[« What is changing today is a greater ability to talk about it ¼]. / « Ce qui change aujourd'hui, c'est une plus grande faculté à en parler ¼.

Victims' associations, social networks and the publication of books have accelerated political and societal awareness of a subject that is still very taboo: incest. In this context, the Independent Commission on Incest and Sexual Violence against Children (Ciivise), created in 2021, has the mission to make recommendations on the evolution of public policies for a better protection and care of child victims, and to collect the voice of victims, now adults. Nathalie Mathieu, co-president of the Ciivise and executive director of the association Docteurs Bru, draws up an inventory of the subject, as much on its legal aspect as on the stakes of society which result from it and on the place of nurses. Interview.

[Mechanisms at play in the perpetrators of incestuous acts]. / Les mécanismes en jeu chez les auteurs d'actes incestueux.

While the perpetrators of incestuous assaults are found in families from all social, cultural and professional categories, the vast majority of them have common characteristics. Linda Tromeleue, a psychologist and family therapist, works in the prison integration and probation service, particularly with incestuous paedocriminals who have been tried and sentenced. She describes their personality traits and the process established to carry out their transgressive acts, often for years.

[Psychopathological consequences of incestuous violence]. / Conséquences psychopathologiques des violences incestueuses.

The psychotraumatic consequences induced by exposure to incestuous violence result in a clinical picture that varies according to age and context, including protective factors. The younger the age, the greater the risk of developing complex psychotrauma. Numerous psychiatric and somatic comorbidities accompany the suffering in children and adults. These are all indicators that can be used for screening.

[Accompanying young girls who are victims of incest, a necessarily holistic approach]. / Accompagner les jeunes filles victimes d'inceste, une approche nécessairement holistique.

Accompanying child and adolescent victims of incest towards reconstruction requires professionals trained in the specificities of this intra-family sexual violence. The Jean-Bru shelter, which takes in young girl victims, has developed the expertise of a complementary multi-partner approach and offers socio-educational, medical-psychological and legal support, for the benefit of a personalized global project that also includes the family link.

[Disability, a factor of vulnerability to incest]. / Le handicap, un facteur de vulnérabilité face à l'inceste.

Disability, a factor of vulnerability to incestThere is a lack of visibility on the issue of sexual violence among people with disabilities. There is an omerta on this subject within the social and medico-social establishments that receive them. Intra-family sexual violence is kept silent, as it is everywhere else. The vulnerability of children with disabilities is a risk factor for rape and sexual assault, and communication problems hinder their disclosure. Interview with Marie Rabatel, President of the Francophone Association of Autistic Women, expert of the High Authority of Health on the issues of violence against women with disabilities, member of the Independent Commission on incest and sexual violence against children.

[Prospective forensic study on the characterization of genital examination in women with consented sexual activity]. / Étude médico-légale prospective sur la caractérisation de l'examen génital chez des femmes ayant une activité sexuelle consentie.

OBJECTIVE: The number of women victims of sexual assault remains high, despite prevention and information campaigns. These victims can be adolescent girls, women of childbearing age or postmenopausal women. As part of examinations of victims of sexual assault, the morpho-anatomical diversity of the female genitalia requires knowledge of the physiological variations existing by the practitioners caring for these victims. Our work aimed to describe and characterize the genital examination of women with consented sexual activity. METHOD: Our cohort consisted of 196 women aged 14 to 81, examined in the context of medical gynecology consultations in two French maternity hospitals. RESULTS: Recent genital traumatic injuries were found in 12.8% of women whose last sexual intercourse was less than 5days old. Intact hymens, free from traumatic tearing despite regular sexual activity, were present in 10.7% of these women. CONCLUSION: Thus, in many cases, genital examination alone cannot confirm or deny the existence of prior sexual intercourse, whether or not it was consented to. The development of work on data on female genital anatomy would make it possible to optimize the medico legal care of victims of sexual assault.

[French validation of the Acceptance of Modern Myths about Sexual Aggression scale (AMMSA) and experience of close relationships with students and perpetrators of domestic violence]. / Validation française de l'échelle de l'adhésion aux mythes modernes sur l'agression sexuelle (AMMSA) et attachement au partenaire auprès d'étudiants et d'auteurs de violence conjugale.

INTRODUCTION: Acceptance of the rape myths (ARM) refers to a set of attitudes, beliefs and stereotypes that tend to make women responsible for rapes or sexual assaults, and to rationalize, minimize or justify the behaviors of sexual offenders. ARM can also promote intimate partner violence (spousal rape). Domestic violence is generally associated with an insecure attachment style (avoidant or ambivalent) in both perpetrators and victims. The attachment insecurity of perpetrators of spousal violence can favor the use of violence against partners. The perpetrators also have a tendency to attribute the responsibility of their acts to their partners. Gerger, Kley, Bohner and Siebler (2007) developed the "Acceptance of Modern Myths about Sexual Aggression Scale" to measure the ARM in a more subtle way, in particular by reducing social desirability bias. The aim of this study is both to explore the psychometric qualities of the French version of the AMMSA and to study the relationships between the ARM, attachment styles and spousal violence in young adults and perpetrators of domestic violence (with the hypothesis that the latter have a greater ARM and a more insecure attachment style with the intimate partner). METHODS: Participants. The participants (n=275) were divided into two samples: sample 1 comprised 243 French psychology students and psychiatry residents, mean age 26.94years (±4.06years, range 19 to 38), with 79 % females (173 women and 50 men). The majority (69%) were in a relationship, and their level of study ranged from 13th grade to 19th grade; sample 2 comprised 32 men treated in a therapy center for perpetrators of spousal violence (in the "Centre-Val-de-Loire" region in France). They had a mean age of 40.84years (±11.06years, range 22 to 61). The majority (59%) was in a relationship and their level of study ranged from 5th grade to 18th grade (mean level=11). INSTRUMENTS: To measure the ARM Myths, we used the AMMSA, which is composed of 30 items structured into a single overarching factor. To assess the styles of attachment to the partner, we used the Experiences in Close Relationships (ECR) scale, which comprises 36 items structured in two dimensions: (i) attachment-related anxiety, and (ii) attachment-related avoidance in the couple. The tools were self-administered. Students completed the questionnaire via the Internet using the Sphinx software during an online survey. Clinical subjects completed the questionnaire in their therapy center. All participants were volunteers and gave their informed consent before anonymously completing the paper or online self-assessment questionnaire. RESULTS: We carried out a principal components factor analysis using Varimax rotation on the data obtained from the answers to the 30 items of the AMMSA of all respondents. The analysis identified a single factor with an eigenvalue of 9.04 and which explained more than 30% of the total variance. This factor saturated (>0.30) 29 of the 30 items of the AMMSA, and the Cronbach alpha (which assesses internal consistency) was 0.91. The comparison of AMMSA scores between the clinical group (men with a history of spousal abuse) and male and female students showed differences, while there were no significant gender differences in the non-clinical group. The mean level of insecurity of attachment to the partner was also higher for the men in the clinical group than those in the non-clinical group (students). Results found correlations between the ARM and ECR for attachment-related anxiety in the non-clinical group (both men and women), a weak and negative correlation between age and attachment-related anxiety, and a correlation between age and AMMSA only for women. DISCUSSION: The results concerning the qualities of the AMMSA are consistent with previous work. In addition, perpetrators of spousal violence have a stronger ARM. The links between (a) older age and a low level of education and (b) the ARM have already been highlighted. However, psychology students and psychiatry residents are probably more likely than others to develop pro-social, egalitarian, sensitive and tolerant attitudes, and therefore to be less in touch with rape myths. Both men and women have sexist representations and acceptance of the rape myths. The ARM is associated with common negative gender stereotypes, notably ambivalent sexism (with its two dimensions: hostile and benevolent sexism). This study has limitations linked both to the small clinical sample and the recruitment of non-clinical subjects from psychological and medical academic fields (with a specialty in psychiatry). Nonetheless, it is also one of the interests of this study to show that the ARM concerns everyone, including students, regardless of their academic or professional orientation. CONCLUSION: The AMMSA, which has been validated in different languages and in different contexts, has always shown good psychometric qualities. This French adaptation shows the same characteristics in terms of unifactorial structure, saturation of scale items and internal consistency. Further studies are needed to confirm external validity and test-retest reliability. It would also be desirable to conduct studies with larger and more representative samples. The AMMSA could be an excellent prevention tool by raising awareness of the continuing extent of negative gender stereotypes, violence against women and rape myths.

[Perpetrators of sexual violence against minors]. / Les auteurs de violences sexuelles sur mineurs.

Sexual violence against minors is diverse and is subject to different criminal qualifications. Health professionals, and clinicians in general, may get to know certain perpetrators in order to assess, guide and/or treat them. This can be complicated if these professionals are not aware of the reality of the situations mentioned. Good knowledge, caution and critical distance must accompany their assessments and clinical acts.

[Characteristics associated with depression and post-traumatic stress disorder among childhood sexual abuse women]. / Caractéristiques associées à la dépression et aux symptômes de stress post-traumatique chez les femmes victimes d'agression sexuelle durant l'enfance.

BACKGROUND: A significant proportion of childhood sexual abuse victims suffer from psychological sequelae in adulthood. Factors that provide a better understanding for the reasons why some victims develop these sequelae remain under-explored. In this context, the main objective is to examine the specific contribution of the contextual characteristics of childhood sexual abuse, multitype childhood maltreatment and adolescent suicide attempts on the development of depression and post-traumatic stress disorder in adulthood among sexually abused women as children. A secondary objective aimed to establish the prevalence of various forms of childhood maltreatment, adult onset post-traumatic stress disorder and depression among those women. METHODS: The sample included 479 women victims of childhood sexual abuse who participated in two separate surveys taken by women in the province of Quebec. RESULTS: More than half of these women reported at least one other form of childhood maltreatment, 30% of them presented post-traumatic disorder and 40% suffered from depression in adulthood. Regression analysis indicates that post-traumatic stress disorder was associated with early onset childhood sexual abuse and intergenerational continuity of sexual victimization, as well as childhood physical maltreatment and negligence. Depression was associated with childhood psychological maltreatment and negligence, a non-supportive response following child sexual abuse related disclosure and suicide attempt in adolescence. CONCLUSION: These results confirm the need to consider the cumulative effects of various childhood adversity factors in the psychosocial assessment of sexually abused women in early life, thus helping to better understand and treat their psychological sequelae.

[An assessment of the direct costs of healthcare for victims of sexual assaults in hospital emergency units]. / Évaluation des coûts directs de la prise en charge en urgence d'une victime de violences sexuelles.

BACKGROUND: The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care. Furthermore, this first assessment may serve as a basis for further reflection on creating other medical judicial units but also for reviewing existing structures. METHODS: The direct costs for medical care of a recent rape victim (<48hours) was quantified by including staff and consumables costs, treatments, biological tests and other expenses. RESULTS: The overall time for the entire medical care procedure was approximately three hours, for an overall cost of 673.92€, of which 41.5 % (279.90€) was paid by the Ministry of Justice. The medical, psychological and social aspects stood for the major expenditure items (394.02€), attributable mainly to the biological screening tests for sexually transmissible infections (STIs). CONCLUSION: These frequent situations require the convergence of human and material needs with a financial burden shared between the Ministry of Justice and health establishments. Authors suggest that in the annual hospital budgetary allocation allotted by the Ministry of Justice, the care of victims of sexual assault be based on the rate of day hospitalization "Medicine, medical specialties part time day or night common regime", allowing to provide optimal multidisciplinary care, which lessens the risks of complications and reduces the global cost created by these situations.

[The myth of virgin cleansing: Latest news on an archaic magico-religious practice]. / Le mythe du nettoyage par les vierges : actualité d'un archaïsme magico-religieux.

BACKGROUND: In the medical anthropology section of the Nanterre Hospital (France) for migrants and refugees, three cases were recorded of "virgin cleansing" in sub-Saharan African countries. PATIENTS AND METHODS: These consisted of sexual assaults (2 instances of rape and 1 of sexual interference) on sexually immature females (young girls) by patients with sexually transmitted infections (mainly HIV, syphilis) hoping they might thereby be cured. DISCUSSION: These particularly atrocious hetero-aggressive sexual practices based on magical arguments are unfortunately universal and are not limited to a specific culture. At the medical anthropology level, the belief in cleansing by virgins is based on the notion that the patient is dirty and impure. In the same way that emetics and/or laxatives are prescribed in the case of intestinal disorders (to "eliminate" the disease), some subjects use diuretics for urinary abnormalities or, literally, "clean vaginas (or anuses)" to purge their own miasma. The rising tide of population migrations (some of whom carry chronic infections), refugee camps, prolonged incarcerations, etc., makes observations of such phenomena increasingly frequent. Belief in cleansing by virgins (and the fatal consequences thereof) will be difficult to eradicate. The education of populations and health professionals should promote absolute respect for the body of children, and, more generally, of others, particularly since at this time of increasingly marked migratory flows, this problem sadly risks becoming widespread.

[Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes]. / Examen médicolégal des victimes d'agression sexuelle : caractéristiques et liens avec les suites judiciaires.

OBJECTIVES: To describe the medical and legal characteristics of sexual assault victims and to highlight which aspects of the medical examination may be associated with a conviction of the alleged offender. METHODS: This study included all women who consulted to the center for the victims of sexual assault in Nancy between 2008 and 2012 and who filed a complaint. Associations were evaluated with a logistic regression trying to explain the presence of a conviction at the end of the legal proceeding. RESULTS: Three hundred seventy-six victims were included. Following aspects were associated with a reduced probability of conviction: the use of psychoactive substances, the prescription of an antiretroviral therapy and the presence of more than one assailant. The prescription of pain killers were contrarily related to the conviction of an assailant. CONCLUSION: A detailed description, an interpretation of the physical injuries and the prescription of toxicological tests if needed are decisive in the outcome of the legal proceedings of victims of sexual assault. The education of populations at risk and the accompanying of the victims can reduce the delay of care and optimize the collection of evidence.

O Adolescente em Situação de Ofensa Sexual: proteção e responsabilização para evitar a reincidência / The Adolescent in Sexual Offense Situation: protection and responsibility to prevent recidivism / El Adolescente en Situación de Delito Sexual: protección y rendición de cuentas para prevenir la recurrencia / L'Adolescent en Situation d'Agression Sexuelle: protection et responsabilisation pour éviter la récidive

A ofensa sexual cometida por adolescentes, também denominada abuso sexual, é um fenômeno complexo e heterogêneo que atinge pessoas de diferentes credos, etnias, nível educacional e statussocioeconômico. É um tema ainda pouco investigado no território brasileiro e desconhecido em termos estatísticos que ocorre tanto no contexto extrafamiliar quanto no intrafamiliar. Este artigo debate a importância do processo de notificação do ato ofensivo, bem como a proteção e a responsabilização do adolescente, com base no Estatuto da Criança e do Adolescente. O texto discute também que para evitar a estigmatização do adolescente é preciso respeitar seu momento de desenvolvimento e suas possibilidades de transformação, sem comparar sua conduta a de adultos que cometem atos semelhantes. Por fim, são abordadas alternativas à justiça convencional, a exemplo dos programas de atendimento psicológico conectados à justiça restaurativa, para evitar a reincidência e prospectar um futuro mais promissor ao adolescente.

The sexual offense, also called sexual abuse, committed by adolescents is a complex and heterogeneous phenomenon that affects people of different beliefs, ethnicities, educational backgrounds and socioeconomic status. It occurs not only in an extrafamilial but also in an intrafamilial context. The sexual offense committed by adolescents is a topic little explored in Brazil and which lacks statistical data. This article discusses the importance of the mandatory reporting of the offensive act, as well as the adolescent protection and responsibility, based on the Child and Adolescent Statute. The text also argues that to prevent adolescent stigma it is necessary to respect their time of development and their transformation possibilities in order not to compare their behavior with adults who commit similar acts. Finally, alternatives to conventional justice are addressed with a view to prevent recidivism and to prospect a more promising future to adolescents.

El delito sexual cometido por adolescentes, también denominado abuso sexual, es un fenómeno complejo y heterogéneo que afecta a personas de diferentes religiones, grupos étnicos, nivel educativo y estatus socioeconómico. Es un tema que aún no se ha investigado en el territorio brasileño y es desconocido en términos estadísticos que se produce tanto fuera del contexto familiar, como en el intrafamiliar. En este artículo se analiza la importancia de la notificación del delito, así como la protección y la rendición de cuentas de los adolescentes, basado en el Estatuto del Niño y del Adolescente. Para evitar el estigma de los adolescentes hay que respetar su tiempo de desarrollo y posibilidades de transformación, sin comparar su comportamiento a los adultos que cometen hechos similares. Por último, se abordan alternativas a la justicia convencional, así como los programas de atención psicológica, para prevenir la recurrencia y favorecer un futuro más prometedor.

L'agression sexuelle commise par des adolescents, aussi appelée abus sexuel, est un phénomène complexe et hétérogène qui atteint les personnes quelques soient leurs croyances, leur ethnie, leur niveau d'études et leur statut socio-économique. C'est un thème encore peu étudié sur le territoire brésilien et méconnu en termes statistiques, qui se produit aussi bien dans le contexte extrafamilial que dans le contexte intrafamilial. Cet article discute l'importance du processus de notification de l'acte offensif, ainsi que la protection et la responsabilisation de l'adolescent, en se basant sur le Statut de l'enfant et de l'adolescent. Le texte précise également que, pour éviter la stigmatisation de l'adolescent, il faut respecter son moment de développement et ses possibilités de transformation, sans comparer son comportement à celui des adultes qui commettent des actes similaires. Enfin, des alternatives à la justice conventionnelle sont abordés, comme des programmes de prise en charge psychologique associés à la justice restaurative, pour éviter la récidive et forger un futur plus prometteur pour l'adolescent.

[Practical guide to the examination and interpretation of genital lesions of minor female victims of sexual assault]. / Victimes féminines mineures d'agressions sexuelles : guide pratique pour l'examen et l'interprétation des lésions génitales.

Through a comprehensive review of the literature on sexual assault, the authors propose to clarify the different stages of the exam and help the practitioner to the forensic interpretation of lesions. The authors describe the basic principles that make consensus in how to interview victims in order to increase the reliability of the information collected. The various medical data that must be collected allowing to guide diagnosis (urogenital symptoms, sexual behaviour disorder) or facilitate the interpretation of lesions (age of puberty, use of tampons…) are specified as well as the different positions of examination and their association to other complementary techniques (Foley catheter, colposcopy, toluidine blue). The authors present a simple decision tree that can help the practitioner to interpret the laceration of the hymen. They detail the description and forensic interpretation of all genital lesions that may be encountered as a result of sexual assault, and the pitfalls to avoid. Finally, two main problems in the interpretation of lesions are described, the absence of injury after penetration and the accidental genital lesions.

Les agressions sexuelles: un aménagement des troubles narcissiques-identitaires / As agressões sexuais: uma organização de transtornos narcísico-identitários / Las agressiones sexuales: una organizacion de trastornos narcísico-identitários / Sexual aggression: adjustment of narcissistic-identity disorder

L'objet de cet article est de montrer, à travers deux cas, comment se traduisent, dans la clinique projective, certains aménagements pervers contre la menace de décompensation dépressive ou psychotique, problématique récurrente chez de nombreux agresseurs sexuels. L'auteur présente deux cas illustrant ces aménagements défensifs. Un cas de jeune adulte violeur dont la structure de personnalité psychotique est compensée par un mode de relation d'objet et des actes pervers glissant vers la perversité ce qui lui évite le recours au délire face à un péril d'inexistence. Et un autre cas d'adulte pédophile se défendant par ce biais contre des angoisses dépressives de type narcissique. Les épreuves projectives sont interprété en référence à la théorie psychanalytique.

O objetivo deste artigo é mostrar, por meio de dois casos, como se traduzem, na clínica projetiva, certas organizações perversas contra a ameaça de descompensação depressiva ou psicótica, problemática recorrente em muitos agressores sexuais. O autor apresenta dois casos que ilustram essas organizações defensivas. Um caso de um jovem adulto estuprador cuja estrutura de personalidade psicótica é compensada por um modo de relação do objeto e de atos perversos que se dirige para a perversidade, evitando o recurso ao delírio frente a um perigo de inexistência. Um outro caso de adulto pedófilo se defende por estas mesmas vias contra angústias depressivas de tipo narcísico. As provas projetivas são interpretadas com referência à teoria psicanalítica.

The study aims to illustrate, through two cases, how certain perverse adjustments against the threat of depressive or psychotic decompensation are expressed in projective clinical work, a recurrent problem in many sexual aggressors. The author presents two cases illustrating these defensive organizations. One case is related to a young adult rapist whose psychotic personality structure is compensated by an object relation and by perverse acts directed to perversity, avoiding delirium when faced with the risk of inexistence. The other case is related to a pedophile adult who uses these same strategies to defend himself against narcissistic depressive anxiety. The projective tests are interpreted based on the psychoanalytic theory.

El objetivo de cuesto articulo es mostrar, por medio de dos casos, como si traducen, en la clínica proyectiva, ciertas organizaciones perversas contra la amenaza de descompensación depresiva o psicótico, problemática recurrente en muchos agresores sexuales. El autor presenta dos casos que ilustran cuestas organizaciones defensivas. Un caso de un joven estuprador cuya estructura de personalidad psicótica es compensada por un modo de relación del objeto y de actos perversos que si direcciona para la perversidad, evitando el recurso al delirio frente a un peligro de inexistencia. Un otro caso de adulto pedófilo si defiende por cuestas mismas vías contra angustias depresivas del tipo Narcísio. Las pruebas proyectivas son interpretadas con referencia a la teoría psicoanalítica.