The Physical Signs of Child Sexual Abuse

The Physical Signs of Child Sexual Abuse

An evidence-based review and guidance for best practice

Book cover of The Physical signs of CSA

This handbook is a revision of the 1997 Royal College of Physicians publication 'Physical Signs of Sexual Abuse in Children'. Based on the best available evidence, it has been produced by the Royal College of Paediatrics and Child Health in collaboration with the Royal College of Physicians of London and its Faculty of Forensic and Legal Medicine.

The review focuses on evidence for the physical signs of child sexual abuse (CSA) in the following areas: female genitalia; male genitalia; anal signs; oral signs; and sexually transmitted infections. 

The literature search has been updated and an interim statement summarising the findings is available to download: CSA Interim statement (PDF,53KB,6 pages)

A full update will be undertaken in 2012/2013 and a second edition published in early 2015. This will include new sections on healing, thermal injuries and accidental/non-intentional injuries.


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Please note: The Royal College of Paediatrics and Child Health, Association of Chief Police Officers and Faculty of Forensic and Legal Medicine have recently updated the document, 'Guidance for best practice for the management of intimate images that may become evidence in court'.

View this and other child protection publications


Get a copy of the CSA publication

The publication is available free of charge to all designated and named doctors (email: It and may otherwise be purchased for delivery

The review may be ordered through the Lavenham Group. The charges include shipping and handling and are as follows:

  • FREE to designated and named doctors
  • Delivery within the UK: £31.06
  • Delivery to Europe: £40.06
  • Delivery to the rest of the world: £46.06


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See the list of reviewers for the CSA book