Adolescent Male Peer Sexual Abuse: An Issue Often Neglected
M, a 13-year-old boy, presented with complaint of small water-filled lesions in the perianal region, which burst to form raw areas, associated with burning pain and bloody discharge. On examination, the lesions were grouped, multiple, superficial with central slough, and peripheral erythema []. Herpes progenitalis was diagnosed (later confirmed by Tzanck smear). Strongly suspecting it to be sexually transmitted, the dermatologist questioned about sexual exposure, which was initially denied by M as well as by his father. On a more tactful enquiry in the absence of his father, M did admit to have been sodomized. The revelation was shocking to his father as he was completely unaware about it. A psychiatric referral was made for psychological evaluation.\nHistory revealed that 10 days back, while roaming around alone in his native village, he was approached by a boy, who was a complete stranger to him. He tried to befriend M, telling him that he was 13 years old and stayed in the neighboring village. He then immediately proposed that he wished to “penetrate” M and promised that the experience would be immensely pleasurable. M gave in to his demand, though with an initial resistance. In an isolated place in the nearby fields, they indulged directly in unprotected peno-anal sex with M being the recipient. Soon after the act began, M felt intense pain and immediately asked to stop, but the boy continued to thrust forcibly. M managed to push him away. He returned home, but could not gather the courage to report it to his parents. He experienced perianal pain for a day, but was asymptomatic thereafter for about 10 days until the appearance of the skin lesion. His father reported that there were no observable emotional or behavioral changes during that period.\nMental status examination did not suggest an overt psychopathology, although it was noted that while narrating the incident, M avoided eye-to-eye contact indicating a sense of guilt and embarrassment attached to it. He also expressed anger toward the perpetrator. He denied having any prior sexual experience. His academic record was good and intelligence was clinically average. He tested negative on Venereal Disease Research Laboratory (VDRL) test, and serological tests for Australia antigen and HIV. He did not come back for follow-up.