Only 38 children (12 percent) had clinical signs consistent with a diagnosis of child sexual abuse. Two-thirds of this small group (22 children) had signs of healed, persistent hymenal damage. These children provided histories of repeated penetrative (digital or penile) abuse over months or years. Much sexual abuse is anal, and the author advises this almost never results in physical evidence of damage, even when it occurs repeatedly. The author advises that most sexual crimes against children are not witnessed, and unless the circumstances and physical evidence are overwhelming, the case is unlikely to get to court. Children under 7 or 8 years old (more than half of the study) almost never get to court. Developmental delay is a strong impediment to court proceedings, as are many other child disabilities. The author further concludes that the most emotionally damaged children, who are often the most severely sexually and physically abused children, do not get to court, since their learned survival strategies makes them unreliable witnesses. The paper concludes that the court systems of Australia, as they currently exist, are not able to address issues from a child's perspective. There should be an exploration of alternative methods of ensuring safe, developmentally appropriate responses for children in cases of alleged child sexual abuse, particularly when family separation is involved. Medical examinations can be instrumental in helping the child to understand what has happened and in improving their emotional outcome.