Medical personnel, however, are not always trained in the diagnosis of child sexual abuse, and lack of training may account for the reluctance many have in identifying and reporting child sexual abuse. Even so, with modest training, physicians, nurses, and other health care personnel can become more alert to the problem of child sexual abuse. Although sexually abused children are often characterized by physical signs and symptoms that are revealed during physical examinations, the diagnosis of sexual abuse in the medical setting can be difficult. When sexual abuse is suspected, the physical examination of a child should be done with maximum sensitivity to the child's feelings of vulnerability and embarrassment. The author notes that the presence of sexually transmitted diseases in children may not necessarily indicate sexual abuse and that pregnancy may result from sexual abuse. She also points out that good forensic examinations of children who have been severely assaulted can facilitate police investigations, that the medical evaluation of sexually abused children should include an assessment of the child's physical and mental health, and that accurate medical records are essential in child sexual abuse cases. 57 references and 3 tables