Signs of abuse may not be apparent without an examination of the genital area. These signs include:

• Bruises, scars, chafing, or bite marks in the genital area.
• Discharge from the vagina or penis.
• Rectal or genital bleeding.
• Anal tears or dilation.
• Symptoms of a sexually transmitted disease (STD), such as gonorrhea, chlamydia, syphilis, or HIV.

Rectal problems, including constipation, pain, leaking of stool, or anal injury, may be caused by physical or sexual abuse that injures the abdominal or rectal area. An injury to the vagina or rectum, or injury to the abdomen, back, or lower spine can prevent normal bowel movements.

Home treatment is not appropriate for rectal problems that are caused by abuse. Unreported abuse is likely to continue and will usually get worse. You may feel uneasy if your health professional brings up the issue of abuse. Health professionals have a professional duty and legal obligation to evaluate the possibility of abuse.

If you think your child has been abused, it is your responsibility to call your health professional or contact the National Child Abuse Hotline and Referral Service at 1-800-422-4453. Adults need to protect young children because children cannot protect themselves.