Signs of sexual 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 or bleeding from the vagina.
• Rectal or genital bleeding.
• Anal tears or dilation.
• Symptoms of a sexually transmitted disease (STD), such as gonorrhea, chlamydia, syphilis, or HIV.

Vaginal bleeding in a child before the beginning of menstruation is abnormal, as are other vaginal or genital symptoms such as sores, warts, pain, or unusual discharge. Abnormal vaginal bleeding may be caused by physical or sexual abuse that injures the abdominal or vaginal area. Vaginal bleeding that is caused by abuse often is the result of minor physical injuries that will get better on their own or with home treatment.

You may feel uneasy if your health professional brings up the issue of abuse. However, health professionals have a professional duty and legal obligation to evaluate the possibility of abuse. It is important to consider this, especially if there were no witnesses to the injury that caused the child's vaginal bleeding.

If you think your child has been sexually abused, call your health professional or contact the National Child Abuse Hotline and Referral Service at 1-800-422-4453.