Physical signs of child sexual abuse - evidence-based review

Also known as the 'purple book', this guidance is for best practice and issues of clinical practice to aid clinical decision-making in examining children referred for evaluation of possible sexual abuse. Here, you can request or purchase a print edition. You can also download additional information related to the review's publication and update.


In 2015 the RCPCH, in collaboration with the American Academy of Pediatrics (AAP), the Royal College of Physicians of London (RCP) and The Faculty of Forensic and Legal Medicine (FFLM), updated the 2008 RCPCH publication entitled ‘The Physical Signs of Child Sexual Abuse’ based on the best available evidence.

The publication updates previous evidence and includes new reviews such as:

  • anogenital signs of accidental injuries in girls and boys
  • genital bleeding in prepubertal girls
  • healing in anogenital injuries.

Named and designated doctors - request your copy

The review is provided free of charge if you are:

  • an RCPCH member and
  • a named or designated doctor for safeguarding children and
  • involved in the forensic medical examination of children for suspected CSA.

Our office closed on 17 March due to the COVID-19 pandemic, and are now periodically open where guidance allows. However, we are currently unable to send out physical documents. This means that there will still be a delay with sending out free copies of this publication at this time. We're sorry for any inconvenience this causes, and will send your order as soon as our office fully re-opens and our staff return.

Complete our order form

Others - purchase your copy

Others may purchase a copy through our stockists, Lavenham Press:

  • If you are a member of the RCPCH, Faculty of Foresnic & Legal Medicine (FFLM), Royal College of Physicians (RCP), British Association of Paediatric Surgeons (BAPS), or American Academy of Pediatrics  the cost is £35 plus delivery - 
    please contact to request your coupon code which you can use when placing your order
  • For all non-members the cost is £49 plus delivery

Order online from Lavenham Press

You can also pay by cheque; contact / 01787 249 290. You'll need to make the cheque payable to 'Lavenham Press Ltd' and post to Lavenham Press Ltd, Arbons House, 47 Water Street, Lavenham, Suffolk CO10 9RN.

Additional information

Summary of changes by chapter (PDF)

Data extraction and quality standard forms (PDF)

Included studies in the evidence base section - by chapter (PDF)

Literature searches (PDF)