Childhood sexual abuse (CSA) is any act that involves the child in any activity for the sexual gratification of another person, whether it is claimed that the child either consented or assented. It involves forcing or enticing a child to take part in sexual activities, whether or not the child is aware of what is happening.
Child sexual exploitation is a form of child sexual abuse. It is where a person takes advantage of their position of power to force or entice a child into sexual activity in return for the child (or someone else) receiving something in return.
Here you can find information on the link between CSA and health inequalities as well as actions that can be taken to address this.
- 18% of women and almost 8% of men have experienced sexual abuse before the age of 18.
- 37% of police recorded sexual crimes in Scotland, 2021-22, related to a victim under the age of 18.
- Over 90% of sexually abused children were abused by someone known to them.
- Girls aged between 15 and 17 are at the highest risk of sexual abuse.
CSA and health inequalities
CSA crosses all boundaries of class, sex, ethnicity, religion and disability. Studies show that girls are more likely to be abused than boys, but a significant percentage of boys experience CSA. For many boys, this has occurred in institutions such as churches, care homes, sporting organisations, clubs and in youth groups.
There are two groups who are particularly vulnerable to child sexual exploitation
- looked after children and teenagers, especially those in care
- young people who have already been sexually abused.
People with a history of CSA are at greater risk of medically unexplained symptoms, especially for chronic pain and gastrointestinal disorders. It is also associated with mental health problems, including:
- post-traumatic stress symptoms
- borderline personality disorder
- suicide/attempted suicide
- anxiety disorders.
CSA can also result in higher rates of health risk behaviours such as:
- drug use
- risky sexual behaviour.
We have created guidance that explains the nature of CSA, its impact on health and how staff can identify and respond to adult survivors of abuse and exploitation. The Scottish Government has also produced Child sexual exploitation: a guide for health practitioners.
Adverse Childhood Experiences (ACEs)
Sexual abuse is recognised as one of the ACEs which are associated with a range of poorer health and social outcomes in adulthood. The Scottish Government has put a programme of actions in place to tackle ACEs which is being supported by us.
The national action plan to prevent and tackle child sexual exploitation includes four outcomes.
- The risk that children and young people are exploited is reduced through a focus on prevention and early identification.
- Children and young people at risk of or experiencing sexual exploitation and their families receive appropriate and high quality support.
- Perpetrators are stopped, brought to justice and are less likely to re-offend.
- Cultural and social barriers to preventing and tackling CSE are reduced.
NHSScotland has a programme of routine enquiry for CSA in the following services:
- mental health
- sexual and reproductive health.
Yes You Can!
'Yes You Can!' emphasises the importance of being a human being rather than a great expert. Understanding trauma, particularly complex trauma, will help you provide a sensitive and appropriate response. You should be prepared to work with other agencies to help increase safety and ensure that a survivor receives the best help possible.
If you have concerns over any child, follow your local child protection procedures and be familiar with the national guidance for child protection in Scotland.
Never too late to tell
NHS Lanarkshire produced ‘Never too late to tell: Understanding childhood sexual abuse’. It's an animation for professionals working with a service user where CSA is a feature.
Each local NHS Board has an Executive Lead and Operational Lead for GBV. You can contact your local lead for information on local policies, training opportunities and support for staff.
Support services for the public
Members of the public can be directed towards Scotland's Service Directory on NHS inform which provides information on