16 Because nausea is a common side effect, antiemetics may also be prescribed. Prophylactic treatment must be started within 72 hours of the assault with two tablets of emergency contraceptive pills (Ovral or Preven) given immediately and two tablets given 12 hours later. 15 (pp49–75) Following acute sexual assault, pregnancy prophylaxis should be offered to adolescent girls after an informed consent has been obtained and urine pregnancy test results are negative. Prophylactic antibiotics for the treatment of gonorrhea, Chlamydia, trichomonas and bacterial vaginosis should be given to sexually active adolescents following an acute sexual assault ( Table 3). Referral for psychologic services is important because victims of abuse are more likely to have depression, anxiety disorders, behavioral problems and post-traumatic stress disorder.Īntimicrobial therapy should be initiated in prepubertal children based on the results of laboratory testing. Forensic evidence collection is indicated in certain cases. Judicious use of laboratory tests, along with appropriate therapy, should be individually tailored. When examining the child's genitalia, it is important that the physician be familiar with normal variants, nonspecific changes and diagnostic signs of sexual abuse. A careful history should be obtained and a thorough physical examination should be performed with documentation of all findings. The child's history as obtained by the physician may be admitted as evidence in court trials therefore, complete documentation of questions and answers is critical. Because the examination findings of most child victims of sexual abuse are within normal limits or are nonspecific, the child's statements are extremely important. Behavioral changes may involve sexual acting out, aggression, depression, eating disturbances and regression. Child victims of sexual abuse may present with physical findings that can include anogenital problems, enuresis or encopresis.
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