title: [Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms].
abstract: OBJECTIVE
  To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions.
  
  
  METHODS
  Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience.
  
  
  RESULTS
  A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry.
  
  
  CONCLUSIONS
  Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.
authors.affiliation: Service d'urologie, université de Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, 40, rue Worth, 92150 Suresnes, France. f.cour@hopital-foch.org
authors.forename: F
authors.initials: F
authors.lastname: Cour
authors.forename: G
authors.initials: G
authors.lastname: Robain
authors.forename: B
authors.initials: B
authors.lastname: Claudon
authors.forename: E
authors.initials: E
authors.lastname: Chartier-Kästler
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008297:Male; D012007:Rectum / Q000293:injuries; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology; D055815:Young Adult
keywords: Abus sexuel; Anisme; Anismus; Childhood; Douleurs pelviennes; Dysfonction sexuelle; Enfance; Intestin irritable; Irritable bowel; Lower urinary tract symptoms; Pelvic pain; Sexual abuse; Sexual dysfunction; Symptômes du bas appareil urinaire