The only procedures necessary in all first examinations of child incest victims are a detailed history of the sexual event; a thorough physical examination; blood and urine samples; pharyngeal, rectal, and vaginal swabs; and a cervical smear in some cases. Evidence collection may not be possible since incest victims may wait weeks or months before reporting the crime. The child's description of what happened, the physical signs, and the presenting symptoms will guide the physical to the appropriate laboratory tests. A pregnancy test is necessary for older children, but young children should be protected from the 'rape kit' if sexual contact occured before the examination. The physical examination should be through; physicians should look for bruises on the body and for vaginal damage, as well as take aspirates and swabs for culture for gonorrhea. Male victims tend to report physical assualts even if they are really sexual in nature. Males may seek help only when associated physical injury forces them to medical attention. Fathers, especially if they are alcoholics and violent, tend to be the perpetrators of male sexual abuse. Boy victims often have hostile or homicidal feelings toward the father. Followup medical care is necessary to ensure that venereal disease will not be a continuing problem and to allow children to touch and communicate safely again. Parents of incest victims often need medical care for alcoholism, depression, and a host of other physical problems. Physicians can support mothers in escaping a destructive marital relationship, provide advice on family planning, and create an appropriate forum for discussing sexuality. Nineteen references and seven case examples are included.