Physical signs of child sexual abuse

An evidence based review and guideline 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 second edition will be published in early 2015. This will include new sections on healing, the causes of vaginal bleeding, 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:; however, if you are not eligable then you can still purchase a copy of the review 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

To purchase online or for further information:

Website (buy online)

Email Lavenham Group -

Cheques may be made payable to 'Lavenham Group plc' and posted to the address below. 


Lavenham Group plc
Arbons House
47 Water Street
CO10 9RN

Telephone - 01787 249 295 

Fax - 01787 248 267




See the list of reviewers for the CSA book