14_2/page/25 | journal = Journal of Child Sexual Abuse | volume = 14 | issue = 2| pages = 25–47 | pmid = 15914409 | s2cid = 1507507 }}</ref> In general, studies have found that children need support and stress-reducing resources after disclosure of sexual abuse.<ref>Arata, C. (1998). To tell or not to tell: Current functioning of child sexual abuse survivors who disclosed their [[victimization]]. ''Child Maltreatment'', 3(1), 63.71.</ref><ref name = "pwmjhq">{{cite journal | last1 = Palmer | first1 = S. | last2 = Brown | first2 = R. | last3 = Rae-Grant | first3 = N. | last4 = Loughlin | first4 = J. M. | year = 1999 | title = Responding to children's disclosure of familial abuse: what survivors tell us | journal = Child Welfare | volume = 2 | issue = 78| pages = 259–282 }}</ref> Negative social reactions to disclosure have been found to be harmful to the survivor's well-being.<ref>{{cite journal | doi = 10.1300/J070v12n01_05 | last1 = Ullman | first1 = S.E. | year = 2003 | title = Social reactions to child abuse disclosure: A critical review | url = https://archive.org/details/sim_journal-of-child-sexual-abuse_2003_12_1/page/89 | journal = Journal of Child Sexual Abuse | volume = 12 | issue = 1| pages = 89–121 | pmid = 16221661 | s2cid = 2926312 }}</ref> One study reported that children who received a bad reaction from the first person they told, especially if the person was a close family member, had worse scores as adults on general trauma symptoms, post traumatic stress disorder symptoms, and dissociation.<ref>{{cite journal | doi = 10.1097/00005053-199411000-00004 | last1 = Roesler | first1 = T.A. | year = 1994 | title = Reactions to disclosure of childhood sexual abuse: the effect on adult symptoms | journal = Journal of Nervous and Mental Disease | volume = 182 | issue = 11| pages = 618–624 | pmid = 7964669 | s2cid = 31403154 }}</ref>  Another study found that in most cases when children did disclose abuse, the person they talked to did not respond effectively, blamed or rejected the child, and took little or no action to stop the abuse.<ref name = "pwmjhq"/> Non-validating and otherwise non-supportive responses to disclosure by the child's primary attachment figure may indicate a relational disturbance predating the sexual abuse that may have been a risk factor for the abuse, and which can remain a risk factor for its psychological consequences.<ref>{{cite journal |pmid=11999103 |year=2002 |last1=Schechter |first1=DS |last2=Brunelli |first2=SA |last3=Cunningham |first3=N |last4=Brown |first4=J |last5=Baca |first5=P |title=Mother-daughter relationships and child sexual abuse: A pilot study of 35 dyads |url=https://archive.org/details/sim_bulletin-of-the-menninger-clinic_winter-2002_66_1/page/39 |volume=66 |issue=1 |pages=39–60 |journal=Bulletin of the Menninger Clinic |doi=10.1521/bumc.66.1.39.23374}}</ref>

The [[American Academy of Child and Adolescent Psychiatry]] provides guidelines for what to say to the victim and what to do following the disclosure.<ref>{{Cite web|url=https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Responding_To-Child-Sexual-Abuse-028.aspx|title=Responding To Child Sexual Abuse|website=www.aacap.org}}</ref> Asa Don Brown has indicated: "A minimization of the trauma and its effects is commonly injected into the picture by parental caregivers to shelter and calm the child. It has been commonly assumed that focusing on children's issues too long will negatively impact their recovery. Therefore, the parental caregiver teaches the child to mask his or her issues."<ref>Brown, Asa Don, "The effects of childhood trauma on adult perception and worldview". (Dissertation) Capella University, 2008, 152 pages. AAT 3297512. {{ISBN|978-0-549-47057-1}}; Publication #3297512.{{page needed|date=November 2013}}</ref>

In many jurisdictions, abuse that is suspected, not necessarily proven, requires reporting to [[child protection]] agencies, such as the [[Child Protection Services]] in the United States. Recommendations for healthcare workers, such as [[primary care provider]]s and [[nurse]]s, who are often suited to encounter suspected abuse are advised to firstly determine the child's immediate need for safety. A private environment away from suspected abusers is desired for interviewing and examining. Leading statements that can distort the story are avoided. As disclosing abuse can be distressing and sometimes even shameful, reassuring the child that he or she has done the right thing by telling and that they are not bad and that the abuse was not their fault helps in disclosing more information. [[Anatomically correct doll]]s are sometimes used to help explain what happened, although some researchers consider the dolls too explicit and overstimulating, which might contribute to non-abused children behaving with the dolls in one or more ways that suggest they were sexually abused.<ref name="Segal">{{cite book|vauthors=Segal DL, Hersen M |title=Diagnostic Interviewing|publisher=[[Springer Science & Business Media]]|isbn=978-1-4419-1320-3|year=2009|page=455|access-date=November 23, 2017|url=https://books.google.com/books?id=LfDRjsei03kC&pg=PA455}}</ref>  For the suspected abusers, it is also recommended to use a nonjudgmental, nonthreatening attitude towards them and to withhold expressing shock, in order to help disclose information.<ref>Wilson, S.F.W, Giddens, J.F.G. (2009) Health Assessment for Nursing Practice. St. Louis: Mosby Elsevier, page 506.</ref>

==Treatment==
{{Main article|Post-assault treatment of sexual assault victims}}
The initial approach to treating a person who has been a victim of sexual abuse is dependent upon several important factors:
*Age at the time of presentation
*Circumstances of presentation for treatment
*Co-morbid conditions

The goal of treatment is not only to treat current mental health issues, and [[Psychological trauma|trauma]] related symptoms, but also to prevent future ones.

===Children and adolescents===
Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from child welfare agencies.<ref name=NCCAN>{{Cite book|author1=Cynthia Winn |author2=Anthony J. Urquiza |title=Treatment For Abused And Neglected Children: Infancy To Age 18 – User Manual Series |publisher=Diane Pub Co |year=2004 |isbn=978-0-7881-1661-2 }}{{page needed|date=November 2013}}</ref>

The three major modalities for therapy with children and adolescents are [[family therapy]], [[Group psychotherapy|group therapy]], and [[psychotherapy|individual therapy]]. Which course is used depends on a variety of factors that must be assessed on a case-by-case basis. For instance, treatment of young children generally requires strong parental involvement and can benefit from family therapy. Adolescents tend to be more independent; they can benefit from individual or group therapy. The modality also shifts during the course of treatment; for example, group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing.<ref name=NCCAN/> In a 2012 systematic review, [[Cognitive behavioral therapy|cognitive behavior therapy]] showed potential in treating the adverse consequences of child sexual abuse.<ref>{{Cite journal|last1=G|first1=Macdonald|last2=Jp|first2=Higgins|last3=P|first3=Ramchandani|last4=Jc|first4=Valentine|last5=Lp|first5=Bronger|last6=P|first6=Klein|last7=R|first7=O'Daniel|last8=M|first8=Pickering|last9=B|first9=Rademaker|date=2012-05-16|title=Cognitive-behavioural Interventions for Children Who Have Been Sexually Abused|journal=Cochrane Database of Systematic Reviews|volume=2012 |issue=5|pages=CD001930|language=en|doi=10.1002/14651858.CD001930.pub3|pmc=7061273|pmid=22592679}}</ref>

Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child's family of origin.  Roland C. Summit, a medical doctor, defined the different stages the victims of child sexual abuse go through, called [[child sexual abuse accommodation syndrome]]. He suggested that children who are victims of sexual abuse display a range of symptoms that include secrecy, helplessness, entrapment, accommodation, delayed and conflicted disclosure and recantation.<ref name="Summit">{{cite journal|last=Summit|first=Roland C.|title=The child sexual abuse accommodation syndrome|journal=Child Abuse & Neglect|date=January 1983|volume=7|issue=22|pmid=6605796|doi=10.1016/0145-2134(83)90070-4|pages=177–93|s2cid=4547031 }}</ref>

===Adults===
Adults who have been sexually abused as children often present for treatment with a secondary mental health issue, which can include [[substance abuse]], [[eating disorders]], [[personality disorders]], [[Depression (mood)|depression]], and conflict in romantic or interpersonal relationships.<ref name="Swaby-">{{Cite journal| last1 = Swaby | first1 = AN. | last2 = Morgan | first2 = KA. | title = The relationship between childhood sexual abuse and sexual dysfunction in Jamaican adults | journal = J Child Sex Abuse | volume = 18 | issue = 3 | pages = 247–66 | year =  2009| doi =  10.1080/10538710902902679| pmid = 19856732 | s2cid = 33062149 }}</ref>

Generally, the approach is to focus on the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person's specific issues. For instance, a person with a history of sexual abuse and severe depression would be treated for [[Major depressive disorder|depression]]. However, there is often an emphasis on [[cognitive restructuring]] due to the deep-seated nature of the trauma. Some newer techniques such as [[eye movement desensitization and reprocessing]] (EMDR) have been shown to be effective.<ref>{{Cite journal| last1 = Edmond | first1 = T. | last2 = Rubin | first2 = A. | title = Assessing the long-term effects of EMDR: results from an 18-month follow-up study with adult female survivors of CSA | journal = J Child Sex Abuse | volume = 13 | issue = 1 | pages = 69–86 | year = 2004 | doi =  10.1300/J070v13n01_04| pmid = 15353377 | s2cid = 28012364 }}</ref>

Although there is no known cure for pedophilia,<ref name=SetoReview>{{cite journal | author = Seto MC | year = 2009 | title = Pedophilia | journal = Annual Review of Clinical Psychology | volume = 5 | pages = 391–407 | doi=10.1146/annurev.clinpsy.032408.153618 | pmid=19327034| s2cid = 241202227 }}</ref> there are [[Pedophilia#Treatment|a number of treatments for pedophiles and child sexual abusers]]. Some of the treatments focus on attempting to change the sexual preference of pedophiles, while others focus on keeping pedophiles from committing child sexual abuse, or on keeping child sexual abusers from committing child sexual abuse again. [[Cognitive behavioral therapy]] (CBT), for example, aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use [[cognitive restructuring]] to change views on sex with children. The most common form of this therapy is [[relapse prevention]], where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions.<ref name="seto171">{{cite book |last= Seto |first= Michael |date= 2008|title= Pedophilia and Sexual Offending Against Children |url= https://archive.org/details/pedophiliasexual00seto |location= Washington, DC |publisher= American Psychological Association|page= [https://archive.org/details/pedophiliasexual00seto/page/n182 171]|isbn= 978-1-4338-0114-3 }}</ref>

The evidence for cognitive behavioral therapy is mixed.<ref name="seto171" /> A 2012 [[Cochrane Collaboration|Cochrane Review]] of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders.<ref name="cochrane">{{cite journal |vauthors=Dennis JA, Khan O, Ferriter M, Huband N, Powney MJ, Duggan C | year = 2012 | title = Psychological interventions for adults who have sexually offended or are at risk of offending | journal = Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD007507 | doi = 10.1002/14651858.CD007507.pub2| pmid = 23235646 }}</ref> Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism.<ref>{{cite journal |vauthors=Lösel F, Schmucker M | year = 2005 | title = The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis | journal = Journal of Experimental Criminology | volume = 1 | issue = 1 | pages = 117–46 | doi=10.1007/s11292-004-6466-7| s2cid = 145253074 }}</ref><ref>{{cite journal  |vauthors=Hanson RK, Gordon A, Harris AJ, Marques JK, Murphy W, etal | year = 2002 | title = First report of the collaborative outcome data project on the effectiveness of treatment for sex offenders | journal = Sexual Abuse | volume = 14 | issue = 2 | pages = 169–94 | doi=10.1177/107906320201400207| pmid = 11961890 | s2cid = 34192852 }}</ref> There is debate over whether non-randomized studies should be considered informative.<ref name=SetoReview/><ref name="rice2012">{{cite book |vauthors=Rice ME, Harris GT | year = 2012 | chapter = Treatment for adult sex offenders: may we reject the null hypothesis? | title = Handbook of Legal & Ethical Aspects of Sex Offender Treatment & Management |veditors=Harrison K, Rainey B | location = London | publisher = Wiley-Blackwell}}</ref> More research is needed.<ref name="cochrane" />

Sexual abuse is associated with many sub-clinical behavioral issues as well, including [[re-victimization]] in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and [[cognitive distortion|distorted thinking]] on the subject of sexual abuse (for instance, that it is common and happens to everyone).  When first presenting for treatment, the patient can be fully aware of their abuse as an event, but their ''appraisal'' of it is often distorted, such as believing that the event was unremarkable (a form of [[Isolation (psychology)|isolation]]). Frequently, victims do not make the connection between their abuse and their present pathology.

==Prevention==
{{Main article|Initiatives to prevent sexual violence}}
Child sexual abuse prevention programmes were developed in the United States of America during the 1970s. Some programme are delivered to children and can include one-to-one work<ref name="Williams one"/> and group work.<ref name="Williams group"/> Programmes delivered to parents were developed in the 1980s and took the form of one-off meetings, two to three hours long.<ref name="Babatsikos">{{cite journal | last=Babatsikos | first=Georgia | title=Parents' knowledge, attitudes and practices about preventing child sexual abuse: a literature review | journal=Child Abuse Review | publisher=Wiley | volume=19 | issue=2 | year=2010 | issn=0952-9136 | doi=10.1002/car.1102 | pages=107–129}}</ref><ref name="Hébert">{{cite journal | last1=Hébert | first1=Martine | last2=Lavoie | first2=Francine | last3=Parent | first3=Nathalie | title=An Assessment of Outcomes Following Parents' Participation in a Child Abuse Prevention Program | journal=Violence and Victims | publisher=Springer Publishing Company | volume=17 | issue=3 | date=2002-06-01 | issn=0886-6708 | doi=10.1891/vivi.17.3.355.33664 | pmid=12102058 | pages=355–372| s2cid=33445782 }}</ref><ref name="Wurtele Moreno Kenny">{{cite journal | last1=Wurtele | first1=Sandy K. | last2=Moreno | first2=Tasha | last3=Kenny | first3=Maureen C. | title=Evaluation of a Sexual Abuse Prevention Workshop for Parents of Young Children | journal=Journal of Child & Adolescent Trauma | publisher=Springer Nature | volume=1 | issue=4 | year=2008 | issn=1936-1521 | doi=10.1080/19361520802505768 | pages=331–340| s2cid=146651342 }}</ref><ref name="Wurtele Kenny 2010 pp. 130–152">{{cite journal | last1=Wurtele | first1=Sandy K. | last2=Kenny | first2=Maureen C. | title=Partnering with parents to prevent childhood sexual abuse | journal=Child Abuse Review | publisher=Wiley | volume=19 | issue=2 | year=2010 | issn=0952-9136 | doi=10.1002/car.1112 | pages=130–152}}</ref><ref>{{Cite web|url=http://library.nspcc.org.uk/HeritageScripts/Hapi.dll/filetransfer/2018FourStepsToThePreventionOfCSAInTheHome.pdf?CookieCheck=43313.725224213&filename=AA58F75CEDE68892A73FB681FE246B8371684F102152F0AA780A14959D3BCE5767137B3B2A935011CBAEC3068664FF681AA6D2524E357BAB96C006752CCD756759AD77BD1E389823A55CFAAE74B2EE64F46C611AD1724BE1AC500B025490CCB1CD8D9D26B00674E723A731951BB13FBE2976BA14838E6BBB09A4FA52BE735F27D92CBFED7FA6CFFA88BC073F0228EAA69F4D1FE158D846D5D4DD33F8F3466703AC49AD67CE927D87622D067280EF2A231A479B85D0572EF2AABC4480&DataSetName=LIVEDATA|title=Four Steps to the Prevention of Child Sexual Abuse in the Home|last=Williams|first=Mike|date=July 2018|website=NSPCC |url-status=dead |archive-url=https://web.archive.org/web/20201107233303/http://library.nspcc.org.uk/HeritageScripts/Hapi.dll/filetransfer/2018FourStepsToThePreventionOfCSAInTheHome.pdf?CookieCheck=44142.9632029167&filename=AA58F75CEDE68892A73FB681FE246B8371684F102152F0AA780A14959D3BCE5767137B3B2A935011CBAEC3068664FF681AA6D2524E357BAB96C006752CCD756759AD77BD1E389823A55CFAAE74B2EE64F46C611AD1724BE1AC500B025490CCB1CD8D9D26B00674E723A731951BB13FBE2976BA14838E6BBB09A4FA52BE735F27D92CBFED7FA6CFFA88BC073F0228EAA69F4D1FE158D846D5D4DD33F8F3466703AC49AD67CE927D87622D067280EF2A231A479B85D0572EF2AABC4480&DataSetName=LIVEDATA |archive-date= Nov 7, 2020 }}</ref><ref>{{Cite web|url=http://library.nspcc.org.uk/HeritageScripts/Hapi.dll/filetransfer/2018WorkingWithACommunityToPreventCSAInTheHome.pdf?filename=AA58F75CEDE68892A73FB681FE246B8371684F102152F0AA780A14959D3BCE5767137B3B2A935011CBAEC3068664FF681AA6D2524E357BAB96C006752CCD756759AD77BD1E389823A55CFAAE74B2EE64F46C611AD1724BE1AC500B025490CCB1CD8D9D26B00674E723A731951BB13FBE2976BA14838E6BBB09A4EB52B96A653DDB0BA5CD78B3E4F0B5A317270E32E79B9F7322E26DEE69E8F9DA1AD4D57D6203CA56A4641A004820ECE9E3EB4F712C3FED9F46CEBCE377C14C55CB2FBCFD7942&DataSetName=LIVEDATA|title=Working with a community to prevent child sexual abuse in the home|last=Williams|first=Mike|date=July 2018|website=NSPCC|access-date=1 August 2018 |url-status=dead |archive-url=https://web.archive.org/web/20201021014225/http://library.nspcc.org.uk/HeritageScripts/Hapi.dll/filetransfer/2018WorkingWithACommunityToPreventCSAInTheHome.pdf?CookieCheck=44124.1918731829&filename=AA58F75CEDE68892A73FB681FE246B8371684F102152F0AA780A14959D3BCE5767137B3B2A935011CBAEC3068664FF681AA6D2524E357BAB96C006752CCD756759AD77BD1E389823A55CFAAE74B2EE64F46C611AD1724BE1AC500B025490CCB1CD8D9D26B00674E723A731951BB13FBE2976BA14838E6BBB09A4EB52B96A653DDB0BA5CD78B3E4F0B5A317270E32E79B9F7322E26DEE69E8F9DA1AD4D57D6203CA56A4641A004820ECE9E3EB4F712C3FED9F46CEBCE377C14C55CB2FBCFD7942&DataSetName=LIVEDATA |archive-date= Oct 21, 2020 }}</ref> In the last 15 years, web-based programmes have been developed. School-based education programs were evaluated in 2015 by Cochrane that demonstrated improvements in protective behaviors and knowledge among children.<ref>{{Cite journal|last1=Walsh|first1=Kerryann|last2=Zwi|first2=Karen|last3=Woolfenden|first3=Susan|last4=Shlonsky|first4=Aron|date=2015-04-16|title=School-based education programmes for the prevention of child sexual abuse |doi-access=free  |journal=The Cochrane Database of Systematic Reviews|volume=2015 |issue=4|pages=CD004380|doi=10.1002/14651858.CD004380.pub3|issn=1469-493X|pmid=25876919|pmc=9805791 }}</ref> The American CDC lists that improving surveillance systems can help monitor and prevent child abuse.<ref>{{Cite web |date=2022-06-09 |title=Fast Facts: Preventing Child Sexual Abuse {{!}}Violence Prevention{{!}}Injury Center |url=https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html |access-date=2023-01-03 |website=CDC |language=en-us}}</ref><ref>{{Cite web |title=Preventing Sexual Violence Among Young People in the United States |url=https://www.cdc.gov/violenceprevention/pdf/RO1-FactsheetYouthBystander-508.pdf |website=CDC |url-status=live |archive-url= https://web.archive.org/web/20230308192445/https://www.cdc.gov/violenceprevention/pdf/RO1-FactsheetYouthBystander-508.pdf |archive-date= Mar 8, 2023 }}</ref> 

==Offenders==

===Demographics===
Offenders are more likely to be relatives or acquaintances of their victim than strangers.<ref>{{Cite journal|last1=Fergusson|first1=DM|last2=Lynskey|first2=MT|last3=Horwood|first3=LJ|s2cid=32786225|title=Childhood sexual abuse and psychiatric disorder in young adulthood: I. Prevalence of sexual abuse and factors associated with sexual abuse|journal=J Am Acad Child Adolesc Psychiatry|volume= 35 |issue= 10 |pages=1355–1364|date=October 1996|doi= 10.1097/00004583-199610000-00023 |pmid= 8885590 |hdl=10523/10282|hdl-access=free}}</ref> A 2006–07 Idaho study of 430 cases found that 82% of juvenile sex offenders were known to the victims (acquaintances 46% or relatives 36%).<ref>{{cite web|author=C.L. Butch Otter |author2=Lawrence Wasden |date=January 2008|title=The Prosecution of Child Sexual Abuse in Idaho July 1, 2006 – June 30, 2007|url=http://www2.state.id.us/ag/sexual_prosecution_reports/2007IdahoProsecutionOfChildSexualAbuseReport.pdf|access-date=2008-01-28|archive-url=https://web.archive.org/web/20080411140946/http://www2.state.id.us/ag/sexual_prosecution_reports/2007IdahoProsecutionOfChildSexualAbuseReport.pdf|archive-date=April 11, 2008|df=mdy-all}}</ref><ref>{{cite web|url=http://www.kpvi.com/Global/story.asp?S=7770431|archive-url=https://web.archive.org/web/20090625194210/http://www.kpvi.com/Global/story.asp?S=7770431|archive-date=25 June 2009|title=KPVI article|work=kpvi.com|access-date=23 March 2015}}</ref>

More offenders are male than female, though the percentage varies between studies. The percentage of incidents of sexual abuse by female perpetrators that come to the attention of the legal system is usually reported to be between 1% and 4%.<ref>{{Cite journal|doi=10.1080/00224490309552195|pmid=14533025|last=M. S.|first=Denov|date=1 Aug 2003|title=The myth of innocence: sexual scripts and the recognition of child sexual abuse by female perpetrators|journal=The Journal of Sex Research|volume=40|issue=3|pages=303–314|s2cid=41459407|url=http://goliath.ecnext.com/coms2/gi_0199-3286320/The-myth-of-innocence-sexual.html}}</ref> Studies of sexual misconduct in US schools with female offenders have shown mixed results with rates between 4% and 43% of female offenders.<ref name="Shakeshaft25">{{cite web|url=http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf|title=Educator Sexual Misconduct: A Synthesis of the Literature", U.S. Department of Education, 2004, p25, Shakeshaft, C.|website=ed.gov}}</ref> Maletzky (1993) found that, of his sample of 4,402 convicted child sex offenders, 0.4% were female.<ref>{{cite journal |doi=10.1007/BF00856862 |title=Factors associated with success and failure in the behavioral and cognitive treatment of sexual offenders |year=1988 |last1=Maletzky |first1=Barry M. |journal=Annals of Sex Research |volume=6 |issue=4 |pages=241–258|s2cid=198915624 }}</ref>

According to research conducted in Australia by Kelly Richards on child sexual abuse, 35.1% of female victims were abused by another male relative and 16.4% of male victims were abused by another male relative. Male relatives were found to be the most relevant predators in the case of both gender.<ref>{{Cite web|url=https://www.aic.gov.au/publications/tandi/tandi429|title=Misperceptions about child sex offenders|first=Australian Institute of|last=Criminology|date=September 30, 2011|website=Australian Institute of Criminology}}</ref>

In U.S. schools, educators who offend range in age from "21 to 75 years old, with an average age of 28".<ref>Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004, p.24-25.</ref>

According to C.E. Dettmeijer-Vermeulen, Dutch national spokeswoman on human traffic and sexual violence against children, in the Netherlands, 3% of the convicted perpetrators are women,<ref name="ontuchtrechter">{{Cite web|url=http://content1a.omroep.nl/urishieldv2/l27m4a273de7013477f0005da98af5000000.f2fcc54cbfc460050cf0cd7108a6c9b9/nos/docs/BNRMOntuchtDEF.PDF|title=Ontucht voor de rechter|access-date=2019-10-18}}{{dead link|date=January 2020|bot=medic}}{{cbignore|bot=medic}}</ref> 14.58% of the victims are boys<ref name="ontuchtrechter"/> and "most victims were abused by a family member, friend or acquaintance."<ref name="ontuchtrechter"/> One in six perpetrators is underage.<ref>{{cite web|url=http://nos.nl/artikel/2084576-seksueel-misbruik-minderjarigen-vrijwel-altijd-door-bekenden.html|title=Seksueel misbruik minderjarigen vrijwel altijd door bekenden|website=nos.nl|date=3 February 2016 }}</ref>

===Typology===
Early research in the 1970s and 1980s began to classify offenders based on their motivations and traits. Groth and Birnbaum (1978) categorized child sexual offenders into two groups, "fixated" and "regressed".<ref name="Groth">{{cite journal |doi=10.1007/BF01542377 |title=Adult sexual orientation and attraction to underage persons |url=https://archive.org/details/sim_archives-of-sexual-behavior_1978-05_7_3/page/175 |year=1978 |last1=Groth |first1=A. Nicholas |last2=Birnbaum |first2=H. Jean |journal=Archives of Sexual Behavior |volume=7 |issue=3 |pages=175–81 |pmid=666571|s2cid=11477434 }}</ref> Fixated were described as having a primary attraction to children, whereas regressed had largely maintained relationships with other adults, and were even married. This study also showed that adult [[sexual orientation]] was not related to the sex of the victim targeted, e.g. men who molested boys often had adult relationships with women.<ref name="Groth"/>

Later work (Holmes and Holmes, 2002) expanded on the types of offenders and their psychological profiles.  They are divided as follows:<ref name="holmes">{{Cite book| last = Holmes | first = Ronald M. |author2=Holmes, Stephen T.  | title =Profiling Violent Crimes: An Investigative Tool  | url = https://archive.org/details/profilingviolent0000holm_y4s6 | publisher = Sage Publications, Inc | location = Thousand Oaks, CA | date = 2002-03-12 | page = 158-171 |  isbn = 978-0-7619-2593-4}}</ref>
*Situational – does not prefer children, but offend under certain conditions.
**''Regressed'' – Typically has relationships with adults, but a stressor causes them to seek children as a substitute.
**''Morally Indiscriminate'' – All-around sexual deviant, who may commit other sexual offenses unrelated to children.
**''Naive/Inadequate'' – Often mentally disabled in some way, finds children less threatening.
*Preferential – has true sexual interest in children.
**''Mysoped'' – Sadistic and violent, target strangers more often than acquaintances.
**''Fixated'' – Little or no activity with own age, described as an "overgrown child".

===Causal factors===
Causal factors of child sex offenders are not known conclusively.<ref name=psychtoday2008>{{cite web |url=http://psychologytoday.com/conditions/pedophilia.html |archive-url=http://arquivo.pt/wayback/20080219104453/http://www.psychologytoday.com/conditions/pedophilia.html |archive-date=19 February 2008 |title=Pedophilia |publisher=Sussex Publishers, LLC |work=Psychology Today |date=7 September 2006 |access-date=9 January 2009 |df=dmy-all }}</ref> The experience of sexual abuse as a child was previously thought to be a strong risk factor, but research does not show a causal relationship, as the vast majority of sexually abused children do not grow up to be adult offenders, nor do the majority of adult offenders report childhood sexual abuse. The US [[Government Accountability Office]] concluded, "the existence of a cycle of sexual abuse was not established." Before 1996, there was greater belief in the theory of a "cycle of violence", because most of the research done was retrospective—abusers were asked if they had experienced past abuse. Even the majority of studies found that most adult sex offenders said they had ''not'' been sexually abused during childhood, but studies varied in terms of their estimates of the percentage of such offenders who had been abused, from 0 to 79 percent. More recent prospective [[Longitudinal study|longitudinal]] research—studying children with documented cases of sexual abuse over time to determine what percentage become adult offenders—has demonstrated that the cycle of violence theory is not an adequate explanation for why people molest children.<ref>{{cite web |title=Cycle of Sexual Abuse: Research Inconclusive About Whether Child Victims Become Adult Abusers |url=http://www.gao.gov/archive/1996/gg96178.pdf |work=US Government Accountability Office General Government Division United States |author1=E L Rezmovic |author2=D Sloane |author3=D Alexander |author4=B Seltser |author5=T Jessor |year=1996 |access-date=2009-01-09 |archive-date=2011-05-24 |archive-url=https://web.archive.org/web/20110524004442/http://www.gao.gov/archive/1996/gg96178.pdf }}</ref>

Offenders may use [[cognitive distortion]]s to facilitate their offenses, such as [[minimisation (psychology)|minimization]] of the abuse, [[victim blaming]], and [[making excuses|excuses]].<ref>{{cite journal |last1=Ward |first1=Tony |last2=Hudson |first2=Stephen M. |last3=Marshall |first3=William L. |year=1995 |title=Cognitive Distortions and Affective Deficits in Sex Offenders: A Cognitive Deconstructionist Interpretation |url=https://www.ojp.gov/ncjrs/virtual-library/abstracts/cognitive-distortions-and-affective-deficits-sex-offenders#:~:text=Cognitive%20Distortions%20and%20Affective%20Deficits%20in%20Sex%20Offenders%3A%20A%20Cognitive%20Deconstructionist%20Interpretation,-NCJ%20Number&text=This%20paper%20conceptually%20integrates%20cognitive,maintaining%2C%20and%20justifying%20sexual%20offending |journal=Sexual Abuse: A Journal of Research and Treatment |volume=7 |issue=1 |pages=67–83 |doi=10.1177/107906329500700107 |s2cid=145666322}}</ref>

=== Treatment ===

==== Cognitive behavioral therapy ====
[[Cognitive behavioral therapy]] (CBT) aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use [[cognitive restructuring]] to change views on sex with children. The most common form of this therapy is [[relapse prevention]], where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions.{{r|seto|p=171}}

The evidence for cognitive behavioral therapy is mixed.{{r|seto|p=171}} A 2012 [[Cochrane Collaboration|Cochrane Review]] of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders.<ref name="cochrane2">{{cite journal |vauthors=Dennis JA, Khan O, Ferriter M, Huband N, Powney MJ, Duggan C |year=2012 |title=Psychological interventions for adults who have sexually offended or are at risk of offending |journal=Cochrane Database of Systematic Reviews |volume=12 |issue=12 |pages=CD007507 |doi=10.1002/14651858.CD007507.pub2 |pmid=23235646}}</ref> Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism.<ref>{{cite journal |vauthors=Lösel F, Schmucker M |year=2005 |title=The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis |journal=Journal of Experimental Criminology |volume=1 |issue=1 |pages=117–46 |doi=10.1007/s11292-004-6466-7 |s2cid=145253074}}</ref><ref>{{cite journal |vauthors=Hanson RK, Gordon A, Harris AJ, Marques JK, Murphy W, etal |year=2002 |title=First report of the collaborative outcome data project on the effectiveness of treatment for sex offenders |journal=Sexual Abuse |volume=14 |issue=2 |pages=169–94 |doi=10.1177/107906320201400207 |pmid=11961890 |s2cid=34192852}}</ref> There is debate over whether non-randomized studies should be considered informative.<ref name="SetoReview2">{{cite journal |author=Seto MC |year=2009 |title=Pedophilia |journal=Annual Review of Clinical Psychology |volume=5 |pages=391–407 |doi=10.1146/annurev.clinpsy.032408.153618 |pmid=19327034 |s2cid=241202227}}</ref><ref name="rice20122">{{cite book |title=Handbook of Legal & Ethical Aspects of Sex Offender Treatment & Management |vauthors=Rice ME, Harris GT |publisher=[[Wiley-Blackwell]] |year=2012 |veditors=Harrison K, Rainey B |location=London, England |chapter=Treatment for adult sex offenders: may we reject the null hypothesis?}}</ref> More research is needed.<ref name="cochrane2" />

==== Behavioral interventions ====
Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and [[covert sensitization]] (or [[Masturbation|masturbatory]] reconditioning) to increase sexual arousal to adults.{{r|seto|p=175}} Behavioral treatments appear to have an effect on sexual arousal patterns during phallometric testing, but it is not known whether the effect represents changes in sexual interests or changes in the ability to control genital arousal during testing, nor whether the effect persists in the long term.<ref>Barbaree, H. E., Bogaert, A. F., & Seto, M. C. (1995). Sexual reorientation therapy for pedophiles: Practices and controversies. In L. Diamant & R. D. McAnulty (Eds.), ''The psychology of sexual orientation, behavior, and identity: A handbook'' (pp. 357–383). Westport, CT: Greenwood Press.</ref><ref>Barbaree, H. C., & Seto, M. C. (1997). Pedophilia: Assessment and treatment. In D. R. Laws & W. T. O'Donohue (eds.), ''Sexual deviance: Theory, assessment and treatment'' (pp. 175–193). New York: Guildford Press.</ref> For sex offenders with mental disabilities, [[applied behavior analysis]] has been used.<ref>{{cite book |author1=Maguth Nezu C. |title=Problem Solving Treatment for Intellectually Disabled Sex Offenders |author2=Fiore A. A. |author3=Nezu A. M |journal=International Journal of Behavioral Consultation and Therapy |year=2006 |isbn=9780470713488 |volume=2 |pages=266–275 |doi=10.1002/9780470713488.ch6}}</ref>

==== Sex drive reduction ====
{{See also|Chemical castration}}Pharmacological interventions are used to lower the sex drive in general, which can ease the management of pedophilic feelings, but does not change sexual preference.<ref name="camilleri199">{{cite book |last1=Camilleri |first1=Joseph A. |url=https://archive.org/details/sexualdevianceth00laws |title=Sexual Deviance: Theory, Assessment, and Treatment, 2nd edition |last2=Quinsey |first2=Vernon L. |date=2008 |publisher=The Guilford Press |isbn=9781593856052 |editor1-last=Laws |editor1-first=D. Richard |pages=[https://archive.org/details/sexualdevianceth00laws/page/199 199]–200 |chapter=Pedophilia: Assessment and Treatment}}</ref> [[Antiandrogens]] work by interfering with the activity of testosterone. [[Cyproterone acetate]] (Androcur) and [[medroxyprogesterone acetate]] (Depo-Provera) are the most commonly used. The efficacy of antiandrogens has some support, but few high-quality studies exist. Cyproterone acetate has the strongest evidence for reducing sexual arousal, while findings on medroxyprogesterone acetate have been mixed.{{r|seto|pp=177-181}}

[[Gonadotropin-releasing hormone analog|Gonadotropin-releasing hormone analogs]] such as [[leuprorelin]] (Lupron), which last longer and have fewer side-effects, are also used to reduce libido,<ref name="pmid15985890">{{cite journal |vauthors=Cohen LJ, Galynker II |year=2002 |title=Clinical features of pedophilia and implications for treatment |journal=Journal of Psychiatric Practice |volume=8 |issue=5 |pages=276–89 |doi=10.1097/00131746-200209000-00004 |pmid=15985890 |s2cid=22782583}}</ref> as are [[Selective serotonin reuptake inhibitor|selective serotonin reuptake inhibitors]].{{r|seto|pp=177-181}} The evidence for these alternatives is more limited and mostly based on open trials and case studies.<ref name="SetoReview2" /> All of these treatments, commonly referred to as "[[chemical castration]]", are often used in conjunction with cognitive behavioral therapy.<ref>{{cite journal |author=Guay, DR |year=2009 |title=Drug treatment of paraphilic and nonparaphilic sexual disorders |journal=Clinical Therapeutics |volume=31 |issue=1 |pages=1–31 |doi=10.1016/j.clinthera.2009.01.009 |pmid=19243704}}</ref> According to the [[Association for the Treatment of Sexual Abusers]], when treating child molesters, "anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan."<ref name="atsacast">{{cite web |year=1997 |title=Anti-androgen therapy and surgical castration |url=http://www.atsa.com/ppantiandro.html |url-status=dead |archive-url=https://web.archive.org/web/20110829070929/http://www.atsa.com/ppantiandro.html |archive-date=August 29, 2011 |work=Association for the Treatment of Sexual Abusers}}</ref> These drugs may have side-effects, such as weight gain, breast development, liver damage and osteoporosis.<ref name="SetoReview2" />

Historically, surgical [[castration]] was used to lower sex drive by reducing testosterone. The emergence of pharmacological methods of adjusting testosterone has made it largely obsolete, because they are similarly effective and less invasive.<ref name="camilleri199" /> It is still occasionally performed in Germany, the Czech Republic, Switzerland, and a few U.S. states. Non-randomized studies have reported that surgical castration reduces recidivism in contact sex offenders.{{r|seto|pp=181–182, 192}} The Association for the Treatment of Sexual Abusers opposes surgical castration<ref name="atsacast" /> and the [[Council of Europe]] works to bring the practice to an end in Eastern European countries where it is still applied through the courts.<ref>{{cite news |date=2009-02-05 |title=Prague Urged to End Castration of Sex Offenders |url=http://www.dw-world.de/dw/article/0,,4004260,00.html |url-status=live |archive-url=https://web.archive.org/web/20120107041148/http://www.dw-world.de/dw/article/0,,4004260,00.html |archive-date=2012-01-07 |access-date=2015-01-19 |newspaper=DW.DE}}</ref>

===Pedophilia===
{{Main|Pedophilia}}
Pedophilia is a condition in which an adult or older adolescent is primarily or exclusively attracted to prepubescent children, whether the attraction is acted upon or not.<ref>World Health Organization, International Statistical Classification of Diseases and Related Health Problems 10. § F65.4</ref><ref>American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (fourth edition text revision), § 302.2</ref> A person with this [[paraphilia]] is called a ''pedophile''.

In [[Police|law enforcement]], the term ''pedophile'' is sometimes used to describe those accused or convicted of child sexual abuse under [[Minor (law)|sociolegal definitions of ''child'']] (including both prepubescent children and adolescents younger than the local [[age of consent]]);<ref name="ames">{{cite journal |doi=10.1007/BF01541928 |title=Legal, social, and biological definitions of pedophilia |url=https://archive.org/details/sim_archives-of-sexual-behavior_1990-08_19_4/page/333 |year=1990 |last1=Ames |first1=M. Ashley |last2=Houston |first2=David A. |journal=Archives of Sexual Behavior |volume=19 |issue=4 |pages=333–42 |pmid=2205170|s2cid=16719658 }}</ref> however, not all child sexual offenders are pedophiles and not all pedophiles engage in sexual abuse of children.<ref name="barbaree-seto">{{Cite book|first1=Richard|last1=Laws|first2=William T.|last2=O'Donohue |year=1997 |title=Sexual Deviance: Theory, Assessment, and Treatment|pages= 175–93 |publisher=Guilford Press |isbn=978-1-57230-241-9|contribution=H. E. Barbaree, M. C. Seto }}</ref><ref name=apaDSM>{{cite web|url=http://www.psych.org/news_room/press_releases/diagnosticcriteriapedophilia.pdf   |title=American Psychiatric Association Statement Diagnostic Criteria for Pedophilia |date=June 17, 2003|publisher=American Psychiatric Association |archive-url = https://web.archive.org/web/20070629090023/http://www.psych.org/news_room/press_releases/diagnosticcriteriapedophilia.pdf |archive-date = June 29, 2007}}</ref><ref>{{cite journal |doi=10.1177/088626091006003002 |title=Self-Report of Crimes Committed by Sex Offenders |url=https://archive.org/details/sim_journal-of-interpersonal-violence_1991-09_6_3/page/286 |year=1991 |last1=Weinrott |first1=M. R. |last2=Saylor |first2=M. |journal=Journal of Interpersonal Violence |volume=6 |issue=3 |pages=286–300|s2cid=143721956 }}</ref> For these reasons, researchers recommend against imprecisely describing all child molesters as ''pedophiles''.<ref>{{cite book | first= Kenneth V. | last= Lanning|title = Child Molesters: A Behavioral Analysis | edition = fifth | year = 2010 | publisher = [[National Center for Missing and Exploited Children]] | url = http://www.missingkids.com/en_US/publications/NC70.pdf | pages = 29–30 | access-date = June 9, 2010 | archive-url = https://web.archive.org/web/20101224092439/http://www.missingkids.com/en_US/publications/NC70.pdf | archive-date = December 24, 2010}}</ref><ref>{{cite book | first=Michael | last=Seto| date = 2008 | title = Pedophilia and Sexual Offending Against Children | location = Washington, DC | publisher = [[American Psychological Association]] | page = vii}}</ref>

The term ''pedocriminality'' ([[German language|De]]: ''Pädokriminalität''; [[French language|Fr]]: ''pédocriminalité'') is a controversial term which originated in the 1980s and has been used by organisations such as [[UNICEF]], [[UNHRC]], the [[World Health Organization]]<ref>{{cite book |last=Schauer |first=Cathrin |title=Kinder auf dem Strich: Bericht von der deutsch-tschechischen Grenze |date=2003 |publisher=Horleman Verlag |isbn=978-3-89502-174-9 |language=de}}</ref> and the [[Council of Europe]]<ref>{{cite web|title=Group of specialists on the impact of the use of new information technologies on trafficking in human beings for the purpose of sexual exploitation (EG-S-NT): Final Report|url=http://www.coe.int/t/dghl/monitoring/trafficking/Docs/activities/EGSNT2002-9rev_en.asp|website=coe.int|publisher=[[Council of Europe]]|access-date=31 July 2015|location=[[Strasbourg]], [[Alsace]], [[France]]|date=16 September 2003}}</ref> to refer to child sexual abuse and sexual violence used against children,<ref>Andrea Buskotte 2010: ''Sexuelle Ausbeutung von Kindern.'' In: Bernd-Dieter Meier (Hrsg.) ''Kinder im Unrecht, Junge Menschen als Täter und Opfer'', Band 27 von Kriminalwissenschaftliche Schriften, LIT Verlag Münster, {{ISBN|3-643-10505-3}} S. 63.</ref><ref name="Gallwitz">Adolf Gallwitz, Manfred Paulus 2009: ''Pädokriminalität weltweit: sexueller Kindesmissbrauch, Kinderhandel, Kinderprostitution und Kinderpornographie''. VDP, Verl. Dt. Polizeiliteratur, {{ISBN|3-8011-0598-9}}.</ref> [[child prostitution]], [[child trafficking]] and the use of [[child pornography]].<ref>[https://so.ch/fileadmin/internet/staatskanzlei/stk-sekretariat/pdf/medienmitteilungen/2006/grundlagenbericht_jugendgewalt_def.pdf Amt für soziale Sicherheit ASO, Kanton Solothurn: ''Grundlagenbericht Dezember 2005/April 2006''] (PDF; 220&nbsp;kB). S. 12</ref> The term "cyber-pedocriminality" has been used to refer to the activities of viewers of child pornography online.<ref>{{cite journal | pmid = 20605633 | doi=10.1016/j.chiabu.2010.01.011 | volume=34 | issue=8 | title=Cyber-pedocriminality: characteristics of a sample of internet child pornography offenders | url = https://archive.org/details/sim_child-abuse-neglect_2010-08_34_8/page/570 | journal=Child Abuse Negl | pages=570–5 | last1 = Niveau | first1 = G| year=2010 }}</ref>

===Recidivism===
Although reconviction data suggest that not many sex offenders reoffend,<ref>{{cite web|url=http://www.csom.org/pubs/mythsfacts.html|title=CSOM Publications|work=csom.org|access-date=23 March 2015|archive-url=https://web.archive.org/web/20150401030750/http://www.csom.org/pubs/mythsfacts.html|archive-date=1 April 2015}}</ref> [[Office of Justice Programs|OJP]] reported that observed recidivism rates of sex offenders are underestimated of actual reoffending.<ref name=bjs-raso>{{Cite web |url=https://smart.ojp.gov/somapi/chapter-5-adult-sex-offender-recidivism |title=Sex Offender Management Assessment and Planning Initiative |access-date=2022-08-02 |work=Office of Justice Programs}}</ref> Estimated rates among child sex offenders vary by surveys and it is difficult to estimate accurately. One study found that 42% of offenders re-offended (either a sex crime, violent crime, or both) after they were released. Risk for re-offense was highest in the first 6 years after release, but continued to be significant even 10–31 years later, with 23% offending during this time.<ref>{{Cite journal|vauthors=Hanson RK, Steffy RA, Gauthier R |title=Long-term recidivism of child molesters |url=https://archive.org/details/sim_journal-of-consulting-and-clinical-psychology_1993-08_61_4/page/646 |journal=Journal of Consulting and Clinical Psychology |volume=61 |issue=4 |pages=646–52 |date=August 1993 |pmid=8370860 |doi=10.1037/0022-006X.61.4.646}}</ref> A study done in California in 1965 found an 18.2% recidivism rate for offenders targeting the opposite sex and a 34.5% recidivism rate for same-sex offenders after 5 years.<ref>{{cite journal |last=Frisbie |first=Louise Viets |year=1965 |title=Treated Sex Offenders Who Reverted to Sexually Deviant Behavior |url=https://archive.org/details/sim_federal-probation_1965-12_29_4/page/52 |journal=Federal Probation |volume=29 |page=52}}</ref>

Because recidivism is defined and measured differently from study to study, one can arrive at inaccurate conclusions being made based on comparison of two or more studies that are not conducted with similar methodology.<ref>{{Cite web|url=https://www.smart.gov/SOMAPI/sec1/ch5_recidivism.html|title=Chapter 5: Adult Sex Offender Recidivism {{!}} Sex Offender Management Assessment and Planning Initiative|website=www.smart.gov|access-date=2019-10-18}}</ref>

===Other children===
{{Main|Child-on-child sexual abuse}}

When a prepubescent child is sexually abused by one or more other children or adolescent youths, and no adult is directly involved, it is defined as [[child-on-child sexual abuse]]. The definition includes any sexual activity between children that occurs without [[consent]], without equality, or due to [[coercion]],<ref name="shaw">{{Cite journal|vauthors=Shaw JA, Lewis JE, Loeb A, Rosado J, Rodriguez RA |title=Child on child sexual abuse: psychological perspectives |url=https://archive.org/details/sim_child-abuse-neglect_2000-12_24_12/page/1591 |journal=Child Abuse & Neglect |volume=24 |issue=12 |pages=1591–600 |date=December 2000 |pmid=11197037 |doi=10.1016/S0145-2134(00)00212-X}}</ref> whether the offender uses physical force, threats, trickery or [[psychological manipulation|emotional manipulation]] to compel cooperation. When sexual abuse is perpetrated by one sibling upon another, it is known as "[[intersibling abuse]]", a form of [[incest]].<ref name="Caffaroa">{{Cite journal|doi=10.1016/j.avb.2004.12.001 |title=Treating sibling abuse families |year=2005 |last1=Caffaro |first1=J |last2=Conn-Caffaro |first2=A |journal=Aggression and Violent Behavior |volume=10 |pages=604–623|issue=5}}</ref>

Unlike research on adult offenders, a strong causal relationship has been established between child and adolescent offenders and these offenders' own prior victimization, by either adults or other children.<ref name=gray2>{{Cite journal|vauthors=Gray A, Pithers WD, Busconi A, Houchens P |title=Developmental and etiological characteristics of children with sexual behavior problems: treatment implications |url=https://archive.org/details/sim_child-abuse-neglect_1999-06_23_6/page/601 |journal=Child Abuse & Neglect |volume=23 |issue=6 |pages=601–21 |date=June 1999 |pmid=10391518 |doi=10.1016/S0145-2134(99)00027-7}}</ref><ref name="gray">{{Cite journal|doi=10.1007/BF02674853 |title=Children with sexual behavior problems and their caregivers: Demographics, functioning, and clinical patterns |year=1997 |last1=Gray |first1=Alison |last2=Busconi |first2=Aida |last3=Houchens |first3=Paul |last4=Pithers |first4=William D. |journal=Sexual Abuse: A Journal of Research and Treatment |volume=9 |pages=267–290|issue=4|s2cid=195274544 }}</ref><ref name=Bromberg>{{Cite journal|doi=10.1002/pits.1023 |title=Sexual interest in children, child sexual abuse, and psychological sequelae for children |url=https://archive.org/details/sim_psychology-in-the-schools_2001-07_38_4/page/343 |year=2001 |last1=Bromberg |first1=Daniel S. |last2=Johnson |first2=Blair T. |journal=Psychology in the Schools |volume=38 |pages=343–355|issue=4}}</ref><ref>{{Cite journal|doi=10.1023/A:1022194021593 |year=1998|last1=Wieckowski|first1=Edward|last2=Hartsoe|first2=Peggy|last3=Mayer|first3=Arthur|last4=Shortz|first4=Joianne|journal=Sexual Abuse: A Journal of Research and Treatment|volume=10 |pages=293–303|issue=4|title=Sexual Abuse: A Journal of Research and Treatment|s2cid=195292356}}</ref>

=== Teachers ===
{{Globalize|section|Africa|date=January 2024}}
{{Main|Sexual abuse in primary and secondary schools}}
According to a 2010 [[UNICEF]] report, 46% of Congolese schoolgirls confirmed that they had been victims of sexual harassment, abuse, and violence committed by their teachers or other school personnel.<ref name=fp>{{cite web|url=https://foreignpolicy.com/articles/2014/04/14/abuse_of_power_sexual_violence_schools_congo|title=Abuse of power|publisher=Foreignpolicy.com|date=14 April 2014|access-date=20 April 2014}}</ref> In [[Mozambique]], a study by the Ministry of Education found that 70 percent of female respondents reported knowing teachers who use sexual intercourse as a necessary condition to advance students to the next grade.<ref name=fp/> A survey by Promundo found that 16% of girls in [[North Kivu]] said they had been forced to have sex with their teachers.<ref name=fp/> According to UNICEF, teachers in [[Mali]] are known to use "La menace du bic rouge" ("the threat of the red pen"), using the threat of bad grades to coerce girls into acquiescing to sexual advances.<ref name=fp/> According to Plan International, 16% of children in [[Togo]], for instance, named a teacher as responsible for the pregnancy of a classmate.<ref name=fp/>

==Prevalence==

===Global===
Based on [[Self-report study|self-disclosure data]], a 2011 [[meta-analysis]] of 217 studies estimated a global prevalence of 12.7%–18% for girls and 7.6% for boys. The rates of self-disclosed abuse for specific continents were as follows:<ref name="stolt">{{cite journal |author1=Stoltenborgh, M. |author2=van IJzendoorn, M. H. |author3=Euser, E. M. |author4= Bakermans-Kranenburg, M. J. |name-list-style=amp | year = 2011 | title = A global perspective on child sexual abuse: meta-analysis of prevalence around the world | journal = Child Maltreatment | volume = 16 | issue = 2 | pages = 79–101 | doi = 10.1177/1077559511403920|pmid=21511741 |s2cid=30813632 }}</ref>

{| class="wikitable sortable"
|-
! Region
! Girls
! Boys
|-
| Africa
|20.2%
|19.3%
|-
| Asia
|11.3%
|4.1%
|-
| Australia
|21.5%
|7.5%
|-
| Europe
|13.5%
|5.6%
|-
| South America
|13.4%
|13.8%
|-
| US/Canada
|20.1%
|8%
|}

A 2009 meta-analysis of 65 studies from 22 countries found a global prevalence of 19.7% for females and 7.9% for males. In that analysis, Africa had the highest prevalence rate of child sexual abuse (34.4%), primarily because of high rates in South Africa; Europe showed the lowest prevalence rate (9.2%); and America and Asia had prevalence rates between 10.1% and 23.9%.<ref name="pereda">{{cite journal |author1=Pereda, N. |author2=Guilera, G. |author3=Forns, M. |author4=Gómez-Benito, J. |name-list-style=amp |year=2009 |title=The prevalence of child sexual abuse in community and student samples: A meta-analysis |url=https://www.sciencedirect.com/science/article/abs/pii/S0272735809000245 |journal=Clinical Psychology Review |volume=29 |issue=4 |pages=328–338 |doi=10.1016/j.cpr.2009.02.007 |pmid=19371992 |hdl-access=free |hdl=2445/27746}}</ref>

===Africa===
{{Further|Virgin cleansing myth}}
{{See also|Sexual violence in the Democratic Republic of the Congo|Sexual violence in South Africa|Child marriage}}
A ten-country school-based study in southern Africa in 2007 found 19.6% of female students and 21.1% of male students aged 11–16 years reported they had experienced forced or coerced sex. Rates among 16-year-olds were
28.8% in females and 25.4% in males. Comparing the same schools in eight countries between 2003 and 2007, age-standardised on the 2007 Botswana male sample, there was no significant decrease between 2003 and 2007 among females in any country and inconsistent changes among males.<ref>{{cite journal |doi=10.1136/bmjopen-2011-000754 |title=Prevalence and risk factors for forced or coerced sex among school-going youth: National cross-sectional studies in 10 southern African countries in 2003 and 2007 |year=2012 |last1=Andersson |first1=N. |last2=Paredes-Solís |first2=S. |last3=Milne |first3=D. |last4=Omer |first4=K. |last5=Marokoane |first5=N. |last6=Laetsang |first6=D. |last7=Cockcroft |first7=A. |journal=BMJ Open |volume=2 |issue=2 |pages=e000754 |pmid=22389362 |pmc=3293138}}</ref>

The prevalence of child sexual abuse in Africa is compounded by the [[virgin cleansing myth]] that sexual intercourse with a virgin will cure a man of [[HIV]] or [[AIDS]]. The myth is prevalent in [[South Africa]], [[Zimbabwe]],<ref>{{cite news|url=http://articles.cnn.com/2009-06-04/living/cnnheroes.betty.makoni_1_young-girls-raped-youngest-girl|title=Child rape survivors saves 'virgin myth' victims|publisher=cnn.com|access-date=2012-04-05|date=2009-06-04|archive-url=https://web.archive.org/web/20120127030305/http://articles.cnn.com/2009-06-04/living/cnnheroes.betty.makoni_1_young-girls-raped-youngest-girl|archive-date=2012-01-27}}</ref> [[Zambia]] and [[Nigeria]] and is being blamed for the high rate of sexual abuse against young children.<ref>''[http://www.aegis.com/news/suntimes/1999/ST990401.html Child Rape: A Taboo within the AIDS Taboo: More and more girls are being raped by men who believe this will 'cleanse' them of the disease, but people don't want to confront the issue] {{webarchive |url=https://web.archive.org/web/20100405222150/http://www.aegis.com/news/suntimes/1999/ST990401.html |date=April 5, 2010 }},'' by Prega Govender, ''Sunday Times (South Africa),'' April 4, 1999.</ref>

In November 2007, [[Thomson Reuters Foundation]] reported that [[Sexual violence in the Democratic Republic of the Congo|child rape is on the rise]] in the war-ravaged eastern [[Democratic Republic of the Congo]].<ref>{{cite news |url=http://www.alertnet.org/db/blogs/35376/2007/10/21-133107-1.htm|title=Child rape on the rise in eastern Congo |author=Sarah Jacobs |work=AlertNet |archive-url=https://web.archive.org/web/20090504202655/http://www.alertnet.org/db/blogs/35376/2007/10/21-133107-1.htm |access-date=23 March 2015|archive-date=2009-05-04 }}</ref>  Aid workers blame combatants on all sides, who operate with much impunity, for a culture of [[sexual violence]].<ref>{{cite news|url=http://news.bbc.co.uk/2/hi/africa/7119567.stm|title=BBC NEWS – Africa – DR Congo child rape victim dies|work=bbc.co.uk|access-date=23 March 2015}}</ref> [[South Africa]] has some of the highest incidences of child rape (including the rape of babies) in the world (also see [[sexual violence in South Africa]]).<ref name=time>{{cite news|url=http://www.time.com/time/world/article/0,8599,1680715,00.html?xid=feed-yahoo-full-world|archive-url=https://web.archive.org/web/20090818063455/http://www.time.com/time/world/article/0,8599,1680715,00.html?xid=feed-yahoo-full-world|archive-date=August 18, 2009|title=Oprah Scandal Rocks South Africa|date=5 November 2007|magazine=[[Time (magazine)|Time]] |access-date=23 March 2015}}</ref> A survey by CIET found around 11% of boys and 4% of girls admitted to forcing someone else to have sex with them.<ref name=time/> In a related [[Statistical survey|survey]] conducted among 1,500 schoolchildren, a quarter of all the boys interviewed said that "jackrolling", a term for [[gang rape]], was fun.<ref name=bbc1>{{cite news|url=http://news.bbc.co.uk/2/hi/africa/258446.stm|title=South Africa's rape shock|work=bbc.co.uk|access-date=23 March 2015}}</ref> More than 67,000 cases of rape and sexual assaults against children were reported in 2000 in South Africa, compared to 37,500 in 1998. Child welfare groups believe that the number of unreported incidents could be up to 10 times that number. The largest increase in attacks was against children under seven. The [[virgin cleansing myth]] is especially common in [[South Africa]], which has the highest number of HIV-positive citizens in the world. [[Eastern Cape]] social worker Edith Kriel notes that "child abusers are often relatives of their victims – even their fathers and providers."<ref name="Flanagan">[https://web.archive.org/web/20080612061053/http://www.telegraph.co.uk/news/worldnews/africaandindianocean/southafrica/1362134/South-African-men-rape-babies-as-%27cure%27-for-Aids.html '' South African Men Rape Babies as "Cure" for AIDS,''] Jane Flanagan, ''Daily Telegraph (UK),'' November 11, 2001.</ref>

A number of high-profile baby rapes appeared since 2001 (including the fact that they required extensive reconstructive surgery to rebuild urinary, genital, abdominal, or tracheal systems). In 2001, a 9-month-old was raped and likely lost consciousness as the pain was too much to bear.<ref>{{cite web|url=https://abcnews.go.com/WNT/story?id=130199&page=1 |title=Baby rape sparks outrage|publisher=abcnews.com|date=July 30, 2011|access-date=2011-07-12}}</ref> In February 2002, an 8-month-old infant was reportedly gang-raped by four men. One has been charged. The [[infant]] has required extensive reconstructive surgery. The 8-month-old infant's injuries were so extensive, increased attention on prosecution has occurred.<ref name=medscape>{{cite web|url=http://www.medscape.com/viewarticle/444213 |title=Child rape in South Africa|website=Medscape|access-date=2010-12-31}}</ref>

===Asia===
{{Further|Child prostitution in Thailand|Child pornography laws in Japan|Ages of consent in Asia}}
In [[Afghanistan]], some boys are forced to participate in [[Bacha bazi|sexual activities with men]].  They are also termed 'dancing boys'. The custom is connected to sexual slavery and child prostitution.<ref>{{cite news|url=https://www.theweek.co.uk/105442/bacha-bazi-the-scandal-of-afghanistan-s-abused-boys  |title=Bacha bazi: the scandal of Afghanistan's abused boys |date=29 January 2020|work=The Week|access-date=16 April 2020}}</ref><ref name= "Foreign Policy">{{cite magazine| last =Mondloch| first =Chris| title =Bacha Bazi: An Afghan Tragedy| magazine =Foreign Policy | date =Oct 28, 2013| url =https://foreignpolicy.com/2013/10/28/bacha-bazi-an-afghan-tragedy/| access-date = 16 April 2020}}</ref>

In [[Bangladesh]], child prostitutes are known to take the drug [[Dexamethasone|Oradexon]], an over-the-counter [[steroid]], usually used by farmers to fatten cattle, to [[Prostitution in Bangladesh|make child prostitutes look larger and older]]. Charities say that 90% of prostitutes in the country's legalized brothels use the drug. According to social activists, the steroid can cause [[diabetes]] and [[high blood pressure]] and is highly addictive.<ref>{{cite news|url=https://www.reuters.com/article/us-bangladesh-prostitution-idUSBRE82I02A20120319 |title=Bangladesh's teenage brothels hold dark steroid secret|publisher=reuters.com|access-date=2012-03-20|date=2012-03-19}}</ref><ref>{{cite news|url=https://www.theguardian.com/society/2010/apr/05/sex-workers-bangladesh-steroid|title=A new danger for sex workers in Bangladesh|publisher=guardian.com|access-date=2012-03-20|date=2010-04-05}}</ref><ref>{{cite news|url=https://www.bbc.co.uk/news/10173115|title=Bangladesh's dark brothel steroid secret|publisher=bbcnews.com|access-date=2012-03-20|date=2010-05-30}}</ref>

In 2007, the [[India|Indian]] [[Ministry of Women and Child Development (India)|Ministry of Women and Child Development]] published the "Study on Child Abuse: India 2007".<ref name = IndiaStudy2007/> It sampled 12447 children, 2324 young adults and 2449 stakeholders across 13 states. It looked at different forms of child abuse: [[physical abuse]], [[sexual abuse]] and [[psychological abuse|emotional abuse]] and girl [[child neglect]] in five evidence groups, namely, children in a family environment, children in school, children at work, children on the street and children in institutions. The study's<ref name=IndiaStudy2007>{{cite web|url=http://wcd.nic.in/childabuse.pdf |title=Study on Child Abuse: India 2007 |publisher=Published by the Government of India, (Ministry of Women and Child Development) |archive-url=https://web.archive.org/web/20100326164558/http://www.wcd.nic.in/childabuse.pdf |archive-date=2010-03-26 }}</ref> main findings included: 53.22% of children reported having faced sexual abuse. Among them, 52.94% were boys and 47.06% girls. [[Andhra Pradesh]], [[Assam]], [[Bihar]] and [[Delhi]] reported the highest percentage of sexual abuse among both boys and girls, as well as the highest incidence of sexual assaults. 21.90% of child respondents faced severe forms of sexual abuse, 5.69% had been sexually assaulted and 50.76% reported other forms of sexual abuse. Children on the street, at work and in institutional care reported the highest incidence of sexual assault. The study also reported that 50% of abusers are known to the child or are in a position of trust and responsibility and most children had not reported the matter to anyone. Despite years of lack of any specific [[child sexual abuse laws in India]], which treated them separately from adults in case of sexual offense, the [[Protection of Children from Sexual Offenses Act|Protection of Children Against Sexual Offences Bill, 2011]] was passed the [[Indian parliament]] on May 22, 2012, which came into force from 14 November 2012.<ref>{{cite news |title=Parliament passes bill to protect children from sexual abuse |url=http://www.ndtv.com/article/india/parliament-passes-bill-to-protect-children-from-sexual-abuse-214437 |publisher=[[NDTV]] |date=May 22, 2012 }}</ref>

According to research published in 2019 India had the largest number of child sexual abuse imagery searches along with being responsible for producing a third of the worlds child sexual abuse content online.<ref>{{cite news | url=https://timesofindia.indiatimes.com/india/india-tops-list-on-reported-child-sexual-abuse-imagery/articleshow/71383544.cms | title=India tops list on reported child sexual abuse imagery | newspaper=The Times of India | date=October 2019 }}</ref><ref>{{cite web | url=https://www.businessinsider.in/law-order/crime/news/a-third-of-the-worlds-child-porn-is-flagged-off-in-india-indonesia-and-thailand/articleshow/71385866.cms | title=A third of the world's child porn is flagged off in India, Indonesia and Thailand }}</ref><ref>{{cite web | url=https://www.vice.com/en/article/k7ez8a/india-has-a-child-pornography-problem-and-delhi-tops-the-list-of-uploads | title=India Has a Child Pornography Problem, and Delhi Tops the List of Uploads | date=28 January 2020 }}</ref>
	
In [[Pakistan]], sexual abuse of children is a problem in some [[Madrassas in Pakistan|madrassas]].<ref name= "sex abuse">{{cite news|url=https://apnews.com/ddd9660f63ae4433966684823f79d3e9/Islamic-schools-in-Pakistan-plagued-by-sex-abuse-of-children  |title=Islamic schools in Pakistan plagued by sex abuse of children |author=Gannon, Kathy|date=22 November 2017|work=[[AP News]]|access-date=14 April 2020}}</ref><ref>{{cite news|url=https://blogs.tribune.com.pk/story/89873/why-are-we-silent-about-the-sexual-abuse-at-madrassas/  |title=Why are we silent about the sexual abuse at madrassas? |author=Ernest, J|date=26 October 2019|work=Pakistan Express Tribune|access-date=14 April 2020}}</ref> Child sexual abuse has also been reported in Madrassas across Bangladesh and India.<ref name="prothomalo">{{cite news |last= |first= |date=29 August 2019|title=Bangladeshi students speak up about rapes in madrasas|url=https://en.prothomalo.com/bangladesh/Bangladeshi-students-speak-up-about-rapes-in|newspaper=Prothomalo}}</ref><ref name="Siasat">{{cite news |last= |first= |date=14 March 2021|title=Torture, including sexual, taking place in madrasas across B'desh: SC|url=https://www.siasat.com/torture-including-sexual-taking-place-in-madrasas-across-bdesh-sc-2110137/|newspaper=Siasat}}</ref><ref name="FE">{{cite news |last= |first= |date=30 December 2017|title=Madrasa horror in Uttar Pradesh: Lucknow police rescues 51 girls, arrests manager over charges of sexual abuse|url=https://www.financialexpress.com/india-news/madrasa-horror-in-uttar-pradesh-lucknow-police-rescues-51-girls-arrests-manager-over-charges-of-sexual-abuse/995619/|newspaper=Financial Times}}</ref><ref name="IT">{{cite news |last= P Khelkar|first= Pankaj|date=28 July 2018|title=36 kids rescued from Pune madrasa after reports of sexual abuse surface, 1 arrested|url=https://www.indiatoday.in/india/story/36-kids-rescued-from-pune-madrasa-after-reports-of-sexual-exploitation-surface-one-arrested-1298621-2018-07-28|newspaper=India Today}}</ref>

The [[Kasur child sexual abuse scandal]], which involved [[forced sex|forced sex acts]] and an estimated 280 to 300 children, was termed the largest child abuse scandal in Pakistan's history.<ref>{{Cite web|url=http://tribune.com.pk/story/935471/kasur-child-pornography-ring-lawyer-accuses-police-of-protecting-culprits|title=Kasur child pornography ring: Lawyer accuses police of protecting culprits|date=August 10, 2015|website=The Express Tribune}}</ref>

In 2019, Pakistan's Human Rights Minister, Shirin Mazari has said that Pakistan was ranked as the country with the largest numbers of [[child pornography]] viewers.<ref name= "HRM">{{cite news|url=https://dailytimes.com.pk/430785/child-pornography-in-pakistan-reality-or-myth/  |title=Child Pornography in Pakistan: Reality or myth?|author=Shahab-ud-Din, Makhdoom|date=15 July 2019|work=Daily Times|access-date=16 April 2020}}</ref>  Geo Pakistan, the [[Federal Investigation Agency]], cyber-crime chief has said, "Child pornography is a business  . . with those involved in the crime linked to international child pornography rings."<ref name ="FIA">{{cite news|url= https://www.geo.tv/latest/228026-child-pornography-a-business-in-pakistan-fia-cyber-crime-chief|title= Child pornography a business in Pakistan: FIA cyber-crime chief|date=13 February 2019|work=Geo News|access-date=16 April 2020}}</ref>

In [[Taiwan]], a survey of adolescents reported 2.5% as having experienced childhood sexual abuse.<ref>{{cite journal | doi = 10.1016/j.chiabu.2007.06.003 | pmid = 18308392 | last1 = Yen | first1 = Cheng-Fang | last2 = Yang | first2 = Mei-Sang | last3 = Yang | first3 = Ming-Jen | last4 = Su | first4 = Yi-Ching | last5 = Wang | first5 = Mei-Hua | last6 = Lan | first6 = Chu-Mei | year = 2008 | title = Childhood physical and sexual abuse: Prevalence and correlates among adolescents living in rural Taiwan | url = https://archive.org/details/sim_child-abuse-neglect_2008-03_32_3/page/429 | journal = Child Abuse & Neglect | volume = 32 | issue = 3| pages = 429–438 }}</ref>

In [[Uzbekistan]], the UK Ambassador [[Craig Murray]] wrote that the government, under president [[Islam Karimov]], used child rape to force false confessions from prisoners.<ref>Dirty Diplomacy, Craig Murray, Scribner, 2007</ref>

===Pacific===
{{See also|Sexual violence in Papua New Guinea}}
According to UNICEF, nearly half of [[Sexual violence in Papua New Guinea|reported rape victims]] in [[Papua New Guinea]] are under 15 years of age and 13% are under 7 years of age<ref name=UNICEF2>{{cite web|url=http://www.unicef.org/infobycountry/papuang_45211.html|title=UNICEF strives to help Papua New Guinea break cycle of violence|publisher=[[UNICEF]]|access-date=26 February 2014|date=18 August 2008|archive-date=14 June 2018|archive-url=https://web.archive.org/web/20180614094336/https://www.unicef.org/infobycountry/papuang_45211.html}}</ref> while a report by [[ChildFund]] Australia citing former Parliamentarian Dame [[Carol Kidu]] stated 50% of those seeking medical help after rape are under 16, 25% are under 10 and 10% are under 8.<ref>{{cite web|url=https://www.theguardian.com/society/2013/nov/26/papua-new-guinea-takes-steps-against-abuse|author=Davidson, Helen|title=Papua New Guinea takes first steps to combat 'epidemic' of abuse|publisher=Guardian News and Media Limited|access-date=9 March 2014|date=26 November 2013}}</ref>

Additionally, a study found that men with a history of victimization, especially having been raped or otherwise sexually coerced themselves, were more likely than otherwise to have participated in both single-perpetrator and [[gang rape|multiple-perpetrator]] non-partner rape.<ref name=Jewkes>{{cite journal|last=Jewkes|first=Rachel|author2=Emma Fulu|author3=Tim Roselli|author4=Claudia Garcia-Moreno |title=Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific|journal=[[The Lancet]]|date=10 September 2013|doi=10.1016/S2214-109X(13)70069-X|volume=323|issue=4|pages=e208-18|pmid=25104346|doi-access=free}}</ref> 57·5% (587/1022) of men who raped a non-partner committed their first rape as teenagers.<ref name=Jewkes/>

===United States and Europe===
Child sexual abuse occurs frequently in Western society,<ref>{{Cite journal|vauthors=Kendall-Tackett KA, Williams LM, Finkelhor D |s2cid=2512368 |title=Impact of sexual abuse on children: a review and synthesis of recent empirical studies |url=https://archive.org/details/sim_psychological-bulletin_1993-01_113_1/page/164 |journal=Psychological Bulletin |volume=113 |issue=1 |pages=164–80 |date=January 1993 |pmid=8426874 |doi=10.1037/0033-2909.113.1.164}}</ref> although the rate of prevalence can be difficult to determine.<ref name="Finklehor-epid">{{Cite journal|author=Finkelhor D |title=Epidemiological factors in the clinical identification of child sexual abuse |journal=Child Abuse & Neglect |volume=17 |issue=1 |pages=67–70 |year=1993 |pmid=8435788 |doi=10.1016/0145-2134(93)90009-T}}</ref><ref>{{Cite journal|first1=Juliette D. G. |last1=Goldman |first2=Usha K. |last2=Padayachi |date=November 2000 |title=Some methodological problems in estimating incidence and prevalence in child sexual abuse research |url=https://archive.org/details/sim_journal-of-sex-research_2000-11_37_4/page/305 |journal=Journal of Sex Research |volume=37 |issue=4 |pages=305–14 |doi=10.1080/00224490009552052|s2cid=143565708 }}</ref><ref name="Kevin M. Gorey and Donald R. Leslie 1997 pp391–398">{{Cite journal|last1= Gorey |first1= Kevin |date=April 1997 |title= The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases |url= https://archive.org/details/sim_child-abuse-neglect_1997-04_21_4/page/391 |journal= Child Abuse & Neglect |volume= 21 |issue= 4 |pages= 391–398 |doi= 10.1016/S0145-2134(96)00180-9 |pmid= 9134267 |last2= Leslie |first2= DR|citeseerx= 10.1.1.465.1057 }}</ref> Research in [[North America]] has concluded that approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.<ref name=Whealin/><ref name="Finkelhor1994">{{Cite journal|author=Finkelhor D|title=Current information on the scope and nature of child sexual abuse|journal=The Future of Children|volume=4 |issue=2 |pages=31–53|year=1994|pmid=7804768 |url=http://www.unh.edu/ccrc/pdf/VS75.pdf |doi=10.2307/1602522 |jstor=1602522}}</ref><!-- Should be specific citations, not homepages<ref>{{cite web|url=http://www.unh.edu/ccrc/|title=Crimes Against Children Research Center|work=unh.edu|access-date=23 March 2015}}</ref><ref>{{cite web|url=http://www.unh.edu/frl/|title=Family Research Laboratory|work=College of Liberal Arts|access-date=23 March 2015}}</ref> --><ref name="Kevin M. Gorey and Donald R. Leslie 1997 pp391–398"/> In the UK, a 2010 study estimated prevalence at about 5% for boys and 18% for girls<ref>{{cite web |title=Child abuse and neglect in the UK today |url=http://www.nspcc.org.uk/Inform/research/findings/child_abuse_neglect_research_PDF_wdf84181.pdf |work=NSPCC |author1=Radford |author2=Lorraine |author3=Corral |author4=Susana |author5=Bradley |author6=Christine |author7=Fisher |author8=Helen |author9=Bassett |author10=Claire |author11=Howat |author12=Nick |author13=Collishaw |author14=Stephan |year=2011 |page=5 |access-date=2011-10-29 |archive-date=2014-08-16 |archive-url=https://web.archive.org/web/20140816090004/http://www.nspcc.org.uk/Inform/research/findings/child_abuse_neglect_research_PDF_wdf84181.pdf |url-status=dead }}</ref> (not dissimilar to a 1985 study that estimated about 8% for boys and 12% for girls<ref name="Baker">{{Cite journal|last= Baker |first= AW |author2=Duncan, SP |year= 1985 |title= Child sexual abuse: a study of prevalence in Great Britain |journal= Child Abuse & Neglect |volume= 9| issue= 4 |pages= 457–67 |pmid = 4084825 |doi= 10.1016/0145-2134(85)90054-7}}</ref>). More than 23,000 incidents were recorded by the UK police between 2009 and 2010. Girls were six times more likely to be assaulted than boys with 86% of attacks taking place against them.<ref>[https://www.bbc.co.uk/news/education-13542007 "NSPCC says child sex abuse has risen to 64 crimes a day"] ''BBC News''. 26 May 2011. Retrieved February 4, 2012.</ref><ref>[http://news.bbc.co.uk/1/hi/uk/8477726.stm "60 sex offences against children a day – NSPCC"] ''BBC News''. 25 January 2010. Retrieved February 4, 2012.</ref> [[Barnardo's]] [[Charitable organization|charity]] estimates that two thirds of victims in the [[United Kingdom]] are girls and one third are boys. Barnardo's is concerned that boy victims may be overlooked.<ref>{{cite news|url=https://www.bbc.co.uk/news/uk-28935733|title=Barnardo's: Sexual exploitation of boys 'overlooked'|newspaper=BBC News|access-date=23 March 2015|date=2014-08-27|last1=Malik|first1=Zubeida}}</ref>

The estimates for the United States vary widely. A literature review of 23 studies found rates of 3% to 37% for males and 8% to 71% for females, which produced an average of 17% for boys and 28% for girls,<ref name="Rind">{{Cite journal|last= Rind |first= B|author2=Tromovitch, P.|author3=Bauserman, R. |year= 1998 |title= A meta-analytic examination of assumed properties of child sexual abuse using college samples |url= https://archive.org/details/sim_psychological-bulletin_1998-07_124_1/page/22 |journal= Psychological Bulletin | issue=   1|pages= 22–53 |doi= 10.1037/0033-2909.124.1.22 |volume= 124 |pmid=9670820|s2cid= 16123776}}</ref> while a statistical analysis based on 16 cross-sectional studies estimated the rate to be 7.2% for males and 14.5% for females.<ref name="Kevin M. Gorey and Donald R. Leslie 1997 pp391–398"/> The [[US Department of Health and Human Services]] reported 83,600 substantiated reports of sexually abused children in 2005,<ref>{{cite web |url=http://faq.acf.hhs.gov/cgi-bin/acfrightnow.cfg/php/enduser/std_adp.php?p_faqid=68&p_created=1001610478&p_sid=xmCO-dUi&p_accessibility=0&p_lva=&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PWRmbHQmcF9ncmlkc29ydD0mcF9yb3dfY250PTEzJnBfcHJvZHM9JnBfY2F0cz0xMCwzMCZwX3B2PSZwX2N2PTIuMzAmcF9zZWFyY2hfdHlwZT1hbnN3ZXJzLnNlYXJjaF9ubCZwX3BhZ2U9MQ**&p_li=&p_topview=1 |title=ACF Questions and Answers Support |work=Administration on Children and Families |access-date=December 26, 2007 |publisher=US Department of Health and Human Services }}{{Dead link|date=November 2018 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite web |url=http://www.acf.hhs.gov/programs/cb/pubs/cm05/chapterthree.htm |title=Child Maltreatment 2005 |work=Administration on Children and Families |access-date=December 26, 2007 |publisher=US Department of Health and Human Services |archive-url=https://web.archive.org/web/20080103004739/http://www.acf.hhs.gov/programs/cb/pubs/cm05/chapterthree.htm#types |archive-date=January 3, 2008 |df=mdy-all }}</ref> while state-level child protective services reported 63,527 sexual abuse incidents in 2010.<ref>{{Cite web|url=https://www.acf.hhs.gov/cb/resource/child-maltreatment-2010-data-tables#page=61|title=Child Maltreatment 2010 – Data Tables|last=Children's Bureau|date=31 December 2010|website=Administration for Children and Families|access-date=29 January 2018|archive-date=30 January 2018|archive-url=https://web.archive.org/web/20180130091300/https://www.acf.hhs.gov/cb/resource/child-maltreatment-2010-data-tables#page=61|url-status=dead}}</ref> Including incidents which were not reported would make the total number even larger.<ref name=aacap2008>{{cite web|url=http://www.aacap.org/cs/root/facts_for_families/child_sexual_abuse |title=Child Sexual Abuse |work=Facts for Families, No. 9|date=May 2008 |publisher=American Academy of Child and Adolescent Psychiatry}}</ref> According to Emily M. Douglas and [[David Finkelhor]], "Several national studies have found that [[African American|black]] and [[Non-Hispanic Whites|white]] children experienced near-equal levels of sexual abuse. Other studies, however, have found that both blacks and [[Hispanic and Latino Americans|Latinos]] have an increased risk for sexual victimization".<ref>[http://www.unh.edu/ccrc/factsheet/pdf/CSA-FS20.pdf Child Sexual Abuse Fact Sheet] {{Webarchive|url=https://web.archive.org/web/20160303185014/http://www.unh.edu/ccrc/factsheet/pdf/CSA-FS20.pdf |date=2016-03-03 }}. (PDF). Emily M. Douglas and [[David Finkelhor]].</ref><ref>"[http://www.empty-memories.nl/science/Hanson_correlates%20ofsexabuse.pdf Correlates of Adolescent Reports of Sexual Assault: Findings From the National Survey of Adolescents]". (PDF). ''[http://cmx.sagepub.com/content/8/4/261.abstract Child Maltreatment]''  Volume:8 Issue:4 Dated:November 2003 Pages:261 to 272</ref>

Surveys have shown that one fifth to one third of all women reported some sort of childhood sexual experience with a male adult.<ref name=Herman>{{Cite book | last =Herman | first =Judith | title =Father-Daughter Incest | publisher =Harvard University Press | year =1981 | location =Cambridge, Massachusetts | page =[https://archive.org/details/fatherdaughterin00herm_0/page/282 282] | isbn =978-0-674-29506-3 | url =https://archive.org/details/fatherdaughterin00herm_0/page/282 }}</ref>
A 1992 survey studying father-daughter incest in Finland reported that of the 9,000 15-year-old high school girls who filled out the questionnaires, of the girls living with their biological fathers, 0.2% reported father-daughter incest experiences; of the girls living with a stepfather, 3.7% reported sexual experiences with him. The reported counts included only father-daughter incest and did not include prevalence of other forms of child sexual abuse.  The survey summary stated, "the feelings of the girls about their incestual experiences are overwhelmingly negative."<ref>{{cite journal |doi=10.1016/0145-2134(96)00072-5 |pmid=8886468 |title=The prevalence and context of incest abuse in Finland |url=https://archive.org/details/sim_child-abuse-neglect_1996-09_20_9/page/843 |year=1996 |last1=Sariola |first1=Heikki |last2=Uutela |first2=Antti |journal=Child Abuse & Neglect |volume=20 |issue=9 |pages=843–850}}</ref> Others argue that prevalence rates are much higher, and that many cases of child abuse are never reported. One study found that professionals failed to report approximately 40% of the child sexual abuse cases they encountered.<ref>Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996{{page needed|date=November 2013}}</ref> A study by Lawson & Chaffin indicated that many children who were sexually abused were "identified solely by a physical complaint that was later diagnosed as a venereal disease&nbsp;... Only 43% of the children who were diagnosed with venereal disease made a verbal disclosure of sexual abuse during the initial interview."<ref>pg7., In. Keuhnle, K., Assessing Allegations of Child Sexual Abuse, Professional Resources Press, Sarastota, FL, 1996</ref>  It has been found in the epidemiological literature on CSA that there is no identifiable demographic or family characteristic of a child that can be used to bar the prospect that a child has been sexually abused.<ref name="Finklehor-epid"/>

[[Child marriage]] is often considered to be another form of child sexual abuse.<ref name=":1" /> Over 200,000 marriages involving minors were allowed between 2000 and 2015 in the US. These marriages were most often between an adult male and female minor.<ref name=":2">{{Cite web|url=http://apps.frontline.org/child-marriage-by-the-numbers/|title=Child Marriage in America By Number|last=Tsui|first=Anjali|date=July 6, 2017|website=apps.frontline.org|access-date=2019-10-10}}</ref> [[Child marriage in the United States]] is allowed in the majority of states as long as parental consent or judicial approval (typically for pregnancy) is given.<ref name=":2" />

In US schools, according to the [[United States Department of Education]],<ref name="shakeshaft2004">Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004</ref> "nearly 9.6% of students are targets of educator sexual misconduct sometime during their school career." In studies of student sex abuse by male and female educators, male students were reported as targets in ranges from 23% to 44%.<ref name="shakeshaft2004" /> In U.S. school settings same-sex (female and male) sexual misconduct against students by educators "ranges from 18 to 28% of reported cases, depending on the study"<ref>Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004, p26.</ref> An American survey found that children sexually abused by relatives were much more likely to be affiliated with Protestantism, while persons sexually abused by nonrelatives were affiliated with liberal denominations or irreligious.<ref name="Ebaugh 2006 p. 252">{{cite book | last=Ebaugh | first=H.R. | title=Handbook of Religion and Social Institutions | publisher=Springer US | series=Handbooks of Sociology and Social Research | year=2006 | isbn=978-0-387-25703-7 | url=https://books.google.com/books?id=j92cSG4HJQ0C&pg=PA252 | access-date=2023-08-17 | page=252}}</ref>

Significant underreporting of sexual abuse of boys by both women and men is believed to occur due to sex stereotyping, social denial, the minimization of male victimization, and the relative lack of research on sexual abuse of boys.<ref>{{cite journal | doi = 10.1111/j.1469-7610.1992.tb00862.x | last1 = Watkins | first1 = B. | last2 = Bentovim | first2 = A. | year = 1992 | title = The sexual abuse of male children and adolescents: a review of current research | url = http://www.sasian.org/papers/boysngirls.htm | journal = Journal of Clinical Psychology & Psychiatry | volume = 33 | issue = 10 | pages = 197–248 | pmid = 1737828 | access-date = 2007-03-23 | archive-date = 2012-06-16 | archive-url = https://web.archive.org/web/20120616062331/http://www.sasian.org/papers/boysngirls.htm | url-status = dead }}</ref> Sexual victimization of boys by their mothers or other female relatives is especially rarely researched or reported. Sexual abuse of girls by their mothers, and other related and/or unrelated adult females is beginning to be researched and reported despite the highly taboo nature of female–female child sex abuse. In studies where students are asked about sex offenses, they report higher levels of female sex offenders than found in adult reports.<ref>Shakeshaft, C, "[http://www.ed.gov/rschstat/research/pubs/misconductreview/report.pdf Educator Sexual Misconduct: A Synthesis of the Literature]", U.S. Department of Education, 2004, p22.</ref> This underreporting has been attributed to cultural denial of female-perpetrated child sex abuse,<ref>Denov, Myriam S.  (2004) "Perspectives on Female Sex Offending: A Culture of Denial"</ref> because "males have been socialized to believe they should be flattered or appreciative of sexual interest from a female."<ref name="Shakeshaft25" /> Journalist Cathy Young writes that under-reporting is contributed to by the difficulty of people, including jurors, in seeing a male as a "true victim".<ref>{{cite news |author=Cathy Young |year=2002 |title=Double Standard |newspaper=The Boston Globe |url=https://pqasb.pqarchiver.com/boston/access/122245371.html?FMT=ABS&date=Jun%203,%202002 |access-date=2017-07-05 |archive-date=2013-07-30 |archive-url=https://web.archive.org/web/20130730063258/http://pqasb.pqarchiver.com/boston/access/122245371.html?FMT=ABS&date=Jun%203,%202002 |url-status=dead }} The article may currently be viewed for free on [http://reason.com/archives/2002/06/04/double-standard Reason.com].</ref>

In the United Kingdom, reported child sex abuse has increased, but this may be due to greater willingness to report.  Police need more resources to deal with it.  Also parents and schools need to give children and adolescents regular advice about how to spot abuse and about the need to report abuse.  Software providers are urged to do more to police their environment and make it safe for children.<ref>[https://www.theguardian.com/society/2017/dec/29/estimated-20000-british-men-interested-in-sexually-abusing-children-police-chief-says Estimated 20,000 British men interested in sexually abusing children] ''[[The Guardian]]''</ref>

=== In pre-industrial societies ===
[[Cross-cultural studies]] have reported that sexual relations between men and pubescent girls were sometimes performed for functional reasons in [[Pre-industrial society|pre-industrial societies]].<ref>{{Cite journal |last=Rind |first=Bruce |date=2013 |title=Critique of Hames and Blanchard (2012), Clancy (2012), and Ryniker (2012) on Hebephilia, Anthropological Data, and Maladaptiveness |url=http://link.springer.com/10.1007/s10508-013-0132-y |journal=[[Archives of Sexual Behavior]] |language=en |volume=42 |issue=5 |pages=685–691 |doi=10.1007/s10508-013-0132-y |pmid=23760771 |s2cid=254259092 |issn=0004-0002}}</ref> Other accounts of sexual relations between adults and minors have also been registered. A 1951 research document reports [[Siwi people|Siwan]] men engaging with anal intercourse with boys. The report also stated that, among [[Arrernte people|Aranda aborigines]], "pederasty [between a man and a boy between the ages of ten and twelve] is a recognized custom". An 18th century report by [[James Cook]] reported an act of copulation between a man and a female estimated to be 11 or 12 in a public street "without the least sense of it being indecent or improper". In some Oceanic societies, adult men have been reported to have sexual contact with prepubertal females. A 19th century document by missionary John Muggeridge Orsmond reads that "in all [[Tahitians]] as well as officers who come in ships there is a cry for little girls". Other instances of adult-child sexual behaviors have been reported in the [[Marquesas Islands]], [[Polynesia]], [[New Guinea]] and in [[Kaluli people|Kaluli]] societies.<ref>{{Cite journal |last=Green |first=Richard |date=2002 |title=Is Pedophilia a Mental Disorder? |url=http://link.springer.com/10.1023/A:1020699013309 |journal=[[Archives of Sexual Behavior]] |volume=31 |issue=6 |pages=467–471 |doi=10.1023/A:1020699013309|pmid=12462476 |s2cid=7774415 }}</ref> 

Accounts of sexual intercourse between children and adults have also been reported in [[Pederasty in ancient Greece|Ancient Greece]] and Rome.<ref>{{Cite book |last1=Williams |first1=Craig A. |title=Roman homosexuality: ideologies of masculinity in classical antiquity |last2=Williams |first2=Craig Arthur |date=1999 |publisher=Oxford University Press |isbn=978-0-19-511300-6 |series=Ideologies of desire |location=New York, NY}}</ref><ref>{{Cite journal |last=Bleibtreu-Ehrenberg |first=Gisela |date=1991-02-04 |title=Pederasty Among Primitives:: Institutionalized Initiation and Cultic Prostitution |url=http://www.tandfonline.com/doi/abs/10.1300/J082v20n01_03 |journal=Journal of Homosexuality |language=en |volume=20 |issue=1–2 |pages=13–30 |doi=10.1300/J082v20n01_03 |pmid=2086628 |issn=0091-8369}}</ref>

==International law==
{{Main|Laws regarding child sexual abuse}}
Child sexual abuse is outlawed nearly everywhere in the world, generally with severe criminal penalties, including in some jurisdictions, [[Life sentence|life imprisonment]] or [[capital punishment]].<ref name=Levesque>{{Cite book |title= Sexual Abuse of Children: A Human Rights Perspective |last= Levesque |first= Roger J. R. |publisher= Indiana University Press |year= 1999 |pages= [https://archive.org/details/sexualabuseofchi0000leve/page/1 1,5–6,176–180] |quote= The world community recently has recognized every child's fundamental human right to protection from sexual maltreatment. This right has been expressed in recent declarations, conventions, and programs of action.  Indeed, the right to protection from sexual maltreatment is now entrenched so strongly in international human rights law that no country can relinquish its obligation. |isbn= 978-0-253-33471-8 |url= https://archive.org/details/sexualabuseofchi0000leve/page/1 }}</ref><ref name=UNchildren>{{cite web|url=http://www2.ohchr.org/english/law/crc.htm |title=United Nations Convention on the Rights of the Child |publisher=Office of the United Nations High Commissioner for Human Rights |year=1989 |quote=Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse&nbsp;... States Parties undertake to protect the child from all forms of sexual exploitation and sexual abuse. For these purposes, States Parties shall in particular take all appropriate national, bilateral and multilateral measures to prevent: (a) The inducement or coercion of a child to engage in any unlawful sexual activity; (b) The exploitative use of children in prostitution or other unlawful sexual practices; (c) The exploitative use of children in pornographic performances and materials. |archive-url=https://web.archive.org/web/20100611182141/http://www2.ohchr.org/english/law/crc.htm |archive-date=2010-06-11 }}</ref>  An adult's sexual intercourse with someone below the legal [[age of consent]] is defined as [[statutory rape]],<ref>''Black's Law Dictionary 8th Edition''. '''child''', "at common law, a person who has not reached the age of 14."  ''See also'' definition under '''rape''' "carnal knowledge of a child is frequently declared to be rape by statute."</ref> based on the principle that a child is not capable of consent and that any apparent consent by a child is not considered to be [[Legal consent#Sex|legal consent]].

The United Nations [[Convention on the Rights of the Child]] (CRC) is an international [[treaty]] that legally obliges states to protect children's rights.  Articles 34 and 35 of the CRC require states to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the [[prostitution of children]], and the [[child pornography|exploitation of children in creating pornography]]. States are also required to prevent the abduction, sale, or trafficking of children.<ref>{{cite web|url=http://www.unhchr.ch/html/menu3/b/k2crc.htm|title=unhchr.ch|website=www.unhchr.ch}}</ref>  As of November 2008, 193 countries are bound by the CRC,<ref name=untreaty>United Nations Treaty Collection.  ''[http://treaties.un.org/Pages/ViewDetails.aspx?src=IND&id=132&chapter=4&lang=en Convention on the Rights of the Child ] {{Webarchive|url=https://web.archive.org/web/20150122055936/https://treaties.un.org/Pages/ViewDetails.aspx?src=IND&id=132&chapter=4&lang=en |date=2015-01-22 }}''.  Retrieved on 26 November 2008.</ref> including every member of the [[United Nations]] except the [[United States]] and [[South Sudan]].<ref>United Nations Treaty Collection.  ''[http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&lang=en Convention on the Rights of the Child] {{webarchive|url=https://web.archive.org/web/20140211151110/https://treaties.un.org/pages/viewdetails.aspx?src=treaty&mtdsg_no=iv-11&chapter=4&lang=en |date=2014-02-11 }}''. Retrieved 21 May 2009.</ref><ref>{{cite web|title=Government of Somalia ratifies UN Convention on the Rights of the Child|url=http://www.unicef.org/media/media_78732.html?p=printme|publisher=UNICEF|access-date=20 January 2015}}</ref>

The Council of Europe has adopted the [[Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse]] in order to prohibit child sexual abuse that occurs within home or family.

In the [[European Union]], child sexual abuse is subject to a [[Directive (European Union)|directive]].<ref>DIRECTIVE 2011/92/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 13 December 2011 on combating the sexual abuse and sexual exploitation of children and child pornography, and replacing Council Framework Decision 2004/68/JHA [http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:335:0001:0014:EN:PDF Eur-lex.europa.eu]</ref> This directive deals with several forms of sexual abuse of children, especially [[commercial sexual exploitation of children]].

==Research==
Child sexual abuse has gained public attention since the 1970s and has become one of the most high-profile crimes. While sexual use of children by adults has been present throughout history, public interest in prevention has tended to fluctuate.<ref name=":0">{{Cite web|url=https://tif.ssrc.org/2012/07/13/placing-childhood-sexual-abuse-in-historical-perspective/|title=Placing childhood sexual abuse in historical perspective – The Immanent Frame|last=Mintz|first=Steven|website=tif.ssrc.org|access-date=2018-01-29|date=2012-07-13}}</ref> Initially, concern centered around children under the age of ten, but over time, advocates have attracted attention toward the sexual abuse of children between the ages of 11 and 17.<ref name=":0" /> Up until the 1930s, the psychological impact of sexual abuse was not emphasized, instead emphasis was placed on the physical harm or the child's reputation.<ref name=":0" /> Widespread public awareness of children's sexual abuse did not occur until the 1970s in the West.<ref>{{Cite journal|last=Conte|first=Jon|date=1994|title=Child Sexual Abuse: Awareness and Backlash|url=https://www.princeton.edu/futureofchildren/publications/docs/04_02_11.pdf|journal=The Future of Children|volume=4|issue=2|pages=224–225|doi=10.2307/1602532|jstor=1602532|pmid=7804765|s2cid=24345673 |access-date=2018-01-29|archive-url=https://web.archive.org/web/20170815035025/http://www.princeton.edu/futureofchildren/publications/docs/04_02_11.pdf|archive-date=2017-08-15}}</ref>

===Early writings===
The first published work dedicated specifically to child sexual abuse appeared in France in 1857: ''Medical-Legal Studies of Sexual Assault'' ''(Etude Médico-Légale sur les Attentats aux Mœurs)'', by [[Auguste Ambroise Tardieu]], the noted French pathologist and pioneer of [[forensic medicine]].<ref>{{cite book  | last = Masson   | pages = 15–25 |first =  Jeffrey Moussaieff  | author-link = Jeffrey Moussaieff Masson  | title = Assault on the Truth  | publisher = Farrar Straus  | year = 1984  | location = New York  | isbn = 978-0-374-10642-3  }}</ref>

== In society ==
{{Globalize|section|USA|2name=the United States|date=October 2015}}
Child sexual abuse became a public issue in the 1970s and 1980s. Prior to this point in time, sexual abuse remained rather secretive and socially unspeakable.{{citation needed|date=December 2012}} Studies on child molestation were nonexistent until the 1920s and the first national estimate of the number of child sexual abuse cases was published in 1948. By 1968 44 out of 50 U.S. states had enacted mandatory laws that required physicians to report cases of suspicious child abuse. Legal action began to become more prevalent in the 1970s with the enactment of the [[Child Abuse Prevention and Treatment Act]] in 1974 in conjunction with the creation of the National Center for Child Abuse and Neglect. Since the creation of the Child Abuse and Treatment Act, reported child abuse cases have increased dramatically.  Finally, the [[National Abuse Coalition]] was created in 1979 to create pressure in congress to create more sexual abuse laws.{{Citation needed|date=August 2023}}

[[Second wave feminism]] brought greater awareness of child sexual abuse and [[violence against women]], and made them public, political issues.<ref>{{Cite book|url=https://books.google.com/books?id=obHkvCPnos0C&pg=PA2|title=New Feminist Stories of Child Sexual Abuse: Sexual Scripts and Dangerous Dialogues|first1=Paula|last1=Reavey|first2=Sam|last2=Warner|date=June 29, 2003|publisher=Routledge|isbn=978-0-415-25944-6|via=Google Books}}</ref><ref>{{Cite book|url=https://books.google.com/books?id=x_k8Aptn6tEC&pg=PA215|title=Social Work Treatment: Interlocking Theoretical Approaches|first=Francis J.|last=Turner|date=March 15, 2011|publisher=Oxford University Press|isbn=978-0-19-983196-8|via=Google Books}}</ref> [[Judith Lewis Herman]], Harvard professor of psychiatry, wrote the first book ever on father-daughter incest when she discovered during her medical residency that a large number of the women she was seeing had been victims of father-daughter incest. Herman notes that her approach to her clinical experience grew out of her involvement in the civil rights movement.<ref name="UCB">{{cite web |url=http://globetrotter.berkeley.edu/people/Herman/herman-con0.html |title=Conversation with History; Dr. Judith Lewis Herman |work=Conversations with History: Institute of International Studies |publisher=UC Berkeley |access-date=December 22, 2007 |archive-date=December 25, 2007 |archive-url=https://web.archive.org/web/20071225063149/http://globetrotter.berkeley.edu/people/Herman/herman-con0.html |url-status=dead }}</ref>  Her second book ''Trauma and Recovery'' coined the term [[complex post-traumatic stress disorder]] and included child sexual abuse as a cause.<ref name = Herman1997>{{Cite book| title = Trauma and recovery: The aftermath of violence from domestic abuse to political terror | url = https://archive.org/details/traumarecovery00herm_0 | first = JL | last = Herman | year = 1997 | publisher = Basic Books | pages = [https://archive.org/details/traumarecovery00herm_0/page/119 119]–121| isbn = 978-0-465-08730-3 }}</ref>

In 1986, Congress passed the [[Child Abuse Victims' Rights Act]], giving children a civil claim in sexual abuse cases. The number of laws created in the 1980s and 1990s began to create greater prosecution and detection of child sexual abusers. During the 1970s a large transition began in the legislature related to child sexual abuse. [[Megan's Law]] which was enacted in 1996 gives the public access to knowledge of sex offenders nationwide.<ref name=wright>{{cite book|last1=Wright|first1=Ph.D Richard G.|title=Sex offender laws: failed policies, new directions|date=2014|publisher=Springer Publishing Co Inc|isbn=978-0-8261-9671-2|pages=50–65|edition=Second|url=https://books.google.com/books?id=Ms75AwAAQBAJ}}</ref>

Anne Hastings described these changes in attitudes towards child sexual abuse as "the beginning of one of history's largest social revolutions."<ref>''From Generation to Generation: Understanding Sexual Attraction to Children'', p.15</ref>

According to John Jay College of Criminal Justice professor B.J. Cling:

{{blockquote|By the early 21st century, the issue of child sexual abuse has become a legitimate focus of professional attention, while increasingly separated from second wave feminism&nbsp;... As child sexual abuse becomes absorbed into the larger field of interpersonal trauma studies, child sexual abuse studies and intervention strategies have become degendered and largely unaware of their political origins in modern feminism and other vibrant political movements of the 1970s. One may hope that unlike in the past, this rediscovery of child sexual abuse that began in the 70s will not again be followed by collective amnesia. The institutionalization of child maltreatment interventions in federally funded centers, national and international societies, and a host of research studies (in which the United States continues to lead the world) offers grounds for cautious optimism. Nevertheless, as Judith Herman argues cogently, 'The systematic study of psychological trauma&nbsp;... depends on the support of a political movement.'<ref>{{Cite book|title=Sexualized Violence Against Women and Children: A Psychology and Law Perspective|url=https://archive.org/details/sexualizedviolen00jdbj|author=B.J. Cling|page=[https://archive.org/details/sexualizedviolen00jdbj/page/n191 177]|year=2004|publisher=Guilford Press|isbn=978-1-59385-061-6}}</ref> }}

=== Media reporting and its quality ===
Media reporting plays a crucial role in tackling the word-wide problem of child sexual abuse because it puts the issue on the public and political agenda.<ref>{{Cite book |last1=Ischebeck |first1=Josephine |title=Child sexual abuse and the media |last2=Stelzmann |first2=Daniela |date=2022 |publisher=[[Nomos publishing house|Nomos]] |isbn=978-3-8487-6332-0 |edition=1st |location=Baden-Baden |oclc=1335407537}}</ref> Media reporting can even contribute to the exposure and criminal investigation of sexual abuse cases in institutions. One notorious example is the ''[[The Boston Globe|Boston Globe]]'' coverage of the [[Catholic Archdiocese of Boston sex abuse scandal|sex abuse scandal in the Catholic Archdiocese of Boston]] for which the newspaper received a [[Pulitzer Prize for Public Service]] in 2003. Another award-winning example is the ''[[The Indianapolis Star|Indianapolis Star]]'' coverage of the [[USA Gymnastics sex abuse scandal]] in 2016. Media reporting can be very beneficial by giving survivors a voice and informing the public.{{citation needed|date=July 2022}}

Media reporting can also violate the rights of abuse survivors and disseminate misleading and harmful messages. Content analyses of news reporting have revealed several quality issues such as a focus on sensationalized individual cases (so-called episodic framing) and neglect of thematic framing in the sense of contextualizing individual cases and pointing to the systematic problems that enable child sexual abuse.<ref>{{Cite journal |last=Weatherred |first=Jane Long |date=2015 |title=Child sexual abuse and the media: A literature review |journal=Journal of Child Sexual Abuse |volume=24 |issue=1 |pages=16–34 |doi=10.1080/10538712.2015.976302 |issn=1053-8712 |pmid=25635896|s2cid=38230484 }}</ref><ref>{{Cite journal |last=Popović |first=Stjepka |date=2018 |title=Child sexual abuse news: A systematic review of content analysis studies |journal=Journal of Child Sexual Abuse |volume=27 |issue=7 |pages=752–777 |doi=10.1080/10538712.2018.1486935 |issn=1053-8712 |pmid=30040599|s2cid=51716256 }}</ref> When media reporting on child sexual abuse is investigated, usual methodological approaches are the media [[content analysis]] and the media quality analysis.<ref>{{Cite journal |last1=Döring |first1=Nicola |last2=Walter |first2=Roberto |date=2020 |title=Media coverage of child sexual abuse: A framework of issue-specific quality criteria |journal=Journal of Child Sexual Abuse |volume=29 |issue=4 |pages=393–412 |doi=10.1080/10538712.2019.1675841 |issn=1053-8712 |pmid=31697189|s2cid=207938189 }}</ref> Here it is important to not only analyze text but also documentary and stock photos commonly used in media that report about child sexual abuse. Research shows that myths and stereotypes about child sexual abuse are disseminated through text and images alike.<ref>{{Cite book |last=Döring |first=Nicola |title=Child Sexual Abuse and the Media |publisher=[[Nomos publishing house|Nomos]] |year=2022 |isbn=978-3-8487-6332-0 |editor-last=Stelzmann |editor-first=Daniela |edition=1st |pages=31–57 |chapter=Quality issues in media representations of child sexual abuse: Newspaper articles, stock photos, and YouTube videos |editor-last2=Ischebeck |editor-first2=Josephine}}</ref> Several checklists and guidelines for journalist have been published by violence prevention and journalism organizations to help improve the quality of news reporting on child sexual abuse.<ref>{{Cite web |last=INHOPE |title=Media guidelines for reporting on child sexual abuse |url=https://inhope.org/EN/articles/media-guidelines-for-reporting-on-child-sexual-abuse?locale=en |access-date=2022-07-15 |website=inhope.org}}</ref><ref>{{Cite web |last=Utah Department of Human Services |date=2022 |title=A journalist's guide to reporting on child abuse & neglect |url=https://dcfs.utah.gov/wp-content/uploads/2022/04/March-2022-Journalists-Guide.pdf |access-date=2022-07-15 |archive-date=2022-07-15 |archive-url=https://web.archive.org/web/20220715095411/https://dcfs.utah.gov/wp-content/uploads/2022/04/March-2022-Journalists-Guide.pdf |url-status=dead }}</ref>

===Civil lawsuits===
In the United States, growing awareness of child sexual abuse has sparked an increasing number of civil [[lawsuits]] for [[monetary damages]] stemming from such incidents. Increased awareness of child sexual abuse has encouraged more victims to come forward, whereas in the past victims often kept their abuse secret. Some states have enacted specific [[laws]] lengthening the applicable [[statutes of limitations]] so as to allow victims of child sexual abuse to file suit sometimes years after they have reached the age of majority.<ref>{{Cite web|url=http://www.ncsl.org/research/human-services/state-civil-statutes-of-limitations-in-child-sexua.aspx|title=State Civil Statutes of Limitations in Child Sexual Abuse Cases|last=Legislatures|first=National Conference of State|website=www.ncsl.org|access-date=2017-10-18}}</ref>  Such lawsuits can be brought where a person or entity, such as a school, church or youth organization, or daycare was charged with supervising the child but failed to do so with child sexual abuse resulting, making the individual or institution liable.  In the [[Catholic sex abuse cases]], the various [[Roman Catholic]] Diocese in the [[United States]] have paid out approximately $1 billion settling hundreds of such lawsuits since the early 1990s. There have also been lawsuits involving the [[American religious right]].  Crimes have allegedly gone unreported and victims were pressured into silence.<ref>{{cite web|url=http://www.dailykos.com/story/2013/05/25/1211671/-The-Church-Child-Sex-Abuse-Scandal-Widens-and-Deepens|title=The Church Child Sex Abuse Scandal Widens and Deepens|work=dailykos.com|access-date=23 March 2015}}</ref>
As lawsuits can involve demanding procedures, there is a concern that [[children]] or adults who file suit will be re-victimized by defendants through the [[legal process]], much as [[rape]] victims can be re-victimized by the accused in [[criminal]] rape trials.  The child sexual abuse plaintiff's attorney [[Thomas A. Cifarelli]] has written that children involved in the legal system, particularly victims of sexual abuse and molestation, should be afforded certain procedural safeguards to protect them from harassment during the legal process.<ref>Cifarelli, T.A.,''Shielding Minors'', Los Angeles Daily Journal, (October 10, 2001).</ref>

In June 2008 in [[Zambia]], the issue of teacher-student sexual abuse and sexual assault was brought to the attention of the High Court of Zambia where a landmark case decision, with presiding Judge Philip Musonda, awarded $45 million Zambian kwacha (US$13,000) to the plaintiff, a 13-year-old girl for sexual abuse and rape by her school teacher. This claim was brought against her teacher as a "person of authority" who, as Judge Musonda stated, "had a moral superiority (responsibility) over his students" at the time.<ref>[http://womennewsnetwork.net/2008/08/11/rapecasezambia-articl804/ "When A Girl Student Stands Up and Wins"], ''Women News Network'' – WNN, August 11, 2008</ref>

A 2000 World Health Organization – Geneva report, "World Report on Violence and Health (Chap 6 – Sexual Violence)" states, "Action in schools is vital for reducing sexual and other forms of violence. In many countries a sexual relation between a teacher and a pupil is not a serious disciplinary offence and policies on sexual harassment in schools either do not exist or are not implemented. In recent years, though, some countries have introduced laws prohibiting sexual relations between teachers and pupils. Such measures are important in helping eradicate sexual harassment in schools. At the same time, a wider range of actions is also needed, including changes to teacher training and recruitment and reforms of curricula, so as to transform gender relations in schools."<ref>[http://whqlibdoc.who.int/publications/2002/9241545615_chap6_eng.pdf World Health Organization Report on Sexual Violence], 2002</ref>

==See also==
{{Portal|Sexuality|Crime}}
{{columns-list|colwidth=18em|
* [[Joseph Calasanz#Death_and_legacy|17th-century sexual molestation at Naples school]]
* [[Abusive power and control]]
* [[Bacha Bazi]]
* [[Betrayal Trauma]]
* [[List of child abuse cases featuring long-term detention#Cases of children imprisoned by relatives|Cases of children imprisoned by relatives]]
* [[Catholic Church sex abuse cases]]
* [[Child erotica]]
* [[Child Exploitation Tracking System]] (CETS)
* [[Child marriage]]
* [[Child-on-child sexual abuse]]
* [[Child pornography]]
* [[Child sex tourism]]
* [[Child sexual abuse in Nigeria]]
* [[Child welfare]]
* [[United States Children's Bureau|Children's Bureau]]
* [[Commercial sexual exploitation of children]]
* [[Complex post-traumatic stress disorder]]
* [[Estimates of sexual violence]]
* [[False allegation of child sexual abuse]]
* [[Institutional abuse]]
* [[Isolation to facilitate abuse]]
* The [[International Centre for Missing & Exploited Children]] (ICMEC) combats child sexual exploitation, child pornography, and child abduction.
* [[Jimmy Savile sexual abuse scandal]]
* [[National Society for the Prevention of Cruelty to Children]] – a UK organisation set up to combat child abuse, gained controversy in the 1980s–1990s over its dealings with [[Satanic ritual abuse]] amongst children.
* [[Online predator]]
* [[Penn State child sex abuse scandal]]
* [[Prostitution of children]]
* [[Protect (political organization)|Protect]]
* [[Rochdale child sex abuse ring]]
* [[Sexual harassment in education#Sexual harassment and abuse of students by teachers|Sexual harassment and abuse of students by teachers]]
* [[Statutory rape]]
}}

==References==
{{Reflist|30em|refs=
<ref name="seto">{{cite book |last=Seto |first=Michael C. |author-link=Michael C. Seto |date=2008 |title=Pedophilia and Sexual Offending Against Children |location=Washington, D.C. |publisher=[[American Psychological Association]] |isbn=978-1-4338-2926-0 |ol=27377980M |oclc=1047607981 |lccn=2018015464 |pages=vii-viii,4,47–48,64,66,72–74,101,123,171,175,177–182,186,189,192}}</ref>
}}

==Further reading==
* Abagnalo, George (2001). ''Boy on a Pony''. Moreland Press. ISBN 978-0-970-667700 (a groundbreaking novel exploring the subject of privileged sexual abuse of children within the healthcare system).
*{{Cite book |author=Lew, Mike |title=Victims No Longer: The Classic Guide for Men Recovering from Sexual Child Abuse |edition=2nd |publisher=Perennial Currents |year=2004 |isbn=978-0-06-053026-6 |url=https://archive.org/details/victimsnolongerc00lewm }}
*{{Cite book|author=Cynthia Crosson-Tower |title=Understanding child abuse and neglect |publisher=Pearson/Allyn & Bacon |location=Boston |year=2008 |isbn=978-0-205-50326-1 }}
*{{Cite web |author=Asa Don Brown |title=Posttraumatic stress disorder in childhood |url=http://family-marriage-counseling.com/mentalhealth/posttraumatic-stress-disorder-childhood.htm |website=Family and Marriage Counseling |year=2009}}
*{{Cite journal| last = Lascaratos | first = J |author2=Ascaratos J |author3=Poulakou-Rebelakou, E | year = 2000 | title = Child Sexual abuse: Historical cases in the Byzantine Empire (324–1453 A.D.) | url = https://archive.org/details/sim_child-abuse-neglect_2000-08_24_8/page/1085 | journal = Child Abuse & Neglect | volume = 24 | issue = 8 | pages = 1085–1090 | doi = 10.1016/S0145-2134(00)00156-3 | pmid = 10983818 }}
*{{Cite journal| last = Durkin | first = KF |author2=Clifton DB | year = 1999 | title = Propagandizing pederasty: A thematic analysis of the on-line exculpatory accounts of unrepentant pedophiles | journal = Deviant Behavior | volume = 20 | issue = 2 | pages = 103–127 | doi = 10.1080/016396299266524}}
*{{Cite book|author=Zimring, Franklin E. |title=An American Travesty: Legal Responses to Adolescent Sexual Offending |publisher=University of Chicago Press |year=2009 |isbn=978-0-226-98358-5}}

==External links==
*{{commons category-inline}}
*[http://www.aacap.org/App_Themes/AACAP/docs/facts_for_families/09_child_sexual_abuse.pdf American Academy of Child and Adolescent Psychiatry Facts for Families: Child Sexual Abuse] (PDF)
*[https://www.researchgate.net/publication/11368470 Men who molest their sexually immature daughters: Is a special explanation required?]
*{{curlie|Society/Issues/Children,_Youth_and_Family/Child_Abuse/Sexual_Abuse/|Child Abuse: Sexual Abuse}}
*[https://www.d2l.org/wp-content/uploads/2017/01/all_statistics_20150619.pdf 2017 child sexual abuse statistics] from Darkness to Light (PDF)

{{Sexual ethics}}
{{Sexual abuse}}
{{abuse}}
{{Pedophilia}}

{{Authority control}}

{{DEFAULTSORT:Child Sexual Abuse}}
[[Category:Child sexual abuse| ]]
[[Category:Human sexuality]]
[[Category:Adverse childhood experiences]]
[[Category:Sex crimes]]