All children less than 18 years old who were referred to a Michigan institution's child protection team clinic for evaluation of suspected sexual abuse during 1997 through 1999 were eligible for the study. Although not required, colposcopy has been used for several years as an examination aid for children and adolescents referred for evaluation of suspected sexual abuse. Although initially designed for viewing the cervix, a colposcope allows improved external anogenital visualization with variable magnification and a good light source, along with photographic documentation. With the attachment of a video camera and monitor, children can observe real-time magnified images of their own genitalia during examination and can take an active role during the examination to improve visualization of anogenital structures, minimize their discomfort, and increase their knowledge of their bodies. For the current study, 227 children (mean age 7.2 years) underwent videocolposcopy; of these children, 55.1 percent disclosed sexual abuse, and 17.2 percent had a positive examination. More than 80 percent were female, prepubertal, and non-Hispanic Whites. Most of the children (85 percent) watched their examination on the monitor and were either cooperative or enthusiastic before and after videocolposcopy. Summed GEDS (Genital Examination Distress Scale) scores were strongly correlated with observed responses after the procedure, and children who disclosed their sexual abuse were three times more likely to watch the monitor and five times more likely than those without disclosure to have improved comfort. Other patient characteristics were not significantly associated with patient reaction to the procedure. The study concluded that although some children may benefit from participating in their examination by using VCO, the long-term effects of the evaluation and any relationship between a child's reaction to VCO and their history of sexual abuse remain to be determined. 3 tables and 20 references