The need to know more about the appearance of genital structures in child sexual abuse cases, the healing of injuries, and the recognition of sexually transmitted diseases parallels the progressive embracing of technology. Videocolposcopy has provided many benefits over simple colposcopy, and recent developments in computer imaging technology have facilitated the translation of analog images to digital format. In addition, over the past 20 years, the basis for the medical diagnosis of child sexual abuse has undergone increasing refinement. Achievements have been made in the development of medical examination protocols, the development of specific hands-on techniques for medical examinations, the adaptation of the colposcope to clinical practice, and the documentation of medical examinations. A research agenda for the technical conduct of medical examinations in child sexual abuse cases is presented, and barriers to research are noted. 91 references