Educational paper

Child sexual abuse is increasingly recognised in all societies, affecting boys and girls alike in all age groups and often involving oral, anal and vaginal penetration. The presence of physical evidence following suspected child sexual abuse is important in confirming the diagnosis and providing legal corroboration that abuse has occurred. Whilst many children have no physical evidence, its presence should be carefully sought and documented by skilled examination, regardless of the time interval between any suspected abuse and the examination. When examination is close to the time of the abuse, forensic sampling may be required. Although many children have no physical findings, understanding the significance of physical findings has increased with both experience and research, although certainty and agreement is lacking in some areas. There are few case control studies of abused and non-abused children where standard terminology, examination method and description allow for meaningful comparison. Conclusions: Physical findings rarely provide conclusive evidence of sexual abuse in isolation but may offer important pieces of the diagnostic “jigsaw picture”.