Proyecto de investigación aprobado por el Comité de Ética e Investigación de la Universidade de São Paulo, registrado en el SISNEP con el número 89341118.0.0000.0065.
INTERPRETATION OF MEDICAL FINDINGS IN SUSPECTED CASES OF SEXUAL ABUSE OF MINORS: ANALYSIS OF 13,870 REPORTS
Luan Salguero de Aguiar (1)
Currículo Lattes: http://lattes.cnpq.br/4780070112183042 – ID ORCID: 0000-0002-2676-8494
Beatriz Fernandes Diogo Alves (1)
Currículo Lattes: http://lattes.cnpq.br/7042033002204164 – ID ORCID: 0000-0003-0772-0978
Carmen Silvia Molleis Galego Miziara (1)
Currículo Lattes: http://lattes.cnpq.br/6916238042273197 – ID ORCID: 0000-0002-4266-0117
Ivan Dieb Miziara (2)
Currículo Lattes: http://lattes.cnpq.br/3120760745952876 – ID ORCID: 0000-0001-7180-8873
(1) Faculdade de Medicina do ABC, Santo André – SP, Brasil. (autor principal)
(2)Universidade De São Paulo, São Paulo – SP, Brasil. (autor principal)
email: luan.salguero@gmail.com
RESUMEN
La violencia sexual es una violación a la dignidad humana con graves consecuencias inmediatas y tardías. No hay límites geográficos, pero tiene mayor prevalencia en países de bajos ingresos. Ambos géneros se ven afectados, aunque predomina el femenino. En general, los menores de 18 años forman el grupo de mayor riesgo. Este estudio tuvo como objetivo enseñar los resultados de los exámenes sexológicos sobre la confirmación de la violencia sexual en niños y adolescentes, con base en los informes medico legales realizados en los Institutos Médicos Legales del Estado de São Paulo, en 2017. Los datos fueron obtenidos a partir de informes de exámenes sexológicos realizados en los Institutos Médico Legales del estado de São Paulo, Brasil. Se analizaron un total de 13.870 informes, de los cuales 10.480 eran del género femenino (edad media: 13 años) y 3.390 del masculino (edad media: 8 años). Considerando edades hasta los 18 años, se analizaron 8.443 informes de personas del género femenino, con mayor incidencia entre los 12 y 13 años, y 2.387 del género masculino, con mayor pico de incidencia entre los 3 y 6 años. La observación de la violencia sexual fue posible sólo en un pequeño grupo. Los datos de este estudio muestran que los niños menores de 12 años son las víctimas más vulnerables de violencia sexual, especialmente las niñas. A pesar del alta incidencia de presuntos abusos sexuales, los resultados de los exámenes medico legales fueron bastante limitados en registrar elementos comprobatorios, hecho que también ha sido descrito en la literatura médica.
Palabras clave: abuso sexual, violación, medicina legal, sexología, violencia sexual.
Referencias bibliográficas
- Roche AJ, Fortín G, Labbé J, Brown J, Chadwick D. The work of Ambroise Tardieu: The first definitive description of child abuse. Child Abuse Negl 2005;29 (4):325-34. doi: https://doi.org/10.1016/j.chiabu.2004.04.007
- OPAS/OMS apresenta estratégia para acabar com violência contra crianças e adolescentes. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5499:opas-oms-apresenta-estrategia-para-acabar-com-violencia-contra-criancas-e-adolescentes&Itemid=820.
- World Health Organization & Pan American Health Organization. (2012). Understanding and addressing violence against women: intimate partner violence. World Health Organization. https://apps.who.int/iris/handle/10665/77432 .
- Lei n°. 12.015, de 7 de agosto de 2009. http://www.planalto.gov.br/ccivil_03/_Ato2007-2010/2009/Lei/L12015.htm,
Brasil. Supremo Tribunal de Justiça. Súmula 593. Diário da Justiça Eletrônico do STJ, 6 nov. 2017. - França GV. Medicina Legal. Nona edição. Guanabara Koogan. 2011. p.265
- Miziara ID, Manual Prático de Medicina Legal, São Paulo: Atheneu, 2014, p.124
- Ezzati M, Lopez AD, Rodgers A, Murray CJL. Comparative Quantification of Health Risks: Global and regional burden of disease attributable to selected major risk factors.
- Genebra, O.M.S. 2:1851–1940. 2004. https://apps.who.int/iris/handle/10665/42770];
- Geneva: World Health organization; [internet]. Child maltreatment. updated 2014. Available from: http://www.who.int/topics/child_abuse/en/
- Pereda N, Guilera G, Forns M, Gómez-Benito J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clinical Psychology Review 2009;29 (4):328-338. https://doi.org/10.1016/j.cpr.2009.02.007.
- Wihbey J. Global prevalence of child sexual abuse. Journalist Resource. [cited 2020 Feb 20]. Available from: https://journalistsresource.org/studies/government/criminal-justice/global-prevalence-child-sexual-abuse/
- Hillis S, Mercy J, Amobi A, Kress H. Global Prevalence of Past-year Violence Against Children: A Systematic Review and Minimum Estimates. Pediatrics March 2016, 137 (3) e20154079. doi: https://doi.org/10.1542/peds.2015-4079.
- Atlas da Violência 2018 Ipea e FBSP. Disponível em: https://www.ipea.gov.br/portal/images/stories/PDFs/relatorio_institucional/180604_atlas_da_violencia_2018.pdf.
- Sexual and reproductive health. Responding to children and adolescents who have been sexually abused. Disponível em: https://www.who.int/reproductivehealth/topics/violence/clinical-response-csa/en/
- Suttipasit P. Forensic spermatozoa detection. Am J Forensic Med Pathol 2019;40: 304–311. doi 10.1097/PAF.0000000000000517.
- Kellog N. The evaluation of sexual abuse in children. Pediatrics 2005;116:506-12. 2005. https://doi.org/10.1542/peds.2005-1336].
- Lei nº. 8069, de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Brasília. DOU 3 de julho de 1990. Disponível em: http://www.planalto.gov.br/ccivil_03/leis/l8069.htm).
- Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. World report on violence and health, Genebra: OMS; 2002.
- Banyard VL, Cross C, Modecki KL. Interpersonal Violence in Adolescence: Ecological Correlates of Self-Reported Perpetration. J. Interpers Violence. 2006; 21: 1314.
- Howard DE, Wang MQ, Yan F. Prevalence and psychosocial correlates of forced sexual intercourse among U.S. high school adolescents. Adolescenc.2007; 42(168).
- Sears HA, Byers ES, Price EL. The co-occurrence of adolescent boys’ and girls’ use of psychologically, physically, and sexually abusive behaviours in their dating relationships. Journal of Adolescence. 2007; 30: 487-504
- Caridade S, Machado C. Violência sexual no namoro: relevância da prevençao. Psicologia. 2008; XXII (1): 77-104.
- Martins CBG, Mello-Jorge MHP. Abuso sexual na infância e adolescência: perfil das vítimas e agressores em município do sul do brasil. Texto Contexto Enferm, Florianópolis. 19(2): 246-55. 2010
- Minayo MCS, Assis SG, Njaine K. Amor e Violência: Um paradoxo das relaçoes de namoro e do ‘ficar’ entre jovens brasileiros. Rio de Janeiro: Editora Fiocruz; 2011.
- Santos MJ, Mascarenhas MDM, Rodrigues MTP, Monteiro RA. Caracterization of sexual violence against children and adolescente in school-Brazil 2010-2014. Epidemiol Serv Saude 2018;27(2):e201759. doi 10.5123/S1796.
- Platt VB, Back IC, Hauschild DB, Guedert JM. Sexual violence against children: authors, victims and consequences. Ciência & Saúde Coletiva 2018;23(4):1019-1031. DOI:
- Magalhães T, Ribeiro C. A colheita de informação a vítimas de crimes sexuais. Acta Med Port 2007;20:439-445
- Du Mont J, White D. Barriers to the Effective Use of MedicoLegal Findings in Sexual Assault Cases Worldwide. Qualitative Health Research 23(9) 1228–1239 doi: 10.1177/1049732313502396.
- Smith TD, Raman SR , Madigan S , Waldman J , Shouldice M .Anogenital Findings in 3569 Pediatric Examinations for Sexual Abuse/Assault. J Pediatr Adolesc Gynecol.2 018;31(2):79-83. doi: 10.1016/j.jpag.2017.10.006.
- London, K., Bruck, M., Wright, D., & Ceci, S. (2008). Review of the contemporary literature on how children report sexual abuse to others: Findings, methodological issues, and implications for forensic interviewers. Memory, 16, 29–47. doi:10.1080/ 0965821070701725732.
- Smith DW, Leturneau EJ, Saunders BE, Kilpatrick DG, Resnick HS, Best C. L. Delay in disclosure of childhood rape: Results from a national survey. Child Abuse Neglect 2000;24:273–287. doi:10.1016/s0145-2134(99)001130-1
- Münzer A, Fegert JM, Ganser HG, Loos S, Witt A, Goldbeck L. Please Tell! Barriers to Disclosing Sexual Victimization and Subsequent Social Support Perceived by Children and Adolescents. Journal of Interpersonal Violence 2014: 1–23 DOI: 10.1177/0886260514555371.
- Priebe, G., & Svedin, C. G. (2008). Child sexual abuse is largely hidden from the adult society: An epidemiological study of adolescents’ disclosures. Child Abuse & Neglect, 32, 1095-1108
- Mishori R, Ferdowsian H , Naimer K , Volpellier M , McHale TThe little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault. Reprod Health. 2019;16(1):74. doi: 10.1186/s12978-019-0731-8. Disponível em https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547601/pdf/12978_2019_Article_731.pdf
- Adams JA, Kaplan RA, Starling SP, Mehta NH, Finkel MA, Botash AS, Kellogg ND, Shapiro RA. Guidelines for medical care of children who may have been sexually abused. J Pediatr Adolesc Gynecol (2007) 20:163e172.
- Johnson D, Peterson J, Sommers I, Baskin D. Use of Forensic Science in Investigating Crimes of Sexual Violence: Contrasting Its Theoretical Potential With Empirical Realities. Violence Against Women 2012;18(2) 193–222 DOI: 10.1177/1077801212440157.
- Magalhães T, Dinis-Oliveira RJ, Silva B, Corte-Real F, Vieira DN.[internet]. Biological evidence management for DNA analysis in cases of sexual assault. The Scientific World Journal 2015. doi: http://dx.doi.org/10.1155/2015/365674. Available from: https://www.researchgate.net/publication/284096055
- Almeida Junior A. Sexologia Forense. In: Lições de Medicina Legal. Rio de Janeiro. Editora Nacional de Direito. 1956. p. 339).