Child sexual abuse occurs if a child under 18 years of age is forced to engage in or help someone else engage in sexually explicit conduct. Child sexual abuse also occurs if a child is molested or raped, involved in incest, or sexually exploited as in child prostitution and pornography. Child sexual abuse may be of concern to many different agencies in the community, such as child protective services, law enforcement, civil justice (juvenile and family court), criminal justice, and health care. Every State requires all health professionals to report to State authorities any knowledge or suspicion of child abuse and neglect. The assessment of child sexual abuse victims consists of taking a history, followed by physical examination. It is sometimes advisable for health professionals to have someone present from child protective services and law enforcement during history-taking and interview. Further, the physical examination should be performed in the presence of someone the child can trust. A sexually abused child may be involved in as many as three different cases: (1) criminal case against the abusive parent; (2) civil action by child protective services to shield the child from further harm; and (3) second civil action, a divorce case, in which one parent requests custody of the child and denial of visitation rights for the other. Symptoms of child sexual abuse and tests health professionals can use to diagnose such abuse are noted. 9 references