联合国大会于 2006 年发布的大规模调查研究结果表明:在 2002 年全球范围内,在 18 岁以下青少年和儿童中,大约有 1.5 亿女孩和 7300 万男孩曾被迫性交或者遭受其他形式的性暴力。[2]United Nations General Assembly, 61st session. Report of the independent expert for the United Nations study on violence against children. 2006: A/61/299.http://www.childcentre.info/projects/protection/dbaFile13486.pdf此研究还引用数据表明:有 7% 至 36% 的女性和 3% 至 29% 的男性报告说他们在童年期间曾经成为性侵犯的受害者。
据针对美国童年性侵犯流行率的国家监测数据估计,大约有 4% 的儿童受到侵犯,但是这些数据组只限于报告案例,因此可能会低估此问题的严重程度。[3]Hussey JM, Chang JJ, Kotch JB. Child maltreatment in the United States: prevalence, risk factors, and adolescent health consequences. Pediatrics. 2006;118:933-942.http://www.ncbi.nlm.nih.gov/pubmed/16950983?tool=bestpractice.com对美国 0 至 17 岁儿童的总体人群调查表明,从 2011 年到 2014 年,性侵犯总数下降 1%。[4]Finkelhor D, Turner HA, Shattuck A, et al. Prevalence of childhood exposure to violence, crime, and abuse: results from the National Survey of Children's Exposure to Violence. JAMA Pediatr. 2015;169:746-754.http://www.ncbi.nlm.nih.gov/pubmed/26121291?tool=bestpractice.com在英国,英国全国防止虐待儿童学会 (NSPCC) 曾进行过一项研究,发现 16 岁以下的儿童中,有 16% 曾遭受过某种形式的性虐待。[5]Cawson P, Wattam C, Brooker S, et al. Child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. London, UK: NSPCC; 2000.http://www.nspcc.org.uk/Inform/research/Findings/childmaltreatmentintheunitedkingdom_wda48252.html有些学者争论,在 20 世纪,美国儿童性虐待的报告比率升高,然后下降,这是代表着真实趋势还是报告实践的变化。[6]Finkelhor D, Dziuba-Leatherman J. Children as victims of violence: a national survey. Pediatrics. 1994;94:413-420.http://www.ncbi.nlm.nih.gov/pubmed/7936846?tool=bestpractice.com[7]Feldman W, Feldman E, Goodman JT, et al. Is childhood sexual abuse really increasing in prevalence? An analysis of the evidence. Pediatrics. 1991;88:29-33.http://www.ncbi.nlm.nih.gov/pubmed/2057270?tool=bestpractice.com[8]Finkelhor D. Improving research, policy, and practice to understand child sexual abuse. JAMA. 1998;280:1864-1865.http://www.ncbi.nlm.nih.gov/pubmed/9846783?tool=bestpractice.com对童年性虐待的流行率进行精确估计时,会遇到许多问题,因为对虐待的定义各不相同,不仅是研究者和政策制定者,受害者也是如此。另外,此话题性质敏感,也非常容易影响官方的报告以及调查时被调查者的反应率。
在对儿童实施性虐待的犯罪者中,大多数人都认识受害者。[2]United Nations General Assembly, 61st session. Report of the independent expert for the United Nations study on violence against children. 2006: A/61/299.http://www.childcentre.info/projects/protection/dbaFile13486.pdf女孩成为性侵犯受害者的风险是男孩的 1.5 至 3 倍。[2]United Nations General Assembly, 61st session. Report of the independent expert for the United Nations study on violence against children. 2006: A/61/299.http://www.childcentre.info/projects/protection/dbaFile13486.pdf儿童虐待的其他形式(例如:忽视、精神虐待以及身体虐待等)与社会压力因素(例如贫困、缺少社区服务等)之间存在一定关联,但儿童性虐待可发生于社会的各个阶层。[9]Hay T, Jones L. Societal interventions to prevent child abuse and neglect. Child Welfare. 1994;73:379-403.http://www.ncbi.nlm.nih.gov/pubmed/7924560?tool=bestpractice.com[10]Leventhal JM. Have there been changes in the epidemiology of sexual abuse of children during the 20th century? Pediatrics. 1988;82:766-773.http://www.ncbi.nlm.nih.gov/pubmed/3186358?tool=bestpractice.com性虐待受害者在其一生中可能会被诊断为:焦虑障碍、抑郁、进食障碍、创伤后应激障碍、睡眠障碍以及自杀企图。[11]Chen LP, Murad MH, Paras ML, et al. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010;85:618-629.http://www.ncbi.nlm.nih.gov/pubmed/20458101?tool=bestpractice.com
性暴力是一个全球性问题。对女性而言,其一生中经历强奸未遂或者被强奸的风险高达 20%,但是男性也经常受到性虐待。尽管任何人(包括老年人)都可能成为受害者,但是以下人群尤其脆弱:青少年和年轻女性、存在学习障碍和其他形式障碍的人群、贫穷和无家可归的人、性工作者以及生活在社会收容机构或者冲突区域的人群。在性侵犯案例中,一人或者多人饮酒的情况,比秘密施用其他药物更加普遍,[12]Connor J, You R, Casswell S. Alcohol-related harm to others: a survey of physical and sexual assault in New Zealand. N Z Med J. 2009;122:10-20.http://www.ncbi.nlm.nih.gov/pubmed/19851416?tool=bestpractice.com[13]Littleton H, Grills-Taquechel A, Axsom D. Impaired and incapacitated rape victims: assault characteristics and post-assault experiences. Violence Vict. 2009;24:439-457.http://www.ncbi.nlm.nih.gov/pubmed/19694350?tool=bestpractice.com但如今对后者的报告更频繁。[14]Marc B. Current clinical aspects of drug-facilitated sexual assaults in sexually abused victims examined in a forensic emergency unit. Ther Drug Monit. 2008;30:218-224.http://www.ncbi.nlm.nih.gov/pubmed/18367984?tool=bestpractice.com大多数的犯罪者与其受害者认识。虽然有些受害者向主管当局报告强奸,但其他人并没有披露性侵犯,仅仅是在事件之后就医。性暴力可能的后遗症包括:非意愿妊娠、包括 HIV 在内的性传播感染、慢性盆腔疼痛、性功能障碍、抑郁以及创伤后应激障碍。[15]Jina R, Jewkes R, Munjanja SP, et al; FIGO Working Group. Report of the FIGO Working Group on Sexual Violence/HIV: guidelines for the management of female survivors of sexual assault. Int J Gynaecol Obstet. 2010;109:85-92.http://www.ncbi.nlm.nih.gov/pubmed/20206349?tool=bestpractice.com[16]World Health Organization. Clinical management of rape survivors: developing protocols for use with refugees and internally displaced persons. 2004. http://www.who.int (last accessed 18 September 2016).http://whqlibdoc.who.int/publications/2004/924159263X.pdf