Sexual Violence Against Children and Vulnerability: Original Article
Sexual Violence Against Children and Vulnerability: Original Article
Sexual Violence Against Children and Vulnerability: Original Article
Summary
Objective: To analyze the demographic and epidemiological profile of children
and adolescents victims of sexual violence treated in a Unit of Forensic Medici-
ne and the relationship between victims and perpetrators.
Methods: A descriptive study, with data collection from information gathered from
sex abuse reports performed in 2009 on victims of sexual violence aged less than
18 years. The data collection tool was a form filled out with demographic infor-
mation about the victim – gender and age - and information regarding the se-
xual violence –, location of the occurrence, time elapsed between abuse and ex-
pert report, complaints reported, sexological examination findings, description
Work carried out by the Department of of lesions outside the genital region, and aggressor’s relationship to victim.
Forensic Medicine of Paraíba (DMl/ PB),
João Pessoa, PB, Brazil.
Results: In 2009, 421 individuals victim of sexual violence were assisted. Of tho-
se, 379 (90%) were younger than 18 years, and 66 cases were excluded from the-
Article received: 1/16/2013
se reports. Most were female (81.2%). The most affected age group was 10 to 13
Accepted for publication: 7/1/2013
years old (36.7%), followed by 5 to 9 year-olds (30.7%). In most cases (86.3%), the-
Correspondence re were family or friendship ties between victims and perpetrators, being most
Rua Aderbal Maia Paiva, s/n, Q 245, L
198 frequently accused an acquaintance or friend of the family (42.3%), followed by
Portal do Sol the stepfather (16.6%) and the father (10.9%).
João Pessoa – PB
ZIP Code: 58046-527
Conclusion: The results are similar to other studies conducted in the country.
Phone: +55 83 3235-8831/ 3218-5214/ This work aims at filling a gap caused by the lack of research on this topic in the
9382-0781 trindadeluc@ig.com.br
State, hoping to collaborate to improve public policies against child sexual abuse.
http://dx.doi.org/10.1590/1806-9282.60.01.015
Conflict of interest: none Uniterms: Sexual violence; child and adolescent protection; crime victims.
Introduction
Every child has the right to a healthy life, free of violen- Sexual violence in Brazil is an old reality, being chil-
ce. Despite this, the World Health Organization estima- dren and adolescents the most frequent victims.3,9 It is
tes that millions of children around the world suffer from estimated that less than 10% of the cases of sexual violen-
violence, directly or indirectly. Among its many forms, is ce against children and adolescents are reported. Still, the
sexual violence.1 incidence and prevalence are considered high. Thus, in
Sexual violence is a universal phenomenon, affecting the 1980s and later, groups for child maltreatment pre-
individuals of both sexes and all age groups.2 It seems to vention appeared in the country, culminating with the
be embedded in a social, historical, and cultural context.3 publication the Statute for Children and Adolescents.9,10
In addition to the body and genital injuries that victims Erotic and sexual practices are imposed to children
are subjected to at the time of abuse, there is an increa- or adolescents through physical violence, threats or by
sed susceptibility to other types of violence in the future, inducing their will. They range from behavior where the-
as well as the possibility of contracting sexually transmit- re is no physical contact (harassment, voyeurism, exhibi-
ted diseases and developing psychological disorders.4 The- tionism) to different types of acts with physical contact
refore, it is seen as a complex public health problem.3,5-8 without penetration (oral sex, interfemoral intercourse,
heavy petting, and frottage) or with penetration (fingers, violence, of both genders, who were less than 18 years old
objects, genital or anal intercourse). It also includes se- at the time the medical examination was performed, re-
xual exploitation, prostitution and pornography.11-13 gardless of the time interval between the incident and the
In the country, sexual crimes are regulated by the expert examination, and who were referred by a police or
1940 Criminal Code (CC), modified by Law no. 12015, of judicial authority.
2009, which now classifies them as “crimes against per- Reports of victims older than 18 years, and females
sonal dignity,” currently being seen as an insult to free- under 18 years, whose motivation for the performance of
dom and sexual morality.14,15 sexological exam was not considered as sexual violence,
The new law has a broader definition of rape, and in- but otherwise related to their own desire, and/or the le-
cluded the rape of vulnerable, defined as “having unlawful gal guardian’s desire to know about or to prove the inte-
carnal knowledge or practice other libidinous acts with grity of the hymen were excluded from the study.
a minor under 14 (fourteen) years,” incurring the same It is a descriptive and retrospective documentary type
penalty for those who practice these actions with someo- study with a quantitative approach, for which data col-
ne who cannot offer resistance.15 lection occurred in January and February 2011, based on
The experience of sexual abuse can affect the develo- information contained in the reports of sexological exa-
pment of children and adolescents in different ways, as minations done at the DFM/PB in 2009. The data collec-
some have minimal sequelae, or no apparent aftereffect, tion tool consisted of a form filled out by the researchers,
while others develop severe emotional, social and/or with sociodemographic information about the victims -
psychiatric problems.16-20 In addition, studies show that sex and age - and about the sexual violence - place of oc-
sexual violence is often accompanied by other forms of currence, time elapsed between the incident and the ex-
violence and violations of the rights of the child and ado- pert examination, the victim’s complaints, findings of the
lescent.4,11,21 Other forms of parental or marital violence, sexological examination, description of lesions outside
such as physical abuse, psychological abuse and neglect, the genital area, type of offender and conclusion of the
as well as community and institutional violence, are com- expert examination.
monly present in the history of children and adolescent Data were entered, reviewed for typos, and analyzed
victims of sexual abuse.11,22 using the Epi Info software program (3.5.3 version, CDC,
Given the above, it is clear that sexual violence needs Atlanta, USA). For data analyses, absolute and percenta-
to be consistently studied. This work focuses on the is- ge frequencies were used.
sue and has the goal of describing the demographic and The study was developed respecting all ethical prin-
epidemiological profile of children and adolescents vic- ciples regarding human research. The research project
tims of sexual violence seen at a Unit of Forensic Medici- was approved by the Research Ethics Committee (CEP)
ne in the Brazilian state of Paraíba, in 2009, as well as of the Nova Esperança Medical School (FAMENE), with
their relationship with the offenders and the injuries pre- prior consent of the Director of the DFM/PB.
sented for forensic examination. There was no conflict of interest in this research.
Methods Results
This study was conducted by the Department of Foren- In 2009, 421 individuals of both genders, victims of se-
sic Medicine of Paraíba (DFM/PB), an agency of the group xual violence, were attended to by the DFM/PB. Of the-
that comprises the Institute of Scientific Police of Paraí- se, 379 (90%) were under 18 years old, whose reports of
ba (IPC/PB), subordinated to the Secretariat of Public Se- examinations constituted the study population; 64 cases
curity and Social Defense of Paraíba. The agency is loca- were excluded (corresponding to 16.9% of the underage
ted on the outskirts of the city of João Pessoa (PB), victims, and 15.2% of the total number of medical reports)
capital of a state located in the Brazilian Northeast re- on account of the motivation for the medical report, which
gion, and is responsible for performing expert medical was not defined as sexual crime, and 2 other victims (0.48%
examination of the victims (including in the case of se- of the medical reports for underage victims, and 0.53%
xual crimes) arising from the capital and surrounding ci- of the total number of reports) who refused to go through
ties. expert examination.
The target population of this study consisted of re- Of the 64 reports of under-18 victims excluded, the
ports of sexual violence of victims seen at the DFM/PB motivations for the exam were: 4 (6.3%) to confirm hy-
in 2009. The study included reports of victims of sexual men integrity as desired by the victim or legal guardian;
31 (48.4%) per request of the authorities, as part of the of the reports there was no reference to such information,
investigation of libelous accusation; 26 (40.6%) due to and 10% of victims had lesions.
the occurrence of consensual intercourse between a fe- The most common types of sexual violence suffered
male over 14 years old and her boyfriend or partner (in- by the victims, according to the conclusion of the expert
cluding 3 for “marriage purposes”), and 3 (4.7%) for ge- reports were: the absence of traces of violence (64.2%),
nital trauma. rape of vulnerable person (13.7%) and inconclusive re-
As for the sociodemographic characteristics of the sults (9.9%). Other findings were: libidinous acts (7%),
victims of sexual violence in this study, 254 were fema- anal rape (3.2%), vaginal rape (1.6%) and other (0.3%).
le (81.2%, confidence interval 76.4 - 85.3%). A minority,
59 of them (18.8%, confidence interval 14.8 - 23.7%), Discussion
were male. With regard to age, victims were divided Sexual violence is defined as any sexual act or play, hete-
into four groups. The median age was 10 years. The rosexual or homosexual relationship, in which the aggres-
most affected age group was 10 to 13 years old (36.7%), sor is in a more advanced psychosexual development sta-
followed by 5 to 9 year-olds (30.7%) (Table 1). Consi- ge than the child or adolescent, with the purpose of
dering age alone, most of the victims were 13 years old sexually stimulating the victim or using him/her for se-
(14.1%). xual stimulation.9.12,13
The municipalities with the highest number of com- It constitutes a complex problem, with cultural roots,
plaints were João Pessoa (55.3%), Santa Rita (10.5%) and that reaches the field of morality and the protection of
Bayeux (4.2%), the latter two located in the metropolitan human rights. Sexual violence has many severe conse-
area of the capital of the state of Paraíba. quences, compromising the development of children and
adolescents, possibly inserting the victims in a cycle of
Table 1 Age range of victims violence that can continue into adulthood.3-5
In Brazil, victims under 14 years are legally considered
Age range Frequency Percentage
vulnerable. Vulnerability from the perspective of bioethics
(in years)
is defined as a relationship of inequality between two in-
0 to 4 52 16.7%
dividuals or among groups, in which one party has its will
5 to 9 96 30.6%
annulled or diminished.23.24 Primarily related to the field
10 to 13 115 36.7%
of research only, the term began to be used also in everyday
14 to 17 50 16.0%
situations, such as gender inequality, social exclusion of
Total 313 100% groups, in relation to the elderly, and more.13, 24-26
The phenomenon of violence has also become of in-
The time elapsed between the incident of sexual vio- terest in bioethics, not only because it involves the brea-
lence and the medical examination was less than 24 hours king of the victims’ autonomy and human rights viola-
in 8.6% of the cases, one day in 9.6%, two days in 3.5% of tion, but also because these victims have often already
the cases, three days in 5.8%, 4 to 29 days in 11.7%, 30 to suffered social vulnerability.4 Moreover, from the pers-
60 days in 5.1%, over 60 days to a year in 10.9% of the ca- pective of distributive justice, there is an interaction with
ses, and 5 years in 0.6% of the cases. This time interval public health: sexual violence being seen as a public health
was not described in 44.2% of reports. problem, the interest in the topic by both fields of knowled-
In most cases (86.3%), there was a link between vic- ge is justified.26.27
tims and defendants, and most often the defendant was In the present study, the majority of victims of sexual
a family acquaintance or friend (42.3%), followed by the violence were children and adolescent females, which is
stepfather (16.6%) and father (10.9%). Other relation- consistent with results from several Brazilian investiga-
ships observed less frequently were: cousin (2.6%); uncle tions.2,9,28 For Ribeiro et al, this can be related to the do-
(2.6%); grandmother’s or aunt’s partner (2.2%); brother, mination and exploitation of the female gender.3.4
godfather and neighbor, each of them with a frequency Regarding age, in this study, the majority of the vic-
of 1%; superior, sister’s father in law, and mother’s ex-hus- tims were between 12 and 14 years, followed by children
band, each with a frequency of 0.3%. In 20 cases (6.4%) the- 9-11 years old, similar to the findings of Ribeiro et al.3
re was no information in this regard. These results differ from studies of other authors, who
As for body injuries presented by victims outside the have found that the most affected age range was that of
genital region, 49.5% did not have any evidence, in 47.3% 5 to 10 year-old children.3.8,12
In terms of the location where the incidents occur- hours) in female victims with previously ruptured hymen,
red, some authors found that, in most cases, they occur or even complacent hymen.
in the victim’s home. For these authors, the home envi- In addition to the genital lesions, sexual violence can
ronment makes abuse easier because it keeps the victims be accompanied by non-genital lesions, which was des-
away from prying eyes.3 De Lonrenzi et al found the fa- cribed in 10% of the reports analyzed in this study. Such
ther as the main responsible for the sexual aggressions.28 findings demonstrate another of the consequences of se-
Uncles and brothers were also cited as responsible, after xual abuse, in addition to the moral and psychological
the stepfather and father, by Ribeiro et al.3 Habigzang et damage, and the risks inherent to situations.7 The pre-
al, analyzing legal cases that occurred between 1992 and sence of non-genital lesions may help to characterize the
1998 in Rio Grande do Sul, found that those responsible use of physical force and coercion in sexual crimes, espe-
for sexual abuse were usually relatives or people who had cially for victims over 14 years of age, when the consen-
a relationship of trust with the victim’s family.11 The pre- sual relationship does not constitute a crime.3
sent study also found that individuals accused of these
crimes had, in most cases, some degree of relationship Conclusion
with the victims, being the father and stepfather link the This work has the intention to help fill a gap resulting
most frequent. This suggests that criminals use the pro- from the lack of research on sexual violence in Brazil. Its
tection provided by private setting, the possible trust of limitations are related to being a retrospective study, with
the victims and their families, and his/her power over data collected indirectly and not from the victim him/
them29, which characterizes, in the opinion of the resear- herself. This prevented relevant data, that could be lin-
chers, qualified vulnerability. ked to the phenomenon of violence, such as the socioe-
Considering the time elapsed between sexual crime conomic conditions of the victim and the perpetrator, is
and medical expertise, intervals over 72 hours were fre- to be left out of the records. Additionally, the reports were
quently observed, which allows evidence to be lost, ma- incomplete, and because of this, the conclusion of the fo-
king the forensic examination more difficult.30 This may rensic examination was often deducted by the researchers
reflect what some studies present about allegations of se- based on the medical descriptions.
xual abuse involving children and adolescents: in most ca- Similarly to what has been described by several au-
ses, the complaints are not made due to feelings of guilt, thors, the main victims of sexual violence in this study
fear of threats, shame and the victim’s tolerance. In addi- were female children and adolescents with some form of
tion, other factors contribute to this situation, such as the emotional or parental relationship with the offender,
reluctance of some doctors to recognize and report abu- which increases their vulnerability.
se, the insistence of courts on strict rules of evidence, and Sexual abuse against children and adolescents is a
fear of family breakdown when the incident is revealed.31 reality in Brazil and in the state of Paraíba, constituting
In sexual offenses, the use of physical force can deter- a public health problem that deserves to be studied con-
mine genital lesions evidenced by forensic medical exami- sistently, so that different players can contribute to the
nation.7 The expert examination allows the victim to be as- prevention and coping strategies of this problem.
sessed through analysis of body, clothes or biological The authors take responsibility for the entire content
samples such as blood or sperm. However, in many cases, of the article. They point out author Luciana C. Trinda-
as occurred in 65% of reports of this research, no evidence de as responsible for the research, and declare no conflict
is found, which does not deny the sexual abuse, but makes of interest, stating that the work was approved definiti-
it more difficult for the authorities to manage the case.29 vely by the Research Ethics Committee of the FAMENE
Still analyzing the forensic examinations, the resear- on 06.06.2012.
chers found inconclusive results in approximately 10% of
the reports, and lack of violence in approximately 65% of Summary
them. These results may be a consequence of the long Violência sexual infantil e vulnerabilidade.
length of time between the violence suffered by the vic- Objetivo: analisar o perfil demográfico e epidemiológi-
tim and the medical examination, or the fact that the cri- co das crianças e dos adolescents vítimas de violência se-
me does not leave evidences, such as the various forms of xual atendidos em uma Unidade de Medicina Legal e o
libidinous acts (fondling, introduction of fingers without vínculo entre as vítimas e os autores.
damaging natural orifices, oral sex, genital manipulation, Métodos: estudo descritivo, com coleta de dados a par-
among others), and the situation of former rape (over 72 tir das informações dos laudos sexológicos, realizados no