ABSTRACT
Until recently, there was much disagreement as to what should be included in the definition of CSA [1]. In some definitions, only contact abuse was included, such as penetration, fondling, kissing, and touching [2]. Noncontact sexual abuse, such as exhibitionism and voyeurism, were not always considered abusive. Nowadays, the field is evolving towards a more inclusive understanding of CSA that is broadly defined as any sexual activity perpetrated against a minor by threat, force, intimidation, or manipulation. The array of sexual activities thus includes fondling, inviting a child to touch or be touched sexually, intercourse, rape, incest, sodomy, exhibitionism, involving a child in prostitution or pornography, or online child luring by cyberpredators [3,4]. CSA experiences vary greatly over multiple dimensions including, but not limited to: duration, frequency, intrusiveness of acts perpetrated, and relationship with perpetrator. Although sexual activity between children has long been thought to be harmless, child on child CSA experiences, such as those involving siblings, is increasingly being recognized as detrimental for the emotional well-being of children as adult on child CSA [5-7]. While adult-to-child interactions in which the purpose is sexual gratification are considered abusive, sexual behaviours between children are less clear-cut as there is no universal definition of sexual abuse that differentiates it from normal sex play and exploration [8]. Although a 2to 5-year age difference between children was first suggested as necessary to consider sexual behaviours between siblings to be incest [9], this criterion is being questioned as studies have shown this age difference to be much lower in many substantiated cases of child-to-child abuse [10]. This formulation of CSA is in keeping with the recommendations from the 1999 World Health Organization Consultation on Child Abuse
Prevention, where CSA is defined as any activity of a sexual nature ‘between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person’. That said, some definitional issues have not yet been resolved in the field. First, much disparity exists regarding age for sexual consent, or age for sexual maturity, which has an influence on the extent to which statutory sex offenses are considered CSA. Sexual activities that involve a person below a statutorily designated age fall under the large umbrella of CSA; however, the age of consent varies greatly across countries, from as young as 12 or 13 (e.g. Tonga, Spain) to 17 or 18 years of age (e.g. some states in the US, Australia). In virtually all European jurisdictions, sexual relations are legal from age 16 onwards, but some countries have set the age for sexual consent at 14 or 15 [11]. In other words, when no coercion or force is used, cases that involve sexual activities between an adult and, for example, a 14-year-old teenager, will be either perceived as a consensual sexual relationship or criminalized and defined as sexual abuse, depending on the legal statutorily designated age of the country where the event occurred. In Canada, a bill was recently adopted to change the age of consent from 14 to 16, a premiere in Canada’s history, which emphasizes the impact governmental decisions can have on definitional issues of CSA in societies over time [12]. Second, although coerced sexual activities that occur in dating or romantic relationships is recognized as a form of sexual violence by the World Health Association (see for example a WHO multicountry study from Garcia-Moreno and colleagues [13]), the extent to which this form of interpersonal violence is socially recognized and acknowledged in different legislations around the world is unclear.
