Sexual abuse of children is estimated to have a prevalence of 8-31% worldwide with slightly higher rates reported in girls than in boys. It is also thought that these estimates are much higher since the majority of abuse never is reported. Over two thirds are relatives or close family members. Other common perpetrators are often authority figures such as teachers or religious leaders. Certainly, any sexual contact can result in HPV exposure and infection including fondling. Forceful attempts at vaginal or anal intercourse can result in tears and exposure of the basal epithelium where HPV infections occur.
Literature was reviewed.
The risk of acquisition may be heightened since the prepubertal and peripubertal vaginal and cervical epithelium is thin and unprotected with easy access to the basal epithelium. There is data to suggest that sexually abused persons are at high risk of anogenital cancers. Risk of cancer by age of sexual exposure is not known. However, it is plausible that the younger that a child is infected, the longer they may experience HPV persistence, a strong risk for anogenital cancers. In addition to potential HPV exposure, high risk behavior may also play a role.
Persons who have experienced childhood sexual abuse often display high risk sexual behaviors including young age at voluntary sexual activity, a high number of sexual partners, and frequent unprotected sex. Persons with history of abuse are at risk for homelessness and substance abuse leading to exchanging sex for food, shelter or money. Alcohol and drug use are also increased in this population which is associated with poor judgement when having sex while intoxicated.
The US Center for Disease control suggest that children with a history of sexual abuse should be vaccinated as early as 9 years of age before the likelihood of engaging in high risk behaviors. Some have suggested that in addition to sexually transmitted infection screening and prophylactic treatment, the HPV vaccine should be offered. There is no data to guide at which age this is appropriate. Expert opinion also suggest that this population should be screened for cervical cancer earlier than 21 years of age---such as 18 years. However, the risk vs benefit of this is not known specifically that the pelvic examination itself as well as the “worry” of cancer may elicit significant psychologic distress.