Child sexual abuse: Listening to the victims

Child Sexual Abuse (CSA) is a global public health concern. We present real testimonies of adults recalling their childhood, clinical refl ections and scientifi c research data. Patients’ testimonies bring professionals closer to understanding their painful reality. All testimonies are from women who gave their consent to use their statement. Doctors and health professionals need to know this reality and be prepared to prevent and cope with abuse. Short Communication Child sexual abuse: Listening to the victims Margarita Ortiz-Tallo1,2* and Isabel Calvo2 1Psychology Faculty, University of Málaga, Spain 2Asociación Con.Ciencia, Escuela de Psicoterapia y Creatividad, Málaga, Spain Received: 29 June, 2020 Accepted: 10 July, 2020 Published: 11 July, 2020 *Corresponding author: Margarita Ortiz-Tallo, PhD, Psychology Faculty, University of Málaga, Spain, E-mail:


Child sexual abuse
Child sexual abuse (CSA) is a serious type of children maltreatment and is classifi ed as violence even if the abuser does not physically harm the child. CSA should be considered a global public health concern. Public health aims to provide maximum benefi t for the largest number of adults and children and reducing violence and its consequences is one of its priorities.
The World Health Organization (WHO) defi nes CSA as the "involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society" [1]. UNICEF estimates that 120 million children are or have been abused during their childhood [2]. The abuse is usually perpetrated by someone close to the child, someone they trust. Studies indicate that abusers are often people from the victims´ surroundings: friends of the family, educators or family members [3]. All the reviewed studies agree that perpetrators are mostly male, and victims are more often, but not exclusively, female [1]. It is very diffi cult for children to reveal what's happening to them. Very often this is because they feel they are to blame [1]. A clear pattern of abuse can be seen in practice: confi dence, trust, secrecy, guilt and silence. Furthermore, abuse does not tend to be an isolated incident; it tends to be a behaviour maintained throughout extended periods of time, often until late adolescence [5]. Sexual violence can be perpetuated from one generation to another, being reported to therapists in clinical contexts. This trauma is frequently transmitted through generations with the secrets somatized in the victim's body [9]. Dissociative amnesia and diffi culty recognising the signs of abuse lead to women with a previous case of CSA not realising the possibility that their children could be abused too, sometimes even leaving them in the care of the perpetrator. Early trauma produces neuronal [10], structural [11] and functional alterations within the brain, leading to a defi cit in mentalization capabilities [12].

Conclusions
CSA is a type of maltreatment that produces physical and Adults and children need to be prepared and informed [13].
In particular doctors, health professionals in general, educators, and law enforcement professionals (lawyers, prosecutors and judges) must be prepared to properly deal with this type of maltreatment. If professionals are not well trained to detect, report and/or prevent child abuse, then minors will have no protection. It is the professional's responsibility to be trained and to prepare everyone surrounding the victim to help them deal with such a diffi cult experience. Training professionals and educators, information to children and families, are essentials to move forward and provide resources to reduce child sexual abuse.
Our team works with children to prevent abuse. We develop resources using creative techniques to reach minors (and adults) through their emotions: theatre, puppets and cartoons. We also conduct research and training. We encourage professionals to be prepared to face CSA.
Finally, considering abuser's prevention Sex Offender Therapy Programs would be another important and complementary way to prevent CSA [14].