The reporting requirement raises several concerns for pediatricians. Their legal responsibilities as reporters may conflict with their traditional relationship with the family as a unit and with the confidentiality of the doctor-patient relationship. Few pediatricians receive training adequate to enable them to determine whether medical observations are consistent with child sexual abuse or to understand the unique considerations and needs when taking the medical history of a possible abuse victim or when preserving evidence for possible later use in court. The medical evidentiary evaluation of suspected sexual abuse also raises concerns. Great variability exists in referral patterns, which determine whether a medical examination will be requested and whether a general practitioner or a specialist will be asked to conduct the examination. In addition, more detailed protocols are needed for addressing the many cases in which findings are ambiguous or subtle. Moreover, physicians often need training in forensics and assistance in coordinating services with multiple agencies and professionals. Finally, attention is needed on ensuring adequate cost reimbursement for medical evaluations. Table, photograph, and 49 reference notes (Author abstract modified)