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Home > Professional Reference > Incest

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Incest

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

This is defined as sexual activity with a person from within the immediate family, usually a child.1 It is a form of sexual abuse.

However, this definition of incest needs to be expanded to take into consideration betrayal of trust and the power imbalance that may exist in children's relationships.
One such definition is:

"The imposition of sexually inappropriate acts, or acts with sexual overtones ... by one or more persons who derive authority through ongoing emotional bonding with that child."2

This definition of incest will therefore include immediate/extended family members and, amongst others, babysitters, school teachers, scout leaders, priests and religious ministers as perpetrators.

Aetiology

Factors involved may be:

  • Need to obey and trust adults
  • Wish to maintain family unity
  • Father's need for sexual outlet when mother is not available, together with daughter's need for love and care
  • Abuse of alcohol
  • Mother may be depressed and herself might have suffered childhood sexual abuse
  • Child may take on adult jobs, including housekeeping
  • Family may appear close and have little outside contact

Epidemiology

Incidence

In a recent study from Scandinavia:3

  • Girls were victims in 85% of the cases, boys in 12%, and boys as well as girls in 3%.
  • Sexual penetration had occurred in 54.5% of cases and the total proportion of hands-on crimes was 83%.
  • Most perpetrators (72%) were well known to the child.
  • The most severe offences took place within the family.

A wide range of acts was classified as sexual child abuse, but most common was sexual penetration of a female child by her biological father or a family friend.

Presenting features

  • In one third of cases the victim was ≤ 6 years old.
  • One third was 6-12 years old.
  • The remaining third was 12-18 years old.

The offender is reported as male in 97% of cases but female involvement may be under-reported.
Brother-sister incest is thought to be the most frequently occurring form but abuse of daughters by fathers or stepfathers is most commonly reported.4
Abuse by stepfathers is up to five times higher than that by biological fathers.
Physical symptoms may include:

  • Vaginal pain
  • Rectal pain
  • Vaginal discharge
  • Bleeding
  • Chronic dysuria
  • Bed wetting
  • Constipation

That incest is usually repeated, often continuing for years, is supported by modern research. As the daughter reaches an age when she is able to resist or flee, the activity may be repeated with a younger sister. Though the profiles of incestuous families may vary, the father-perpetrator is typically an immature individual with low self-esteem, while the wife-mother is depressed, helpless or otherwise emotionally absent.5
The father often uses alcohol to allay his inhibitions before molesting his daughters.
Theories have proposed that girls allow the sexual relationship to continue to prevent family disunity.6

Psychological symptoms include:

Associated factors

The increase in the divorce rates may have placed more children at risk than previously. When women begin new relationships, they may unwittingly be putting their children at greater risk for sexual abuse from the men they date.

According to one survey, if the mother remarries the "stepdaughters are over eight times more at risk of sexual abuse by the stepfathers who reared them than are daughters reared by their biological fathers".7

"As some researchers have begun to suspect, it may be the case that a growing number of stepfathers are really 'smart paedophiles', men who marry divorced or single women with families as a way of getting close to children".8

Investigations

Forensic examination by a paediatrician experienced in the area of child abuse.

Management

There should be local guidelines.

If there is no doubt:

  • Consider immediate admission to hospital and/or contact social services child protection team who can provide a Place of Safe Order if necessary.
  • In the extreme, police can take child into protective custody.9

If only suspicious:

  • Consult at-risk register via social services
  • Check for family history of similar
  • Consult health visitor and colleagues
  • Record concerns in notes and follow-up

Historical context

Perhaps the first report of father-daughter incest appears in the Bible in the book of Genesis 19. However, the seducer this time is not the father, Lot, whose wife was transformed into a pillar of salt; rather, the seducers are his two daughters, who conspire to become pregnant by him. Both liaisons result in pregnancies. "And the older one gave birth to a boy, and she named him Moab, he is the father of the Moabites of this day. And the younger also gave birth to a boy, and she named him Ben Ami, he is the father of the Ammonites of this day".
(Genesis 19, 37-38)

Document references

  1. Nelson Textbook of Pediatrics. 16th Edition. Behrman RE et al. WB Saunder Co. 2000.
  2. Blume, E. Sue. 1990. Secret Survivors: Uncovering Incest and Its Aftereffects in Women. John Wiley and Sons, New York, NY
  3. Carlstedt A, Forsman A, Soderstrom H; Sexual child abuse in a defined Swedish area 1993-97: a population-based survey.; Arch Sex Behav. 2001 Oct;30(5):483-93. [abstract]
  4. Cyr M, Wright J, McDuff P, et al; Intrafamilial sexual abuse: brother-sister incest does not differ from father-daughter and stepfather-stepdaughter incest.; Child Abuse Negl. 2002 Sep;26(9):957-73. [abstract]
  5. Kutz I; Revisiting the lot of the first incestuous family: the biblical origins of shifting the blame on to female family members.; BMJ. 2005 Dec 24;331(7531):1507-8.
  6. Herman JL. Father-daughter incest. Boston: Harvard University Press, 2000.
  7. Russel DEH. The secret trauma: incest in the lives of girls and women. Rev Ed. New York: Basic Books, 1999.
  8. Crewdson, John. 1988. By Silence Betrayed: Sexual Abuse of Children in America. Harper & Row, Publishers, New York, NY
  9. Oxford Handbook of General Practice, Eds Simon C et al. OUP 2003.

Acknowledgements

EMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 1042
Document Version: 23
Document Reference: bgp1893
Last Updated: 11 Aug 2009
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