Child sexual abuse in Paraguay: a review of detection, diagnosis, and medico‑legal management

Abstract

Child sexual abuse is a major public health and human rights issue in Paraguay. Most cases occur within the family environment and lead to severe physical, psychological, and social consequences. This review examines national epidemiological trends, detection mechanisms, and recommended medico-legal procedures for comprehensive victim care. A narrative review was conducted using data from the Judicial Statistics Office (2019–2024), scientific literature, national and international regulations, and institutional reports. Three core areas were analyzed: epidemiology, detection, and medico-legal assessment. Between 2019 and 2024, 6,279 cases of child sexual abuse were reported in Paraguay, averaging more than three cases per day. Approximately 80% of incidents occur within the family. Detection relies heavily on community actors, particularly neighbors, mothers, and social agents. Warning signs include behavioral, physical, and emotional changes. The medico-legal examination should ideally be performed within 72 hours and includes medical history, assault history, full physical examination, and biological evidence collection under chain of custody. WHO guidelines emphasize minimizing interviews and examinations to prevent secondary victimization. Child sexual abuse in Paraguay remains a persistent and predominantly intrafamilial problem. Early detection and proper medico-legal evaluation are essential for victim protection and judicial progress. Strengthened public policies, professional training, and interinstitutional coordination are required to improve prevention and response systems.