In this chapter I draw on the material in the book to develop an analysis which considers the nature and extent of child sexual abuse; the contributing factors and causal relationships for boys between having been sexually abused and becoming a sexual abuser; and the psychoanalytic as a theory of process. I develop an analytical framework with which to explain the 'male monopoly on molestation' and the 'female monopoly on self harm and revictimisation' in terms of what I call the social and psychological construction of gendered power relations. There is a section on 'gendering the language of child sexual abuse', which shows how men who are identified in community and clinical studies as primarily the sexual abusers of children become invisible as the abusers in the normative use of the ungendered language of 'parents' and 'families' in research, and in child protection and criminal justice system policy. I consider also the 'language of “paedophilia”' and how that obscures and protects ordinary heterosexual men's sexual abuse of their own and other people's children. I then turn to how this gender-neutral language leads on to women being blamed and held responsible for men's sexual abuse of their children. In the final section on child protection and child sexual abuse prevention conceptualised as stopping abusers abusing, I set out a 'philosophy of treatment intervention'; argue the need to abandon current child sexual abuse prevention which puts the burden of protection on children; describe, as a model, an integrated multi-disciplinary and multi-agency community response to the sexual abuse of children in Grand Rapids, Michigan, USA; and argue for making child sexual abuse a public health priority.
Because of differences in methodology, and in particular the age ranges covered, the definitions of sexual abuse used and the ways in which questions were asked, the prevalence rates of child sexual abuse for women and men found in studies in the USA and UK over the past twenty years have varied considerably. Peters, Wyatt and Finkelhor (1986), for example, found, in a review of community