It is observed that the frequency of reports of sexual violence in Espirito Santo was 32.6%, higher than the previously reported national prevalence of 24.7% between 2011 and 2017 [28]. As for associated factors, the sexual violence was significantly predicted by younger age of the victim with 10 to 12 year olds most at risk. Most sexual violence, cases occurred at home, and were part of a history of violence with a perpetrator known to the victims. In females, the sexual violence was also more likely by a lone perpetrator, and in males, perpetrators aged 20 years and older.
It is noted that the number of reported cases of sexual violence against girls is significantly higher when compared to the number of reported cases in male adolescents. This finding is similar to that found in a study conducted with reported cases of sexual violence throughout Brazil, in which the prevalence of the outcome was 77.1% in females [29], which is similar to that found in other studies [30–32]. It is worth highlighting a study of cases of violence reported in Pernambuco, that the prevalence of sexual violence was higher in females compared to males [33].
Historically, in the context of a patriarchal society deeply marked by the asymmetry of power in gender relations, there is a perpetuation of eroticization and objectification of the female body, which begins during childhood and intensifies during adolescence [34]. In this context, it is important to emphasize that sexual violence is one of the manifestations of gender inequality that mainly affects women across the lifespan, and one of the cruelest forms of demonstration of dominance imposed on them [1]. Sexual violence against adolescents is a favored form of gender-determined violence, as it is usually perpetrated by an older, experienced man who has a trusting relationship with the victim [35].
Although sexual violence is mostly committed against girls, it is important to emphasize that it also affects male youth; however, the data available in the literature limit knowledge of its magnitude [2]. Some factors may be related to the underreporting of these cases in males, namely: fear of homosexuality and/or fear of being seen as homosexual; emotional responses differentiated from teenagers; fear of being blamed, as they are generally seen as able to defend themselves; difficulty of guardians to perceive relevant signs and symptoms of abuse, and; denial of abuse when it occurs through perpetrators such as parents and other adolescents [36, 37]
In both sexes, there is a higher prevalence of reports of sexual violence against adolescents aged between 10 and 12 years. Girls become more exposed to sexual violence during puberty, when secondary sexual characteristics develop [2, 30]. Moreover, individuals in the early stages of adolescence are physically, psychologically and socially more vulnerable, not having sufficient maturity to understand or anticipate violence by the perpetrators, who often gain the victims’ trust and may also impose authority over victims to perpetrate violence [1, 30]. Therefore, in order to break with this type of violence, it is necessary that third parties denounce and activate the protection network for adolescents, as they depend on the initiative of others to break the silence [1].
It is important to highlight the higher prevalence of sexual violence against girls in the age groups from 10 to 12 years and from 13 to 17 years, compared to the age of 18 to 19 years, suggesting perpetuation of the cycle of violence throughout adolescence. On the other hand, in males, the highest prevalence was associated only with boys aged between 10 and 12 years. These findings suggest that boys are victims more often while there is still no possibility of defense, and for this reason the outcome is less prevalent in older ages [34].
In the present study, the main place of occurrence of sexual violence was in the victims’ homes. A survey of reported cases of sexual violence registered in SINAN observed that the chances of sexual violence were approximately twice as high at home than other spaces [31]. In a study carried out in the state of Paraná, sexual violence was most often carried out in the homes of victims, followed by the homes of perpetrators and relatives [30].
The first experience of human interaction usually takes place at home, in a positive, nurturing, and loving context. However, the home is also a place where the first exposure to violence and perpetuation of the cycle is likely to occur [2]. Due to home privacy, violence against children and adolescents is practiced without public knowledge, making interventions difficult to be carried out to deconstruct youths’ perception of a safe and trustworthy place [30, 31]. In addition to these factors, home privacy contributes to the silence of recurrent episodes [31].
After adjusting for the multivariate analysis, revictimization remained associated with a higher prevalence of sexual violence in both sexes. In a longitudinal study carried out with adolescents in the United States, there was a recurrence of sexual violence in a quarter of victims during the academic semester [38]. Between 2010 and 2014, 680 cases of sexual violence against adolescents were reported in schools, of which 40.0% were recur-rent cases [29], supporting similar prevalence found in other studies conducted with data from SINAN [39] [31].
In a study that analyzed the recurrence of reported cases of violence, it was possible to note that there was a recurrence of sexual violence or negligence, even after previous reports of physical and sexual violence, suggesting that in some cases reporting is not enough to change the victim’s environment may not prevent revictimization [40]. A systematic review revealed that, revictimization is associated with greater suffering, presence of psychiatric disorders, difficulty in interpersonal relationships and coping, self-blame, shame, and revictimization in adult life [41–44].
Regarding perpetrator characteristics, a higher prevalence of sexual violence among females remained associated with having only one perpetrator. According to national descriptive studies that used reported data on violence, most sexual assaults against adolescents are by a lone perpetrator [28, 31]; however, it is important to emphasize that although the reported cases mostly contain only one perpetrator, adolescents may be ex-posed to more than one perpetrator frequently [38].
In males, the perpetrator was likely to be an adult (aged 20 years or more) regardless of r adjustment. This finding corroborates other research in which most perpetrators were adults [45]. The relationship of adults with children and adolescents is guided by hierarchy and power relations; thus, adults can more easily take advantage of these relation-ships to coerce, manipulate and attack their victims who are more vulnerable [46].
As for the perpetrators’ relationships with the victims, the highest prevalence of sexual violence was associated with the perpetrator being unknown. During adolescence, contact with people in environments outside family life tends to increase, which makes adolescents more exposed to violence by people outside the home. However, it is worth raising a hypothesis that suspected or confirmed cases of sexual violence committed by strangers or by acquaintances without family ties to the victim can be more easily reported by youth and relatives, compared to cases where the perpetrator is a relative, since chronicity and silence are common in the domestic environment [35]. Additionally, it is note-worthy that the data in this study come from the reporting of the health sector, which can facilitate the omission by victims and their families as to the perpetrator’s true identity [1].
Limitations of this study include the use of a secondary database, which makes it impossible to correct, or fill in, missing data. Furthermore, selection bias may also be a limitation as only cases reported via the health system are reported, that is we did not access legal system reports. Thus, it is not possible to infer the real prevalence of sexual violence, since there are cases that, even when they arrive at the health service, are not re-ported, and cases that occur in the community in general that are not attended to by health services.
Despite the limitations, studies using secondary databases such as SINAN are important for determining the predictors and profiles of sexual violence for healthcare professionals and managers. This type of study is also relevant to signal managers about possible improvements that can be made in the sexual violence reporting instrument, in information systems and in continuing education of professionals about identification and report of injuries.