INDIAN PEDIATRICS 144 VOLUME 46 __ FEBRUARY 17, 2009 C hild sexual abuse is a global public health problem. It is a cruel and tragic occurrence and a serious infringement of a child’s rights to health and protection. Till the early 1970s, child sexual abuse was thought to be rare, and centered among the poor. Experts now agree that child sexual abuse exists in all socioeconomic groups. Increased public awareness has led to greater reporting; from 1970 to 1990, child sexual abuse reports increased more than other categories of neglect or abuse(1). Despite this gain, child sexual abuse still remains vastly under- reported. WHO estimates that globally some 40 million children aged 0–14 years suffer some form of abuse and neglect requiring health and social care(2). Figures from USA show that 1 in 4 girls and 1 in 6 boys is sexually abused before the age of 18, whereas the median age for reported abuse is 9 years old(3-5). The exact magnitude of the problem in other areas in Asia and Africa is not known but it is probably even greater (6-10). DEFINITION OF CHILD SEXUAL ABUSE Sexual abuse includes any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child. Sexual abuse includes oral-genital, genital-genital, genital-rectal, hand-genital, hand-rectal, or hand- breast contact; exposure of sexual anatomy; forced view of sexual anatomy; and showing pornography or using a child in the production of pornography. Sexual intercourse includes vaginal, oral, or rectal penetration. Penetration is entry into an orifice with or without tissue injury. Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity, in the context of a relationship of responsibility, trust or power(2). Child sexual abuse is the involvement of a child REVIEWARTICLE Forensic Investigation of Child Victim with Sexual Abuse EMMANOUIL I SAKELLIADIS, CHARA A SPILIOPOULOU AND STAVROULA A PAPADODIMA From the Department of Forensic Medicine and Toxicology, Medical Faculty, University of Athens, Greece. Correspondence to: Stavroula A Papadodima, Mikras Asias 75, Goudi,PO Box 11527, Athens, Greece. E-mail: stpapd@gmail.com Sexual abuse includes any activity with a child, before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child. Sexual mistreatment of children by family members (incest) and nonrelatives known to the child is the most common type of sexual abuse. Intrafamiliar sexual abuse is difficult to document and manage, because the child must be protected from additional abuse and coercion not to reveal or to deny the abuse, while attempts are made to preserve the family unit. The role of a comprehensive forensic medical examination is of major importance in the full investigation of such cases and the building of an effective prosecution in the court. The protection of the sexually abused child from any additional emotional trauma during the physical examination is of great importance. A brief assessment of the developmental, behavioral, mental and emotional status should also be obtained. The physical examination includes inspection of the whole body with special attention to the mouth, breasts, genitals, perineal region, buttocks and anus. The next concern for the doctor is the collection of biologic evidence, provided that the alleged sexual abuse has occurred within the last 72 hours. Cultures and serologic tests for sexually transmitted diseases are decided by the doctor according to the special circumstances of each case. Pregnancy test should also be performed in each case of a girl in reproductive age. Key Words: Child, Forensic, Sexual abuse.