A 5-year-old girl and her mother are seen in your office. The mother explains that the child has been complaining of genital pain for one day, since she picked her up from the new child care yesterday afternoon. Because of recent articles the mother has read about sexual abuse, she is worried her daughter’s symptoms may indicate abuse. When you ask the child why she is there to see you today, she tells you, “My private hurts,” and grasps her genitals.
- “Did you fall down?”
- “Did someone touch you?”
- “What happened when your private started to hurt?”
- “Are you bleeding anywhere?”
The child says, “I was scratching and then it hurt when I went potty.” You examine the child and find some mild nonspecific excoriated areas but no signs of sexual abuse.
2. You take this opportunity to speak with mom about sexual violence prevention and detection. An important point to make is
- Children who have been sexually abused usually complain of pain or bleeding.
- Children usually show fear of their abuser.
- Sexual abuse is best prevented through good communication skills.
- Sexual abuse usually involves nonfamily perpetrators.
A mother visits with her 11-year-old boy, concerned about the excessive amount of time he spends on the computer. When she walks into his room she can see that he will quickly hide the screen he is viewing and act nervous. He has recently gotten in trouble at school for making a sexual comment to a classmate. She is worried he is viewing pornography and seeks your advice.
1. Which of the following is the most reasonable approach to this clinical presentation?
- Confront the child in front of the mother.
- Interview the child out of the presence of the mother.
- Encourage the mother to enforce strict punishment for his behavior at school.
- Have the mother confront the child in your presence.
The boy indicates that he likes to view MySpace and YouTube but denies any viewing of pornography. He says that he made a comment about a girl’s breasts being large to another boy and a teacher overheard the comment. He is embarrassed about the incident and says he doesn’t want to get into that kind of trouble again.
2. Your advice to the patient is
- Do not post any personal information about yourself while viewing these sites.
- His computer interests may increase his tendency to bully.
- His comment at school may indicate his tendency to be a sex offender.
- His mother is overreacting and his behavior is normal.
3. Your advice to the mother is
- Take away his computer for awhile as punishment for the behavior at school.
- Forbid him to look at MySpace and YouTube.
- Give him a brochure to read about sexual harassment.
- Place the computer in a high-traffic area of the house and install computer monitors or blockers.
A 16-year-old girl is seen for a health maintenance visit and reluctantly tells you she is worried about a vaginal discharge she has noticed. You ask about sexual contact and she tells you she has had sexual contact with one boy, also 16, last month. In discussing the relationship, she mentions that she did not want to have sex, but did because he threatened to break up with her if she didn’t.
1. A good next question would be
- “Why did you give in to him?”
- “Has he threatened you in any other ways?”
- “What do you like about him?”
- “Does your mother know about this?”
2. She tells you he has slapped her a few times when he became jealous that she was talking with another boy. You tell her
- “If it left a mark when he hit you, you should leave him because it will only get worse.”
- “Have you asked him to get some counseling? If he cares for you he would do it.”
- “If he’s done this to other girls, he probably won’t stop. Talk to your friends about what he’s like.”
- “I am worried about the way he treats you, and from my experience in talking with other teens in similar situations, he is not likely to change.”
1. In taking a sexual history, you ask
- “Have you had any girlfriends?”
- “You aren’t having sex, are you?”
- “Are you straight or gay?”
- “Have you had any sexual partners?
2. The patient tells you he has had sexual contact with 2 males, both 17 years old. After a discussion about sexually transmitted infections and condom use, he asks, “Is it normal for sex with guys to be rough?” You respond
- “Sex with anyone should not be forced or hurtful.”
- “If you don’t tell partners ‘no,’ they won’t know they’re being rough.”
- “Maybe you would feel more comfortable with a female partner.”
- “Do you get sexual gratification even when it is rough?
3. You would like to offer the young man some help. Which of the following is a reasonable resource for this situation?
- Domestic violence hotline
- Teens anonymous
- A rape crisis hotline
- Gay, lesbian, bisexual, transgender, and questioning (GLBTQ) organization