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The fact that only a small proportion of childhood sexual assault cases will ever result in prosecution has been blamed, at least partially, on structures within law that continue to prejudice the outcomes of sexual offence cases Mack ; Taylor Neame and Heenan note that proponents of law reform have particularly criticised: 'the continued use of corroboration warnings, where judges routinely caution juries against convicting unless other evidence can independently support the victim's version of events.

This substantially impacts on cases involving adult survivors who in recounting. In other criminal proceedings where the prosecution must establish the accused's guilt through the oral evidence of a single witness, corroboration warnings are nevertheless usually considered unnecessary in the face of the high standard of proof 'beyond reasonable doubt' , and the standards of testing the evidence through cross-examination. Feminist legal scholars and other advocates of abolishing the corroboration warning have suggested that judges' use of the warning in childhood sexual assault cases is a reflection of the systemic prejudice that 'women and children, especially girl-children, possess a seemingly natural propensity to lie about sexual abuse and to fabricate allegations' Taylor 5.

Taylor also highlights what she perceives as the failure of the criminal justice system to understand delayed disclosure of sexual assault and its association with so-called victim acquiescence - 'especially in long-term sexual abuse cases, these responses occur as a consequence of the offender's conduct and trauma-induced suffering of the victim.

Very often complex and perhaps counter-intuitive behaviours manifested by traumatised children are simply interpreted as evidence of the falsity of the alleged charge s ' Taylor There is also an urgent need for evaluations of the therapeutic responses to the abuse for both children and adults so that appropriate services can be developed.

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These fears are linked to pervasive social myths about sexual assault, especially that women and children often lie about rape, and that their right to live free from such abuse can be sacrificed for the sake of 'keeping the family together'. As Easteal 1 notes: 'One of the only means available to reduce sexual assault and to enhance the probability that its victims will report it to authorities is through knocking down the false images of rape that act to perpetuate it in society.

According to feminist legal theorists, not only do these myths act as barriers to disclosure, they are likely to be perpetuated by criminal justice responses following the reporting of childhood sexual assault Taylor Many fear disclosing the abuse out of fear they will not be believed, and, of those who do disclose, many report disbelief on the part of family and friends Easteal Those who somehow find the courage to seek help from services are unlikely to receive the long-term support they need because of discriminatory funding guidelines.

Over the coming year, ACSSA will be mapping existing service provision in this area throughout the country, with the aim of identifying good practice, along with the difficulties services face and the consequent gaps in current levels of provision.

Victim of Child Sexual Exploitation tells her story

Copyright information. Paper aims to provide an overview of complex trauma as a concept for classifying a varying range of symptomatology. Reviews the emergence of trauma-informed care in Australia and overseas and how it is being implemented in practice. What are the conceptual, policy and practice challenges that the prevention of child sexual abuse presents? Presents a five-tier model for the analysis of current Commonwealth child abuse prevention activities as well as for the recommendations for progra.

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Finland under pressure to criminalise lack of consent in rape laws

What is childhood sexual assault? Who sexually assaults children, and how common is it? How do we know what we know? They do not, in themselves, reveal how prevalent such experiences are, nor the extent to which individual experiences are typical, although the latter may be theorised in accompanying socio-structural analyses. Official data This includes reports to statutory child protection departments and police statistics. The limitations associated with these sources include gross levels of under-reporting; few cases being substantiated, because of lack of physical evidence which is rare ; and under-representation of the extent to which child abuse is committed by biological parents Wallis Findings of this report Holden 21 highlighted the issues and needs for adult survivors and workers as follows: ' The demand for counselling and group services by adult survivors continues to be high, with many services in the government and non-government sector reporting they are unable to respond to a large number of requests for services.

There is a lack of a coordinated approach to issues of childhood sexual abuse for adult survivors in relation to service provision, training and policy issues. Limited training opportunities exist for workers in this area, including basic and advanced childhood sexual abuse training. There is no specialist after hours crisis service. Holden 22 notes that without such an agency there remains a continuing lack of coordination around service delivery, training and community education, resulting in: 'Limited identification of the health cost associated with poor coordination between services dealing with childhood sexual abuse, mental health and other related issues such as domestic violence.

The needs of adult survivors of childhood sexual abuse not being reflected in policy development, organisational strategic planning and subsequent service delivery.

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Limited encouragement of research and community education strategies, including prevention. Inadequate development of comprehensive training for allied health workers and limited opportunities to warehouse appropriate literature or amass a body of knowledge or expertise for workers to access. Lack of a systematic approach to informing health planners and purchasers of services about current service trends and issues for adult survivors of childhood sexual abuse. Further reading Acknowledging complexity in the impacts of sexual victimisation trauma.

Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care. Obstetrician-gynecologists can offer support to abuse survivors by giving them empowering messages, counseling referrals, and empathic care during sensitive examinations.

Women who are survivors of childhood sexual abuse often present with a wide array of symptoms. Frequently, the underlying cause of these symptoms is unrecognized by both the physician and patient. The obstetrician-gynecologist should have the knowledge to screen for childhood sexual abuse, diagnose disorders that are a result of abuse, and provide support with interventions.

Adult childhood sexual abuse survivors disproportionately use health care services and incur greater health care costs compared with adults who did not experience abuse 1. Child sexual abuse is defined as any sexual activity with a child where consent is not or cannot be given.

This includes sexual contact that is accomplished by force or threat of force, regardless of the age of the participants, and all sexual contact between an adult and a child, regardless of whether there is deception or the child understands the sexual nature of the activity. Sexual contact between an older child and a younger child also can be abusive if there is a significant disparity in age, development, or size, rendering the younger child incapable of giving informed consent.

The sexually abusive acts may include sexual penetration, sexual touching, or noncontact sexual acts such as exposure or voyeurism 2. Legal definitions vary by state; however, state guidelines are available by using the Child Welfare Information Gateway www. Shame and stigma prevent many survivors from disclosing abuse. Incest, once thought to be rare, occurs with alarming frequency 3. Survivors come from all cultural, racial, and economic groups 4.

Approximately one in five women has experienced childhood sexual abuse 4. Symptoms or behavioral sequelae are common and varied. More extreme symptoms can be associated with abuse onset at an early age, extended or frequent abuse, incest by a parent, or use of force. Common life events, like death, birth, marriage, or divorce may trigger the return of symptoms for a childhood sexual abuse survivor.

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The primary aftereffects of childhood sexual abuse include the following:. Chronic and diffuse pain, especially abdominal or pelvic pain 1 , lower pain threshold 7 , anxiety and depression, self-neglect, and eating disorders have been attributed to childhood sexual abuse. Adults abused as children are four to five times more likely to have abused alcohol and illicit drugs 8.

They are also twice as likely to smoke, be physically inactive, and be severely obese 8. Disturbances of desire, arousal, and orgasm may result from the association between sexual activity, violation, and pain.

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Survivors are more likely to have had 50 or more intercourse partners, have had a sexually transmitted infection, and engage in risk-taking behaviors that place them at risk of contracting human immunodeficiency virus HIV 8, 9. Early adolescent or unintended pregnancy and prostitution are associated with sexual abuse 10, Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, and nonspecific vaginitis, are common diagnoses among survivors Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care Adult survivors of sexual abuse may be less skilled at self-protection.

They are more apt to accept being victimized by others 15, This tendency to be victimized repeatedly may be the result of general vulnerability in dangerous situations and exploitation by untrustworthy people. With recognition of the extent of family violence, it is strongly recommended that all women be screened for a history of sexual abuse 15, Patients overwhelmingly favor universal inquiry about sexual assault because they report a reluctance to initiate a discussion of this subject Following are some guidelines:. If the physician suspects abuse, but the patient does not disclose it, the obstetrician-gynecologist should remain open and reassuring.

Patients may bring up the subject at a later visit if they have developed trust in the obstetrician-gynecologist. Not asking about sexual abuse may give tacit support to the survivor's belief that abuse does not matter or does not have medical relevance and the opportunity for intervention is lost Once identified, there are a number of ways that the obstetrician-gynecologists can offer support.

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These include sensitivity with the gynecologic or obstetric visit and examination in abuse survivors, the use of empowering messages, and counseling referrals. Pelvic examinations may be associated with terror and pain for survivors. Feelings of vulnerability in the lithotomy position and being examined by relative strangers may cause the survivor to re-experience past feelings of powerlessness, violation, and fear. Many survivors may be traumatized by the visit and pelvic examination, but may not express discomfort or fear and may silently experience distress All procedures should be explained in advance, and whenever possible, the patient should be allowed to suggest ways to lessen her fear.

For example, the patient may desire the presence of friends or family during the examination and she has the right to stop the examination at any time. Techniques to increase the patient's comfort include talking her through the steps, maintaining eye contact, allowing her to control the pace, allowing her to see more eg, use of a mirror in pelvic examinations , or having her assist during her examination eg, putting her hand over the physician's to guide the examination It is important to ask permission to touch the patient.

Pregnancy and childbirth may be an especially difficult time for survivors. The physical pain of labor and delivery may trigger memories of past abuse Women with no prior conscious memories of their abuse may begin to experience emotions, dreams, or partial memories.

Pregnant women who are abuse survivors are significantly more likely to report suicidal ideation and depression 7, There are no consistent data regarding adverse pregnancy outcomes for women with histories of childhood sexual abuse. Some positive and healing responses to the disclosure of abuse include discussing with the patient that she is the victim of abuse and is not to blame.

She should be reassured that it took courage for her to disclose the abuse, and she has been heard and believed 19, Traumatized patients generally benefit from mental health care. The obstetrician-gynecologist can be a powerful ally in the patient's healing by offering support and referral. Efforts should be made to refer survivors to professionals with significant experience in abuse-related issues.

Physicians should compile a list of experts with experience in abuse and have a list of appropriate crisis hotlines that operate in their communities.

Adult victim/survivors of childhood sexual assault

Contacting state boards of psychology or medicine can be beneficial in locating therapists who are skilled in treating victims of such trauma. Denmark also defines rape as involving force or a threat of violence, rather than looking at whether or not there was consent. The definition of rape in Finnish law, which is based on physical violence and incapacity, is outdated and discourages survivors from coming forward.

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