Pedophilia (or paedophilia) is a psychological disorder in which an adult or older adolescent experiences a sexual preference for prepubescent children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), pedophilia is specified as a form of paraphilia in which a person either has intense sexual urges towards children, and experiences recurrent sexual urges towards and fantasies about children that they have either acted on, or cause distress or interpersonal difficulty. The diagnosis can be made under the DSM or ICD criteria for persons age 16 and older. The disorder is common among people who commit child sexual abuse; however, some offenders do not meet the clinical diagnosis standards for pedophilia.[8] In strictly behavioral contexts, the word “pedophilia” has been used to refer to child sexual abuse itself, also called “pedophilic behavior”.

In law enforcement, the term “pedophile” is loosely used without formal definition to describe those convicted of child sexual abuse or the sexual abuse of a minor, including both prepubescent children and pubescent or post-pubescent adolescents. An example of this use can be seen in various forensic training manuals. Researchers recommend that this imprecise use be avoided. In common usage, the term refers to any adult who is sexually attracted to young children or who sexually abuses a child or adolescent minor.

The causes of pedophilia are not known; research is ongoing.] Most pedophiles are men, though there are also women who are pedophiles. Due to the stereotype that pedophiles are always male, it has been difficult to determine the prevalence of female pedophiles; however, studies in the United Kingdom and United States suggest that a range of 5% to 20% of child sexual abuse offenses are perpetrated by women.

In forensic psychology and law enforcement, there have been a variety of typologies suggested to categorize pedophiles according to behavior and motivations. No significant curative treatment for pedophilia has yet been found. There are, however, certain therapies that can reduce the incidence of pedophilic behaviors that result in child sexual abuse.

Etymology and history

The word comes from the Greek: παιδοφιλία (paidophilia): παῖς (pais), “child” and φιλία (philia), “friendship”. Paidophilia was coined by Greek poets either as a substitute for “paiderastia” (pederasty),[22] or vice versa.

The term paedophilia erotica was coined in 1886 by the Viennese psychiatrist Richard von Krafft-Ebing in his writing Psychopathia Sexualis.[23] The term appears in a section titled “Violation of Individuals Under the Age of Fourteen,” which focuses on the forensic psychiatry aspect of Child Sexual Offenders in general. Krafft-Ebing describes several typologies of offender, dividing them into psychopathological and non-psychopathological origins, and hypothesizes several apparent causal factors that may lead to the sexual abuse of children.

After listing several typologies of sexual offender, Krafft-Ebing then mentioned one final typology, which he refers to as a “psycho-sexual perversion”: paedophilia erotica. He noted that he had only encountered it four times in his career and gave brief descriptions of each case, as well as noting they all have three traits in common:

Their attraction is persistent (Krafft-Ebing refers to this as being “tainted”)

The subject’s primary attraction is to children, rather than adults.

The acts committed by the subject are typically not intercourse, but rather involve inappropriate touching or manipulating the child into performing an act on the subject.

It is notable that this work also indicates several cases of pedophilia among adult women (provided by another physician), and also considered the abuse of boys by homosexual men to be extremely rare. Further clarifying this point, he indicated that cases of adult men who have some medical or neurological disorder and abuse a male child are not true pedophilia, and that in his observation victims of such men tended to be older and pubescent. He also lists “Pseudopaedophilia” as a related condition wherein “individuals who have lost libido for the adult through masturbation and subsequently turn to children for the gratification of their sexual appetite” and claimed this is much more common.

In 1908, Swiss neuroanatomist and psychiatrist Auguste Forel wrote of the phenomenon, proposing that it be referred to it as “Pederosis,” the “Sexual Appetite for Children.” Similar to Krafft-Ebing’s work, Forel made the distinction between incidental sexual abuse by person’s with dementia and other organic brain conditions, and the truly preferential and sometimes exclusive sexual desire for children. However, he disagreed with Krafft-Ebing in that he felt the condition of the latter was largely ingrained and unchangeable.

The term “Pedophilia” became the generally accepted term for the condition and saw widespread adoption in the early 20th century, appearing in many popular medical dictionaries such as the 5th Edition of Stedman’s. In 1952, it was included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders This edition and the subsequent DSM-II listed the disorder as one subtype of the classification “Sexual Deviation,” but no diagnostic criteria were provided. The DSM-III, published in 1980, contained a full description of the disorder and provided a set of guidelines for diagnosis. The revision in 1987, the DSM-III-R, kept the description largely the same, but updated and expanded the diagnostic criteria.


The ICD (International Statistical Classification of Diseases and Related Health Problems) (F65.4) defines pedophilia as “a sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age.”[1] Under this system’s criteria, a person 16 years of age or older meets the definition if they have a persistent or predominant sexual preference for prepubescent children at least five years younger than them.

The Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV-TR) outlines specific criteria for use in the diagnosis of this disorder. These include the presence of sexually arousing fantasies, behaviors or urges that involve some kind of sexual activity with a prepubescent child (often aged 13 or younger) for six months or more, and that the subject has acted on these urges or suffers from distress as a result of having these feelings. The criteria also indicate that the subject should be 16 or older and that child or children they fantasize about are at least five years younger than them, though ongoing sexual relationships between a 12-13 year old and a late adolescent are advised to be excluded. A diagnosis is further specified by the sex of the children the person is attracted to, if the impulses or acts are limited to incest, and if the attraction is “exclusive” or “nonexclusive”.

Exclusive pedophiles are attracted to children, and children only. They show little erotic interest in adults their own age and in some cases, can only become aroused while fantasizing or being in the presence of prepubescent children. Nonexclusive pedophiles are attracted to both children and adults, and can be sexually aroused by both. According to a U.S. study on 2429 adult male pedophile sex offenders, only 7% identified themselves as exclusive; indicating that many or most pedophiles fall into the nonexclusive category.[7] Some systems further differentiate types of offender in more specific categories (see Child Sexual Offender Types).

Neither the ICD nor the DSM diagnostic criteria require actual sexual activity with a prepubescent youth. The diagnosis can therefore be made based on the presence of fantasies or sexual urges even if they have never been acted upon. On the other hand, a person who acts upon these urges yet experiences no distress about their fantasies or urges can also qualify for the diagnosis. Acting on sexual urges is not limited to overt sex acts for purposes of this diagnosis, and can sometimes include indecent exposure, voyeuristic or frotteuristic behaviors, or masturbating to child pornography. Often these behaviors need to be considered in-context with an element of clinical judgment before a diagnosis is made. Likewise, when the patient is in late adolescence, the age difference is not specified in hard numbers and instead requires careful consideration of the situation.[29]

Nepiophilia, also called infantophilia, is used to refer to a sexual preference for toddlers and infants (usually ages 0–3).[30]

Ego-dystonic sexual orientation (F66.1) includes people who do not doubt that they have a prepubertal sexual preference, but wish it were different because of associated psychological and behavioral disorders. The WHO allows for the patient to seek treatment to change their sexual orientation.

Biological associations

Beginning in 2002, researchers began reporting a series of findings linking pedophilia with brain structure and function: Pedophilic (and hebephilic) men have lower IQs, poorer scores on memory tests, greater rates of non-right-handedness, greater rates of school grade failure over and above the IQ differences, lesser physical height, greater probability of having suffered childhood head injuries resulting in unconsciousness and several differences in MRI-detected brain structures. They report that their findings suggest that there are one or more neurological characteristics present at birth that cause or increase the likelihood of being pedophilic. Evidence of familial transmittability “suggests, but does not prove that genetic factors are responsible” for the development of pedophilia.

Another study, using structural MRI, shows that male pedophiles have a lower volume of white matter than a control group.

Functional magnetic resonance imaging (fMRI) has shown that child molesters diagnosed with pedophilia have reduced activation of the hypothalamus as compared with non-pedophilic persons when viewing sexually arousing pictures of adults.[43] A 2008 functional neuroimaging study notes that central processing of sexual stimuli in heterosexual “paedophile forensic inpatients” may be altered by a disturbance in the prefrontal networks, which “may be associated with stimulus-controlled behaviours, such as sexual compulsive behaviours.” The findings may also suggest “a dysfunction at the cognitive stage of sexual arousal processing.”

Blanchard, Cantor, and Robichaud (2006) reviewed the research that attempted to identify hormonal aspects of pedophiles. They concluded that there is some evidence that pedophilic men have less testosterone than controls, but that the research is of poor quality and that it is difficult to draw any firm conclusion from it.

While not causes of pedophilia themselves, comorbid psychiatric illnesses — such as personality disorders and substance abuse — are risk factors for acting on pedophilic urges. Blanchard, Cantor, and Robichaud (2006) noted about comorbid psychiatric illnesses that, “The theoretical implications are not so clear. Do particular genes or noxious factors in the prenatal environment predispose a male to develop both affective disorders and pedophilia, or do the frustration, danger, and isolation engendered by unacceptable sexual desires—or their occasional furtive satisfaction—lead to anxiety and despair?”They indicated that, because they previously found mothers of pedophiles to be more likely to have undergone psychiatric treatment, the genetic possibility is more likely.

Psychopathology and personality traits

Several researchers have reported correlations between pedophilia and certain psychological characteristics, such as low self-esteem[46][47] and poor social skills.[48] Cohen et al. (2002), studying child sex offenders, states that pedophiles have impaired interpersonal functioning and elevated passive-aggressiveness, as well as impaired self-concept. Regarding disinhibitory traits, pedophiles demonstrate elevated sociopathy and propensity for cognitive distortions. According to the authors, pathologic personality traits in pedophiles lend support to a hypothesis that such pathology is related to both motivation for and failure to inhibit pedophilic behavior.

According to Wilson and Cox (1983), “The paedophiles emerge as significantly higher on Psychoticism, Introversion and Neurotocism than age-matched controls. [But] there is a difficulty in untangling cause and effect. We cannot tell whether paedophiles gravitate towards children because, being highly introverted, they find the company of children less threatening than that of adults, or whether the social withdrawal implied by their introversion is a result of the isloation engendered by their preference (i.e., awareness of the social approbation and hostility that it evokes”

Studying child sex offenders, a review of qualitative research studies published between 1982 and 2001 concluded that pedophiles use cognitive distortions to meet personal needs, justifying abuse by making excuses, redefining their actions as love and mutuality, and exploiting the power imbalance inherent in all adult-child relationships. Other cognitive distortions include the idea of “children as sexual beings,” “uncontrollability of sexuality,” and “sexual entitlement-bias.”

One review of the literature concludes that research on personality correlates and psychopathology in pedophiles is rarely methodologically correct, in part owing to confusion between pedophiles and child sex offenders, as well as the difficulty of obtaining a representative, community sample of pedophiles.[53] Seto (2004) points out that pedophiles who are available from a clinical setting are likely there because of distress over their sexual preference or pressure from others. This increases the likelihood that they will show psychological problems. Similarly, pedophiles recruited from a correctional setting have been convicted of a crime, making it more likely that they will show anti-social characteristics.

Prevalence and child molestation

The prevalence of pedophilia in the general population is not known,[54] and research is highly variable owing to varying definitions and criteria. The term pedophile is commonly used to describe all child sexual abuse offenders, including those who do not meet the clinical diagnosis standards. This use is seen as problematic by some people.[8] Some researchers, such as Howard E. Barbaree,[55] have endorsed the use of actions as a sole criterion for the diagnosis of pedophilia as a means of taxonomic simplification, rebuking the American Psychiatric Association’s standards as “unsatisfactory”.

A perpetrator of child sexual abuse is commonly assumed to be and referred to as a pedophile; however, there may be other motivations for the crime[55] (such as stress, marital problems, or the unavailability of an adult partner).[56] Child sexual abuse may or may not be an indicator that its perpetrator is a pedophile. Many terms have been used to distinguish “true pedophiles” from nonpedophilic offenders, or to distinguish among types of offenders on a continuum according to strength and exclusivity of pedophilic interest, and motivation for the offense (see Child Sexual Offender Types).

Perpetrators who meet the diagnostic criteria for pedophilia offend more often than non-pedophile perpetrators, and with a greater number of victims. According to the Mayo Clinic, approximately 95% of child sexual abuse incidents are committed by the 88% of child molestation offenders who meet the diagnostic criteria for pedophilia.[7] A behavioral analysis report by the FBI states that a “high percentage of acquaintance child molesters are preferential sex offenders who have a true sexual preference for children (i.e., pedophiles).”

A review article in the British Journal of Psychiatry notes the overlap between extrafamilial and intrafamilial offenders. One study found that around half of the fathers and stepfathers in its sample who were referred for committing extrafamilial abuse had also been abusing their own children.

As noted by Abel, Mittleman, and Becker[58] (1985) and Ward et al. (1995), there are generally large distinctions between the two types of offenders’ characteristics. Situational offenders tend to offend at times of stress; have a later onset of offending; have fewer, often familial victims; and have a general preference for adult partners. Pedophilic offenders, however, often start offending at an early age; often have a large number of victims who are frequently extrafamilial; are more inwardly driven to offend; and have values or beliefs that strongly support an offense lifestyle. Research suggests that incest offenders recidivate at approximately half the rate of extrafamilial child molesters, and one study estimated that by the time of entry to treatment, nonincestuous pedophiles who molest boys had committed an average of 282 offenses against 150 victims.

Some child molesters — pedophilic or not — threaten their victims to stop them from reporting their actions.[3] Others, like those that often victimize children, can develop complex ways of getting access to children, like gaining the trust of a child’s parent, trading children with other pedophiles or, infrequently, get foster children from non-industrialized nations or abduct child victims from strangers.[3] Pedophiles may often act interested in the child, to gain the child’s interest, loyalty and affection to keep the child from letting others know about the abuse.


Although pedophilia has yet no cure, various treatments are available that are aimed at reducing or preventing the expression of pedophilic behavior, reducing the prevalence of child sexual abuse. Treatment of pedophilia often requires collaboration between law enforcement and health care professionals. A number of proposed treatment techniques for pedophilia have been developed, though the success rate of these therapies has been very low.

Cognitive behavioral therapy (“relapse prevention”)

Cognitive behavioral therapy has been shown to reduce recidivism in contact sex offenders.

According to Canadian sexologist Michael Seto, cognitive-behavioral treatments target attitudes, beliefs, and behaviors that are believed to increase the likelihood of sexual offenses against children, and “relapse prevention” is the most common type of cognitive-behavioral treatment. The techniques of relapse prevention are based on principles used for treating addictions. Other scientists have also done some research that indicates that recidivism rates of pedophiles in therapy are lower than pedophiles who eschew therapy, says Dr. Zonana.

Behavioral interventions

Behavioral treatments target sexual arousal to children, using satiation and aversion techniques to suppress sexual arousal to children and covert sensitization (or masturbatory reconditioning) to increase sexual arousal to adults.[63] Behavioral treatments appear to have an effect on sexual arousal patterns on phallometric testing, but it is not known whether the test changes represent changes in sexual interests or changes in the ability to control genital arousal during testing.

Applied behavior analysis has been applied with sex offenders with mental disabilities.

Pharmacological interventions

Medications are used to lower sex drive in pedophiles by interfering with the activity of testosterone, such as with Depo-Provera (medroxyprogesterone acetate), Androcur (cyproterone acetate), and Lupron (leuprolide acetate).

Gonadotropin-releasing hormone analogues, which last longer and have fewer side-effects, are also effective in reducing libido and may be used.

These treatments, commonly referred to as “chemical castration”, are often used in conjunction with the non-medical approaches noted above. According the Association for the Treatment of Sexual Abusers, “Anti-androgen treatment should be coupled with appropriate monitoring and counseling within a comprehensive treatment plan.”

In a controlled Depo-Provera treatment study of 40 sex offenders — including 23 pedophiles — who received Depo-Provera, and 21 sex offenders who received psychotherapy alone, the outcome follow-up of the treated group as compared to the untreated group demonstrated that the reoffense rate for the Depo-Provera-treated group was significantly lower. Eighteen percent reoffended while receiving medication; 35 percent reoffended after stopping medication. In contrast, 58 percent of the control patients, who received psychotherapy alone, reoffended. Patients defined as regressed were much more likely to reoffend off therapy than the patients defined as fixated.

Other therapies

Klaus M. Beier of the Institute of Sexology and Sexual Medicine at Charité, a university hospital in Berlin, reported success in a preliminary study using role-play therapy and “impulse-curbing drugs” to help pedophiles avoid sexually assaulting a child. According to researchers, contact child sex offenders were better able to control their urges once they understood the prepubescent youth’s view.

Limitations of treatment

Although these results are relevant to the prevention of reoffending in contact child sex offenders, there is no empirical suggestion that such therapy is a cure for pedophilia. Dr. Fred Berlin, founder of the Johns Hopkins Sexual Disorders Clinic, believes that pedophilia could be successfully treated if the medical community would give it more attention.

Legal and social issues

Misuse of terminology

The words “pedophile” and “pedophilia” are frequently misused to refer to situations in which an older person has sexual relations with a person who is below the legal age of consent, but is pubescent or post-pubescent . The terms “hebephilia” or “ephebophilia” may be more accurate in these cases,[16] but even then may be erroneously used to refer to the actus reus itself, rather than the correct meaning, which is a preference for that age group on the part of the older individual. Even more problematic are situations where the terms are misused to refer to relationships where the younger person is an adult of legal age, but is either perceived socially as being too young in comparison to their older partner, or the older partner occupies a position of authority over them.

Pedophile activism

During the late 1950s to early 1990s, several pedophile membership organizations advocated age of consent reform to lower or abolish age of consent laws, and for the acceptance of pedophilia as a sexual orientation rather than a psychological disorder,[80] and the legalization of child pornography. The efforts of pedophile advocacy groups did not gain any public support[76][79][81][82][83] and today those few groups that have not dissolved have only minimal membership and have ceased their activities other than through a few websites.

Anti-pedophile activism

Main article: Anti-pedophile activism

Anti-pedophile activism encompasses opposition against pedophiles, against pedophile advocacy groups, and against other phenomena that are seen as related to pedophilia, such as child pornography and child sexual abuse.[86] Much of the direct action classified as anti-pedophile involves demonstrations against sex offenders, groups advocating legalization of sexual activity between adults and children,[88] and internet users who solicit sex from teens.

Moral panic and vigilantism

In the 1990s and 2000s, there have been several moral panics related to misuse of the term “pedophile” with regards to unusual crimes of abuse such as high-profile cases of child abduction and murder,[89] and popular press reports of ideas such as stranger danger, satanic ritual abuse and the day care sex abuse hysteria. There has been vigilatism directed against convicted or publicly suspected child sex offenders such as the mob violence resulting from the News of the World “naming and shaming” campaign in the UK in the early 2000s.




It is difficult to estimate the true prevalence of pedophilia because few pedophiles voluntarily seek treatment and because most of the available data are based on individuals who have become involved with the legal system. It is unknown how many individuals have pedophilic fantasies and never act on them or who do act but are never caught. An estimated 1 in 20 cases of child sexual abuse is reported or identified. Two Canadian studies, which randomly sampled 750 women and 750 men between the ages of 18 and 27 years, found that 32% of the women and 15.6% of the men had experienced “unwanted sexual contact” before the age of 17 years. These numbers are similar to studies in the United States that report 17% to 31% of females and 7% to 16% of males experienced unwanted sexual contact before the age of 18 years. In the Canadian studies, of those reporting unwanted sexual encounters, 21% of the females and 44% of the males experienced repetitive assault Of note, most of the one-time offenses reported by females were committed by another adolescent of similar age. A strong correlation was found between the number of times either a girl or a boy was molested and the occurrence of eventual unwanted penetration (either vaginal or anal) One percent of the males, who were anonymously surveyed, reported having sexually assaulted a child themselves since they became an adult  


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Clinical Evaluation of Victims Child Sexual Abuse


In incidents of child sexual abuse (CSA), the interview with the child is typically the most valuable component of the medical evaluation. Elicited history is frequently the only diagnostic information that is uncovered. Additionally, if performed in a sensitive and knowledgeable manner, the history-taking process can be a first step in the healing process for the child who is sexually traumatized. Regardless of the history provided, the members of the interdisciplinary team need to demonstrate an open, nonjudgmental, and caring attitude toward the child; the willingness to advocate for the child must be demonstrated as the evaluation unfolds.

  • General principles for successful history taking
    • To assist in creating a comfortable and nonthreatening environment, allow an extended period of time when taking the history in children who are suspected of being sexually abused.
    • When interviewing the child, use a developmentally sensitive approach to the questioning so that the child can understand what is being asked and is able to answer as accurately as possible.
    • Rely on nonleading questions as much as possible to permit the child to relate information in a credible and reliable framework.
    • An interview often has a healing value for children, enabling them to start to feel some control with what occurs in their lives in contrast to the abusive situation that took away the control they should have with their own bodies.
    • In an effort to demystify the information-gathering process, consider permitting children to sit where they want to sit, slowing down the pace of the interview if it starts to go too fast, permitting time for play breaks, and encouraging children to use their own words for body parts.
  • Initial introduction with efforts to build up trust
    • During the initial meeting, the health care provider and any members of the interdisciplinary team who are involved with the treatment of the child should introduce themselves to the child and caregiver.
    • At this point, the primary health care provider should explain how the evaluation usually proceeds, including the need to first speak alone with the caregiver and then alone with the child.
    • After these initial conversations, ask the caregiver to rejoin the child for a physical examination, which frequently is understood as a “check-up” by the child.
  • Caregiver interview
    • Ensure that caregivers who accompany children have an opportunity to describe their concerns, provide information about the children’s health, and outline any information they have related to the suspected abuse.
    • By interviewing the caregiver first, the interviewer allows the child an extra bit of time to become familiarized with the clinical setting and, hopefully, to become more comfortable with the environment.
    • Initially explain to the caregiver the extent to which the information elicited during the interview is required to be shared with child protective services (CPS) staff and law enforcement personnel who may be involved with the case.
    • Clarifying the limits of confidentially in suspected incidents of child sexual abuse is paramount to avoid feelings of betrayal later if and when information is shared with the various involved agencies.
  • Child interview
    • When verbal children are interviewed when the caregivers are not present, children may not provide the most valuable information.
    • Using a sensitive approach and building on what has been learned in the warm-up and caregiver interview components, begin with nonthreatening topics such as favorite activities, school subjects, and personal interests.
    • Once rapport has been established in the interview, ask the children why they have come to the doctor’s office.
    • By focusing on asking simply worded, open-ended, nonleading questions, the person taking the history can progress through the standard “what, when, where, and how” questions, which are important to the medical evaluation of suspected child sexual abuse.
    • The full potential of the interview can be realized by a reliance on such questioning as “tell me more” followed by “and then what happened?”
    • Supporting the child for working hard to answer the questions (but not for the content of the answers) is vital to the credibility of the information elicited.
    • The clinician must understand the developmental capacity of the child and work within the child’s abilities to garner the information needed. Thus, children may not know dates but they remember holidays; children may remember something happened before or after school began.
    • Asking children to explain what they mean to avoid misunderstanding important points in the history is always appropriate.
    • Using the child’s words for body parts may make the child more comfortable with difficult conversations about sexual activities.
    • Using drawings may also help children describe where they may have been touched and with what they were touched.
    • Meticulous documentation is a necessity for these types of histories, because the documentation may be considered as evidence in subsequent legal proceedings emanating from the overall investigation.
    • To the extent possible, document specific quotes that the child makes about the abusive events.
    • Often, entries made in medical charts by health care providers of children’s words detailing their own sexual victimization assist those advocating for children as they argue for suitable protection from people and situations that may be threats to the children’s well-being.
    • Consider videotaping or audiotaping the interview if the jurisdiction permits this.
  • Wrap-up and preparation for the physical examination
    • After the child interview concludes, the caregiver can be invited back in the room to help facilitate the transition to the physical examination.
    • Being honest and empathetic with the child is critically important.
    • Therefore, do not promise that needles are not to be used unless absolutely sure that obtaining blood is not necessary; if not sure, reassure children that blood is obtained only if needed and, if blood is needed, children are told at the end of the examination.
    • Inform children if genital swabs are to be collected; allow them to handle the swabs in order to gain some comfort with the procedure.
    • If a colposcope is to be used during the physical examination, introduce it as a “special camera” that the doctor uses that does not touch the child.
    • After an appropriate discussion, leave the room and allow the child to prepare for the examination by suitable disrobing and putting on a gown with the caregiver’s assistance.



As opposed to adult sexual abuse and in general, authorities agree that more than three fourths of physical examinations of children suspected of having been sexually abused are without definitive findings of sexual abuse. Heger and colleagues conducted a comprehensive study that included the review of physical examinations performed on 2,384 children evaluated for suspected child sexual abuse in a regional referral.11 They found that, overall, only 4% of the children had abnormal findings. Of 182 children specifically referred for evaluation of a suspected finding identified by a health care provider, the child abuse specialist only found 8% of these children with a finding (this is the group expected to have the highest likelihood of a finding on examination due to the initial concern from the referring health care provider).
Additionally, of children who reported either vaginal or anal penetration, only 5.5% had physical examination findings. Thus, Heger and colleagues concluded that the vast majority of suspected child sexual abuse physical examinations are likely to not discover physical findings (what are commonly referred to as “normal” physical examination findings). Numerous reasons are believed to account for this general lack of findings. First, the child and family typically know the perpetrators, and physical force is not often a major component as in adult sexual assaults. Disclosure of the abuse frequently is delayed, and evaluations may be performed weeks to months after the abusive contact. Finally, mucous membranes that compose the genital structures heal rapidly and, often, without obvious scarring.

The general approach to the physical examination follows the standard examination techniques for a comprehensive physical examination (ie, complete head-to-toe approach). When examining the child who is suspected of being sexually abused, place particular emphasis on the genital and anal examination; however, children should experience this more thorough inspection of their anogenital anatomy only in the context of a complete examination. In this way, children receive messages that their whole bodies and health are important; this helps to avoid any undue focus on their anogenital areas.

  • Examining genital and perianal structures: To perform a complete examination of the child’s genitalia and perianal structures for abnormalities attributed to abuse, the examiner first must understand the basic anatomy of this body area. Initially considering the female prepubertal genitalia with minimal palpation, externally inspect the vulvar structures. Tissues of interest are mons pubis, labia majora, labia minora, clitoris, urethral meatus, hymen, fossa navicularis, and posterior fourchette. The postpubertal child may require a more extensive examination requiring internal examination of the vagina and cervix, depending on the suspected type of contact. This section focuses on the external examination of the prepubertal female genitalia. Child Abuse & Neglect: Physical Abuse includes a detailed description of the examination of the female adolescent patient. Structure descriptions are as follows:
    • Mons pubis
      • This genital structure is the skin-covered mound of fatty tissue above the pubic symphysis.
      • Due to maternal estrogen effect, the neonate’s mons pubis appears generous and rounded; however, as the estrogen effect decreases, the roundness is lost until the child’s endogenous estrogen level increases at the time of puberty.
      • In response to circulating hormones, the mons pubis is the site for pubic hair growth during pubertal development and adulthood.
    • Labia majora
      • These bilateral skin-covered longitudinal folds of fatty and connective tissue serve as external protection for the more recessed vulvar structures.
      • The neonate’s labia majora are thicker due to maternal estrogen effect, and this decreases over time.
      • The child’s labia majora do not completely cover the internal structures.
      • During puberty, pubic hair grows on the skin covering the labia majora as well.
    • Labia minora
      • These bilateral, thin, mucous membrane longitudinal folds are observed medial and more recessed in relation to the skin-covered labia majora.
      • Because of maternal estrogen, the neonate’s labia minora are frequently larger than expected and may protrude beyond the labia majora; however, this decreases over time.
      • Anteriorly, the labia divide into lateral and medial components, with the lateral labial component fusing centrally to form the prepuce of the clitoris.
      • The medial labial components fuse to form the clitoral frenulum.
      • Posteriorly, the labia fuse to form the posterior fourchette.
      • No hair grows on the labia minora.
    • Clitoris
      • The clitoris is the small, cylindrical, erectile structure composed of a prepuce, frenulum, glans, and body.
      • Similar to the other structures described above, the maternal estrogen effect causes a transient enlargement of this structure, which decreases over weeks to months after birth.
    • Urethral meatus
      • This genital structure is the round outlet of the urinary system inferior to the clitoris.
      • This outlet may be difficult to routinely visualize in the child, but urethral tissue occasionally may prolapse, creating a beefy red donut-shaped protrusion at the site of the meatus.
    • Hymen
      • The hymen is the mucous membrane sheetlike structure that has an opening and is situated at the entrance to the vagina, sitting in a recessed fashion between the medial aspects of labia minora.
      • Hymenal tissue is very sensitive to estrogen, and the estrogenized hymen is pink and opaque compared to the relatively unestrogenized hymenal tissue, which generally is thin, translucent, and reddish with an obvious lacy vascular pattern.
      • The shape of the hymenal orifice varies, and the various shapes are generally described as crescentic (half-moon), annular (circular), fimbriated (redundant tissue that folds over on itself like excess ribbon around an opening), septate (column of tissue that crosses the opening), and cribriform (series of small openings).
      • The shape of the orifice can be further described by the appearance of clefts, bumps, notches, tags, and the presence of thickening or thinning at the orifice’s edge.
      • The observed size of the hymenal orifice varies, depending on the state of relaxation of the child, the position of the child, and examiner technique.
      • As such, most authorities agree that measurement of the hymenal orifice has limited utility in the evaluation.
    • Posterior fourchette: Formed by the posterior meeting of the labia minora, the posterior fourchette is the floor of the fossa navicularis.
    • Fossa navicularis: The fossa navicularis is the space bounded by the posterior fourchette and the point where the hymen attaches to the inferior aspect of the vaginal wall at its entrance.
  • Standard positioning: To expose the prepubertal genital structures as fully as possible, several standard positions are used, namely frog-leg supine, knee-chest, and the left lateral decubitus.
    • Frog-leg supine position
      • This position is ideal for optimal visualization of the genital structures and for a fair degree of comfort for the child.
      • The child lays supine on the examining table or on the caregiver’s lap and flexes her knees, bringing the heels of her feet together while abducting her hips; thus, her legs can move laterally, providing an excellent view of the external genitalia.
    • Knee-chest position
      • The knee-chest position provides clear observation of the anus; it also offers an opportunity to examine the vulvar structures, including the hymen, from a different vantage point.
      • This position can be helpful in assessing a difficult-to-visualize hymenal orifice.
      • As the child kneels down, resting her chest against her knees on the examination table and moving her buttocks superiorly, the anterior abdominal wall falls forward, and the hymenal tissues may be extended somewhat more than in the frog-leg supine position.
      • The main disadvantage to this position is that children may feel vulnerable and are often uncomfortable remaining in this position.
    • Left lateral decubitus
      • This alternative position is most appropriate for anal examination and most commonly is used with boys.
      • The left lateral decubitus position does not offer a clear visualization of the female vulvar structures.
      • The child lies on his left side with knees flexed and buttocks placed toward the examining table’s edge and the examiner.
  • Calming the child during examination: In addition to positioning, make efforts to keep the child engaged and calm during the examination. Often, calming the child is accomplished by talking to the child and explaining what to expect during the examination. Additionally, proper attention to modesty is necessary, and the use of a quiet room, with adequate privacy, is essential. Use gowns and drapes as appropriate.
  • Genital and anal examination: Examiners may find it helpful to progress through the genital and anal examination in a fairly routine sequence, during both the actual examination and the subsequent documentation.
    • General observation and inspection
      • The genital examination begins with general observation and inspection.
      • With the child in the appropriate position and with adequate light and privacy, look for signs of injury on the skin surfaces, make a judgment about the presence and character of pubic hair for sexual maturity rating purposes, and look for any obvious signs of infections.
      • Note the child’s emotional status.
    • Visualizing the more recessed genital structures
      • Once the inspection is completed with gloved hands, the examiner may use gentle palpation to move the tissues and further visualize the more recessed genital structures.
      • By applying gentle lateral traction to the labia majora, the labia minora and hymen may be observed more clearly.
      • Magnification, provided by a hand-held magnifying glass or colposcope, may be helpful during the genital examination. The colposcope has the advantage of providing an excellent light source and having the capability to take photographs during the examination.
      • Internal examinations and the use of instruments are almost never necessary in the prepubertal examination for suspected child sexual abuse.
      • If deemed necessary because of a serious finding (eg, bleeding with no identified source), arrange an examination under anesthesia.
    • Collection of specimens
      • At this point in the examination, specimens may be collected for STD screening and forensic evidence collection.
      • These procedures are described in more detail in the Workup section.
    • Possible observable findings: Most individuals who have been sexually abused present with essentially normal examination findings. However, possible observable findings include (1) those attributable to acute injury if the examination is performed a relatively short time after the sexual contact or (2) chronic findings that may be residual effects following repeated episodes of genital contact, which have occurred over an extended period of time.
      • Examples of acute trauma include subtle erythema, abrasions, lacerations, friability, bleeding, and disruption of the hymen. Additionally, if the perpetrator ejaculated on or near the child’s genitalia, seminal products may be found. Signs related to the existence of STDs may also be present. These signs may include vaginal discharge, signs of vulvovaginitis, and characteristic lesions, such as the viral lesions observed in genital herpes and the warts observed with human papilloma virus infection (ie, condyloma acuminata).
      • Chronic findings that may be found include scars on the genital skin and mucous membranes, remodeled hymenal tissue from repeated trauma, and disrupted vascular patterns in the translucent tissues. Healing occurs in these tissues. Over months to years of abusive contact, angular margins in hymenal tissue tend to smooth out, and, with the onset of puberty, the appearance of estrogen and resultant hypertrophy of the genital mucous membranes tend to obscure subtle changes.
  • Muram diagnostic categorization system: From a historical perspective, the Muram categorization system is of note and offers valuable insight into how various prepubertal genital examination findings may assist diagnosis.
    • Category I – Genitalia with no observable abnormalities
    • Category II – Nonspecific findings that are minimally suggestive of sexual abuse but also may be caused by other etiologies
    • Category III – Strongly suggestive findings that have a high likelihood of being caused by sexual abuse
    • Category IV – Definitive findings that have no possible cause other then sexual contact (eg, seminal products in a prepubertal female child’s vagina, the presence of a nonvertically transmitted gonorrhea or syphilis infection)
  • Alternate classification
    • Adams and colleagues have built upon the Muram classification approach and have combined it with information from other components of the sexual abuse assessment.12  These clinical investigators propose an approach to the interpretation of medical findings in suspected child sexual abuse that offers a sound basis from which the examining health care provider can a differential diagnosis and offer a diagnostic impression at the conclusion of the health care evaluation. According to the 2008 update, Adams and colleagues propose an approach that has the following 8 categories of findings:13  
      • Findings documented in newborns or commonly seen in nonabused children (ie, normal variants)
      • Findings commonly caused by other medical conditions
      • Indeterminate findings (ie, insufficient/conflicting research data so requires caution in interpretation) 
      • Findings diagnostic of trauma and/or sexual contact
      • Residual/healing injuries
      • Injuries of blunt force penetrating trauma
      • Presence of infection that confirms mucosal contact with infected bodily secretions (ie, contact most likely to have been sexual)
      • Diagnostic of sexual contact (ie, pregnancy or sperm directly taken from a child’s body)
    • Because of the complexity of evaluation and the expertise required to accurately identify and interpret examination findings, Adams et al conclude their 2008 update with a call for standardization of the training of medical professionals who perform suspected child sexual abuse evaluations to ensure appropriate and continuing competence. 


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Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved.

Prevalence and Incidence Child Sexual Abuse


Professionals conservatively use child sexual abuse prevalence estimates of 20% in women and 5-10% in men. A classic prevalence study of New England male and female college students done by Finkelhor (1984), which used a definition that included both contact and noncontact abuse with older perpetrators and children younger than 17 years, revealed that 19.2% of female students (1 in 5 women) and 9% of male students (1 in 10 men) reported sexual misuse during their childhoods.  These figures are believed to be conservative estimates; other studies using different methodologies support using these figures as reasonable prevalence estimates. Analysis by various experts of 16 prevalence studies of nonclinical North American samples supports setting the upper end of prevalence figures at about 17% for women and 8% for men.


According to the US Federal Government’s official report, Child Maltreatment 2006, approximately 905,000 children were determined to be victims of child abuse; the overall child maltreatment rate was 12.1 cases per 1,000 children. Of these, about 8.8%, or close to 80,000, represented cases of sexual abuse that were substantiated by child protective services (CPS) for a child sexual abuse rate of 1.1 cases per 1,000 children. Overall, in 2006, the 905,000 substantiated cases emerged from approximately 3.3 million reports of alleged child abuse and neglect, involving about 6 million children. In addition to the 8.8% of substantiated cases of sexual abuse, an additional 16% were substantiated for physical abuse, and 64.1% were substantiated for child neglect.
In 2009, release of the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4) is expected and eagerly awaited. The NIS-4 was mandated by the Keeping children and Families Safe Act of 2003 (P.L. 108-36) and aims to estimate the most current national incidence, severity and demographic distribution of child abuse and neglect in the United States. The NIS-4 will collect data from a nationally representative sample of 122 counties.

Prior to the NIS-4’s release, older data remain available from the previously congressionally mandated Third National Incidence Study of Child Abuse and Neglect (NIS-3). In 1993, this study reported an estimated sexual abuse incidence rate of 3.2 cases per 1000 children (or a total of 217,000);7 this represented 29% of the total number of children known to have been abused. NIS-3 used a definition that subsumed a range of behaviors, including intrusion, genital molestation, exposure, inappropriate fondling, and unspecified sexual molestation.

At present, the NIS-3 is the single most comprehensive source of information about the current incidence of child abuse and neglect in the United States and is based on a nationally representative sample. At best, the incidence is an underestimate; however, the cases counted are only those occurrences known to professionals and do not include incidents of sexual abuse that have not been disclosed. With sexual abuse, the number of undisclosed incidents is believed to be large due to the stigma and criminal behavior involved.

The 1993 NIS-3 incidence figure of 3.2 cases per 1000 children represents a statistically significant (68%) increase from the 1986 Second National Incidence Study of Child Abuse and Neglect (NIS-2) incidence of 1.9 per 1000 children. In part, this difference is due to increased recognition of sexual abuse in the pediatric population. Finkelhor and Jones (2008) at the Crimes Against Children Research Center have been tracking the trends in child maltreatment statistics collected by the Federal Government and have found a national decline in the incidence of both physical and sexual abuse that began in the middle the 1990s and continues through the early 2000s. However, no decline was found in the rate of child neglect. Specifically, child sexual abuse substantiations have seen a 53% downward trend from the peak annual incidence observed in 1992 From2005-2006,substantiated child sexual abuse cases declined 5%.

Finkelhor and Jones have explored the potential reasons for the decline in child sexual abuse cases and have focused on factors that may be impacting the actual incidence as well as factors that may be influencing the reporting and investigation of reported cases, which may then downstream impact the number of substantiated cases

Optimistically, prevention efforts, incarceration, and treatment of perpetrators (along with other societal factors) may actually be decreasing the number of children who are harmed by sexual abuse. On the other hand, more pessimistically, fears of lawsuits and retribution, higher thresholds set for investigation and substantiation, and changes in policies and procedures may be changing the numbers but not impacting the actual amount of children under abuse. 

No consensus has been reached about what may be causing the steady decline; Finkelhor and Jones draw attention to the idea that factors such as increasing economic prosperity, increasing numbers of agents of social intervention, and increasing availability of highly effective psychiatric medications may very well be leading to a decline in incidence with a resultant decline in substantiations.



Numerous psychological and medical consequences have been described as associated with sexual abuse. Psychological disorders are reported as having an increased incidence in those who have been abused sexually and include depression, eating disorders, anxiety disorders, substance abuse, somatization, posttraumatic stress disorder (PTSD), dissociative disorders, psychosexual dysfunction in adulthood, and numerous interpersonal problems, including difficulties with issues of control, anger, shame, trust, dependency, and vulnerability.

PTSD and its relationship to sexual abuse have received considerable professional attention. The diagnosis of PTSD in the context of sexual abuse requires the occurrence of maltreatment and (1) frequent reexperiences of the event via intrusive thoughts and/or nightmares; (2) avoidance behavior and a sense of numbness toward common events; and (3) increased arousal symptoms, such as jumpiness, sleep disturbance, and/or poor concentration. Note that no universal short-term or long-term impact of sexual abuse has been identified, and the presence or absence of various symptoms or conditions does not indicate nor disprove the occurrence of sexual abuse.

Medical sequelae of sexual abuse include numerous medical conditions, including functional GI disorders (eg, irritable bowel syndrome, dyspepsia, chronic abdominal pain), gynecologic disorders (eg, chronic pelvic pain, genital or anal tears), and various forms of somatization involving neurologic conditions and pain syndromes. Additionally, children may contract STDs via sexual abuse, and postpubertal females may become pregnant.

In groundbreaking work, Felitti et al have explored the connection of exposure to childhood abuse and household dysfunction to subsequent health risks and the development of illness in adulthood in a series of studies referred to as the Adverse Childhood Experiences (ACE) studie s. Of 13,494 adults who completed a standard medical evaluation in 1995 and 1996, 9,508 completed a survey questionnaire that asked about their own childhood abuse and exposure to household dysfunction; the investigators then made correlations to risk factors and disease conditions.

In order to assess exposure to child abuse and neglect, the ACE questionnaire asked about categories of child maltreatment, specifically psychological, physical, and sexual abuse. When asking about sexual abuse, the questionnaire asked the patients if an adult or person at least 5 years older then had ever (1) touched or fondled them in a sexual way; (2) made them touch the adults or older person’s body in a sexual way; (3) attempted oral, anal, or vaginal intercourse with them; or (4) actually had oral, anal, or vaginal intercourse with them. In order to assess exposure to household dysfunction the ACE questionnaire asked questions by category of dysfunction, such as having a household member who had problems with substance abuse (eg, problem drinker, drug user), mental illness (eg, psychiatric problem), or criminal behavior (eg, incarceration) and having a mother who was treated violently.

In addition to the questionnaire information, the standardized medical examination of the adult assess risk factors and actual disease conditions. The risk factors included smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, any drug abuse, a high lifetime number of sexual partners, and a history of STDs. The disease conditions included ischemic heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, hepatitis, and skeletal fractures. Once all of the data were collected and analyzed, Felitti et al reported that the most prevalent ACE was substance abuse (25.6%), the least prevalent ACE was criminal behavior (3.4%), and the prevalence of sexual abuse was 22%. In total, 52% of the respondents to the questionnaire had one or more exposure, and 6.2% of respondents had 4 or more exposures. The following were findings in respondents who experienced 4 or more ACEs compared with those who had none:

  • Risk of alcoholism, drug abuse, depression, and suicide attempt increased 4-12 fold
  • Rates of smoking, poor self-rated health, and high number of sexual partners and STDs increased 2-4 fold
  • Physical inactivity and severe obesity increased 1.4-1.6 fold

The major finding of the ACE studies was a graded relationship between the number of exposures to maltreatment and household dysfunction during childhood to the presence in later life of multiple risk factors and several disease conditions associated with death in adulthood.  graphically depicts the hypothesized connection between ACEs and later risk-taking behaviors and the development of life-threatening conditions.



No race differences emerged from the 1993 NIS-3 data. This initially may be surprising due to the disproportionate overrepresentation of children of color who are involved with the child welfare system. NIS-3 data were consistent with the 1986 NIS-2 findings, which also failed to demonstrate any evidence of disproportionate victimization in relationship to children’s race. Finkelhor has concluded that race, ethnicity, and social class do not appear to be associated with risk of child sexual maltreatment.


Gender differences are noted in the reported incidence of sexual abuse. In the NIS-3, a statistically significant difference was noted, with girls experiencing sexual abuse at more than 3 times the rate of boys (4.9 per 1000 girls compared with 1.6 per 1000 boys). Child Maltreatment 2006 did not separately report the number of sexual abuse cases by gender. However, Douglas and Finkelhor have conducted extensive studies on child sexual abuse incidence rate trends; they conclude that the overwh lming majority of rigorous studies report a higher incidence of sexual abuse among girls, with females typically representing 78-89% of cases.


Age differences are observed in the reported incidence rates of sexual abuse for children aged 0-2 years (incidence is 1 per 1000) compared with children aged 12-14 years (incidence is 2.6 per 1000) and children aged 15-17 years (incidence is 2.7 per 1000). Incidence rates of sexual abuse in children aged 3-11 years widely varied and made the statistical comparisons unreliable. Of the approximately 78,000 children for whom age data are reported in Child Maltreatment 2006, the age breakdown shows that 6% of children who were sexually abused were younger than 4 years, 22% were aged 4-7 years, 23% were aged 8-11 years, and 47% were aged 12 years or older.


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Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved.


Child sexual abuse (CSA) refers to the use of children in sexual activities when, because of their immaturity and developmental level, they cannot understand or give informed consent. A wide range of activities is included in sexual abuse, including contact and noncontact activities. Contact activities included are sexualized kissing, fondling, masturbation, and digital and/or object penetration of the vagina and/or anus, as well as oral-genital, genital-genital, and anal-genital contact. Noncontact activities include exhibitionism, inappropriate observation of child (eg, while the child is dressing, using the toilet, bathing), the production or viewing of pornography, or involvement of children in prostitution.

The sexual activities are imposed on the child and represent an abuse of the caregiver’s power over the child. The sequence of activities often progresses from noncontact to contact over a period of time during which the child’s trust in the caregiver is misused and betrayed.

Since the mid 1970s, health care professionals have paid serious attention to sexual abuse of children. Despite the recognition of the clinical importance of sexual abuse of children, some pediatricians may not feel adequately prepared to perform medical evaluations. However, pediatricians are often in trusted relationships with patients and families and are in an ideal position to offer essential support to the child and family. Thus, pediatricians need to be knowledgeable about available community resources, such as consultants and referral centers for the evaluation and treatment of sexual maltreatment. Several paradigms have been proposed to help professionals understand the events that surround the sexual maltreatment of children.

Preconditions for sexual abuse

  • Motivation of perpetrator: The perpetrator is willing to act on impulses associated with sexual arousal related to children.
  • Overcoming internal inhibitions: The perpetrator ignores internal barriers against sexually abusing children.
  • Overcoming external inhibitions: The perpetrator is able to bypass the typical barriers in the caregiving environment that normally serve to impede the sexual misuse of children.
  • Overcoming child resistance: The perpetrator is able to manipulate the child to the point of involving the child in the sexual activity. Manipulation often involves either implicit or explicit coercion to ensure that the child keeps the inappropriate activities a secret.

Longitudinal progression of sexual abuse

  • Engagement: The perpetrator begins relating to the child during nonsexual activities to gain the child’s trust and confidence.
  • Sexual interaction: The perpetrator introduces sexual activities into the relationship with the child; the perpetrator often begins with noncontact types of activities and, over time, progresses to more invasive forms of contact activities.
  • Secrecy: The perpetrator attempts to maintain access to the child and to avoid disclosure of the abuse by coercing the child to keep the activities hidden. Coercion to keep the secret can be explicit (eg, threatening the child or the child’s family’s safety) or it can be implicit (eg, manipulation of the child’s trust to create a fear of losing the “friendship” or “attention” should the truth become known to others).
  • Disclosure: Sexual abuse can become known to others either accidentally, when a symptom from the maltreatment or a third party witnessing the abuse leads to an evaluation, or can be purposeful, as when the child reveals the abuse that is taking place and seeks help.
  • Suppression: The tumult that occurs after the disclosure prompts the people in the child’s caregiving environment to think that they are unable to support the child; thus, these people exert pressure on the child to recant what the child has told in order to go back to the perceived “stable” situation that existed prior to the disclosure.

Sexual abuse typically presents as a pattern of maltreatment that occurs over time. Children or their families usually know the perpetrators, because they often are either relatives or acquaintances.

Traumagenic dynamics model

  • Traumatic sexualization: The child’s sexual feelings and attitudes are shaped in a developmentally inappropriate and interpersonally dysfunctional manner. The child learns that sexual behavior may lead to rewards, attention, or privileges. Traumatic sexualization may also occur when the child’s sexual anatomy is given distorted importance and meaning.
  • Betrayal: The child learns that a trusted individual has caused him or her harm, misrepresented moral standards, or failed to protect him or her properly.
  • Powerlessness: This is a process of disempowerment in which the child’s sense of self-efficacy and will are consistently thwarted by the perpetrator’s coercion and manipulation. The child manifests symptoms of fear, anxiety, and impaired coping.
  • Stigmatization: The child’s self-image incorporates negative connotations and is associated with words such as bad, awful, shameful, and guilty. This stigmatization is consistent with the “damaged goods” mentality originally described by Sgroi et al (1982), in which the child feels deviant and not as whole as he or she felt prior to the abuse.

Situational Child Molesters


  Regressed Morally Indiscriminate Sexually Indiscriminate Inadequate
Basic Characteristic Poor coping skills User of people


Sexual experimentation


Social misfit
Motivation Substitution


Why not?




Insecurity and curiosity
Victim Criterteria Availability


Vulnerability and opportunity


New and different




Metode of operation Coercion


Lure, force or manipulation Involve in existing activity Exploits size, advantage


Pornography collection Possible


Sadomasochistic, detective magazine Highly likely; varied nature






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Phone : 62(021) 70081995 – 5703646

email :,


Foundation and Editor in Chief

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Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved.

Situational Child Molester


Situational child molester tidak memiliki preferensi seksual yang sebenarnya terhadap anak, namun melakukan hubungan seks dengan anak untuk alas an yang bervariasi dan terkadang kompleks. Situational child molester biasanya memiliki korban anak yang lebih sedikit dan berbeda-beda. Selain itu orang-orang rentan yang lain seperti orang tua, orang sakit, atau orang cacat juga memiliki risiko untuk menjadi korban seksualnya. Sebagai contoh, situational child molester yang melakukan kekerasan seksual pada anak di tempat penitipan anak dapat meninggalkan pekerjaannya di tempat itu dan melakukan kekerasan seksual pada orang tua di panti jompo. Situational child molester memiliki empat pola perilaku mayor, yaitu regresi (regressed), tidak memiliki diskriminasi secara moral (morally indiscriminate), tidak memiliki diskriminasi secara seksual (sexually indiscriminate), dan inadekuat (inadequate).



  1. Regresi (regression) Pelaku biasanya memiliki rasa percaya diri yang rendah dan kemampuan mengatasi masalah yang kurang (poor coping skills). Ia menganggap anak sebagai pengganti (substitusi) pasangan seks yang setara dengan dirinya yang lebih ia sukai. Stress memainkan peranan cukup besar dalam mencetuskan perilaku cabulnya. Kriteria utama korbannya adalah ketersediaan (availability) sehingga banyak pelaku mencabuli anaknya sendiri. Metode operasi utamanya adalah memaksa (coerce) anak berhubungan seks. Pelaku tipe ini bisa mengumpulkan pornografi anak atau dewasa, bisa juga tidak. Jika memiliki pornografi anak, biasanya berupa foto atau video buatan sendiri yang menampilkan anak yang ia cabuli.
  2.  Tidak memiliki diskriminasi secara moral (morally indiscriminate) Untuk pelaku tipe ini kekerasan seksual pada anak adalah bagian dari sebuah pola umum kekerasan dalam hidupnya. Ia adalah orang yang memperalat (user) dan melakukan kekerasan (abuser) terhadap orang lain. Ia melakukan kekerasan terhadap istri, teman, dan rekan-rekan sekerjanya. Ia berbohong, melakukan kecurangan, atau mencuri jika ia mengira ia tidak perlu mempertanggungjawabkannya. Ia mencabuli anak-anak dengan alasan sederhana: “Kenapa tidak?” (Why not?). Kriteria utama korbannya adalah kerentanan (vulnerability) dan  kesempatan (opportunity). Ia memiliki keinginan, seorang anak kebetulan berada di sana, maka ia bertindak. Biasanya ia menggunakan kekuatan (force), umpan (lures), atau manipulasi untuk mendapatkan korbannya. Ia biasanya mengoleksi majalah-majalah detektif atau pornografi dewasa yang bersifat sadomasokistik (sadomasochistic).
  3.  Tidak memiliki diskriminasi secara seksual (sexually indiscriminate) Perbedaannya dengan morally indiscriminate adalah pelaku memiliki diskriminasi dalam perilakunya kecuali dalam hal seks. Pelaku mau mencoba segala sesuatu yang bersifat seksual. Motif dasarnya adalah percobaan seksual (sexual experimentation), dan tampaknya ia melakukan hubungan seks dengan anak karena ia bosan. Kriteria utama korbannya adalah mereka baru dan berbeda (new and different), dan ia melibatkan anak-anak dalam aktivitas seksual yang ada sebelumnya (previously existing sexual activity). Dari semua situational child molester,  tipe ini adalah yang paling mungkin memiliki korban multipel, memiliki latar belakang sosioekonomi tinggi, dan mengoleksi pornografi dan erotika. Namun pornografi anak merupakan sebagian kecil dari koleksinya yang banyak dan bervariasi.
  4.  Inadekuat (inadequate) Termasuk di dalam pola perilaku ini orang-orang yang mengalami psikosis, gangguan kepribadian eksentrik, retardasi mental, dan ketuaan (senility). Walaupun kebanyakan dari orang-orang tersebut tidak berbahaya, beberapa dapat menjadi pelaku pencabulan anak dan, dalam beberapa kasus, bahkan menjadi pelaku pembunuhan anak. Pelaku ini terlibat hubungan seks dengan anak karena rasa ketidakamanan (insecurity) atau rasa penasaran (curiosity). Ia menganggap anak sebagai objek yang tidak berbahaya (nonthreatening objects) sehingga ia dapat mengeksplorasi fantasi seksualnya. Dalam beberapa kasus pelaku memilih anak tertentu sebagai pengganti orang dewasa tertentu (mungkin kerabat anak tersebut) yang tidak dapat didekati secara langsung oleh pelaku. Selain anak, orang tua juga dapat menjadi korbannya, siapapun yang terlihat tidak berdaya. Pelaku mungkin mengoleksi pornografi, namun kemungkinan besar berupa pornografi dewasa.


Provided by

Yudhasmara Foundation


Phone : 62(021) 70081995 – 5703646

email :,


Foundation and Editor in Chief

Dr Widodo Judarwanto


Copyright © 2009, Fight Child Sexual Abuse and Pedophilia  Network  Information Education Network. All rights reserved.