Fort- und Weiterbildung

Abstracts des Münchener Symposiums für Kinder- und Jugendgynäkologie
Anlässlich des 25-jährigen Bestehens der Arbeitsgemeinschaft vom 23. bis 25. Oktober 2003, Frauenklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München

Dr. med. Roland Csorba, Ungarn

Hungarian characteristics of child sexual abuse that occurred between 1986 and 2001: A longitudinal, prospective study

Objective:
To summarize the characteristics of child sexual abuse and to explore common features that may be utilized as targets for possible methods of prevention.

Design:
Prospective, longitudinal study

Setting:
A Hungarian county, University of Debrecen

Participiants:
Between 1986 and 2001, 209 girls under the age of eighteen, who had been exposed to sexual abuse visited the Department of Adolescent Gynecology.

Table 1: Characteristics of the victims (n = 209)
Characteristics Category Number
of cases 		%
Age (years) <10 25 12
  11-14 98 47
  > 86 41
Occupation Pre-school 9 4
  Pupil 157 76
  Worker 17 8
  Unemployed 24 11
  Mentally handicapped 2 1
Relation to perpetrator Daughter 23 11
  Daughter-in-law 22 10
  Cousine 4 2
  Grandchild 2 1
  Niece 1 0,5
  Other relative 1 0,5
  Familiar 86 41
  Stranger 72 34
Escorter Mother 82 39
  Parents 13 6
  Mother-in-law 4 2
  Police officer 89 43
  Grandmother 2 1
  Nanny 5 2
  Paramedical officer 11 5
  Teacher 3 2
Time of the examination Immediate 101 48
  Within 72 hours 35 17
  More than 72 hours 73 35

Methods:
We prospectively collected data regarding the characteristics of all cases. Events in which victim and perpetrator were members of the same family were considered as intrafamiliar. Subsequent legal procedures were also evaluated.

Main outcome mesaures:
We describe the medical and legal approaches to handling child neglect.

Results:
Seventy-five percent of the victims were students, 47 % of them were between 11 and 14 years of age. The perpetrator was familiar to the victim in 66 % of the cases, and a stranger in 34 %. Fifty-two (25 %) perpetrators were intrafamiliar. He was the victim’s father in 11 %, and the stepfather in 10 %. The abuse occurred on multiple occasions in 21 %. The occurrance rate of assault was the highest in the summer season (59%). Thirty-nine percent of victims were accompanied by their mothers and 43 % by the police. Vaginal penetration was the type of abuse in 80 %, and sexual perversion in 20 %. Sixty-six victims were physically injured, the presence of sperms could be confirmed on vulvovaginal smears in 38 cases. One pregnancy conceived. 127 cases were reported to the police and as a result of legal proceedings 56 perpetrators have been sentenced.

Table 2: Characteristics of sexual child abuse cases
Characteristics Category Number
of cases 		%
Occurrence Multiple 44 21
  Single 165 79
Type Pre-school 169 80
  Pupil 40 20
Physical abuse   66 32
Forensic evidence Presence of sperm 38 18
  Gravidity 1 0,5
Diurnal occurrence Morning 16 8
  Afternoon 87 42
  Evening 42 20
  Night 64 30
Seasonal occurrence Spring 14 7
  Summer 123 59
  Autumn 31 15
  Winter 41 19

Conclusion:
A high proportion of child sexual abuse takes place within the family and is revealed only after multiple episodes. The low reported prevalence of sexual assault is the consequence of the lack of harmony between the conditions of emergency care in Hungary and the Hungarian criminal law. Prevention requires vigilance at off-school times, child education, early involvement of health professionals, and the adjustment of jurisdiction.

Dr. med. Roland Csorba, Department of Obstetrics and Gynecology,
University of Debrecen, Medical and Health Science Center, Debrecen, Hungary