Sexual abuse is defined by state law and is usually indicated by a child’s disclosure and a combination of physical indicators including difficulty in walking or sitting, torn, stained, or bloody underclothing, pain, swelling, or itching in genital area, pain during urination, bruises, bleeding or laceration in external genitalia, vaginal, or anal areas; vaginal/penile discharge, venereal disease, especially in pre-teens, poor sphincter tone, pregnancy, bizarre, sophisticated or unusual sexual behavior or knowledge, poor peer relationships, delinquency, running away, change in school performance, withdrawal, fantasy or infantile behavior.