The NYTimes and the European press are on a witch-hunt against the Pope, and using 30 year old episodes of sexual abuse as the excuse to hint that the Pope should resign (and in his place, put a more politically correct person who will approve of the religion of modern promiscuity, abortion, and euthanasia).

Yes, I get upset at reading that there have been 10 thousand cases of sexual abuse accusations against the Catholic church over the last fifty years, or that 400 or so claims were made against church workers in Ireland over the last 85 years.

But as a physician, could I point out that this number, albeit terrible, is actually a tiny percentage of victims, as compared with the millions who have been or are being exploited by sexual predators in the world?

Most of my experience has been with girls (as the only woman doc in the days when only 10 percent of doctors were women, one tended to get called in for these cases). But like any other “epidemic”, it has a spectrum, from being “mooned” to serial traumatic rape. But there are statistics out there.

How common is sexual abuse? From Medscape:

In 2005, 83,850 children in the United States  reported to Child Protective Services, were determined to be suspected victims of child sexual abuse. The actual number is likely to be higher because these numbers reflect only children whose cases are investigated by Child Protective Services.2

About half of the girls I examined had no abuse, one quarter had minor trauma (i.e. touching) and the rest were abuse cases. Half of these cases went to trial; the others lacked physical evidence, and were not prosecuted, not to protect the predator, but to protect the victim.

The dirty little secret of the American justice system is that the trial was often more traumatic for the victim than the abuse itself. (Often the abuser claimed innocence, and the girl would have to go through repeated interrogations by aggressive defense lawyers; often we would plea bargain if we had physical evidence to spare the girl. In one case, we were happy when we caught the perpetrator in a lie and he pled guilty).

But not all cases were seen at the time of abuse. A lot of women revealed to me they had been abused as a child or teenager years earlier, but often the abuse was by family members so not reported at all (when reported, often the victim was accused of lying). Many of these women were depressed or had a history of substance abuse or promiscuity/multiple partners.

So how common is the problem?

From a European study in the BMJ:

  • The prevalence of sexual abuse involving physical contact was 20.4% among girls and 3.3% among boys; the prevalence of abuse involving some form of penetration was 5.6% among girls and 1.1% among boys
  • Half of the children reporting sexual abuse experienced the first event before the age of 12; in one third of cases the abuser was an adolescent

Another European study, from Sweden:

Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded.

Well, how about in the US? From a JAMA survey of the literature:

We identified 166 studies representing 149 sexual abuse samples. Studies were methodologically limited and definitions of sexual abuse varied widely. Prevalence estimates varied widely (by definition used and population studied), ranging from 4% to 76%. Boys at highest risk were younger than 13 years, nonwhite, of low socioeconomic status, and not living with their fathers. Perpetrators tended to be known but unrelated males. Abuse frequently occurred outside the home, involved penetration, and occurred more than once. 

Yet if you include age or coercion, the numbers might be higher:

In a study of male college students, Fromuth and Burkhart53 found that the prevalence estimates of childhood sexual abuse were directly related to the definition of abuse. Prevalence was 22% when either a graded age differential or coercion was required, 14% when only the former was required, and 10% when both were required. Prevalence fell further to 8% when physical contact was required

Since only ten percent of males are gay or bisexual, this suggests that the gay community needs to do it’s own soul searching to root out the sexual predators in their midst: I suspect a lot of “homophobia” is a result of the abuse, but again, there is no hard data on this.

Another problem: Either abuse is now epidemic, or now there are more reports (I suspect both) Image from Pediatrics

And if lack of reporting in the past was the problem, it continues to be a problem in less sophisticated countries in Asia and Africa.

The reason is cultural:

UNICEF notes that sexual activity is often seen as a private matter, making communities reluctant to act and intervene in cases of sexual exploitation.

And in some of these countries, thousands of children are routinely exploited to serve the sexual needs of pedophiles, many of whom travel to these countries as “sexual tourists”. Yet this doesn’t include the casual abuse of street children or poor children exploited by family members or acquaintances.

From the ILO via Wikipedia:

While it is impossible to know the true extent of the problem, given its illegal nature, International Labour Organization (ILO) global child labour figures for the year 2003 estimate that there are as many as 1.8 million children exploited in prostitution or pornography worldwide. [4]

So the dirty little secret is that the sexual revolution, the internet, cheap travel, and globalization has resulted in “one of the fastest growing criminal activities in the world.”

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Nancy Reyes is a retired physician living in the rural Philippines. She writes on Human Rights at Makaipa blog.

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bitionism was excluded.

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