Up to 25 percent of all female children suffer rape or molestation by age 20, the greatest risk coming from family members. However, boys may be at equal risk as they are the preferred targets of pedophiles and child sex rings. A review of 40 clinical case studies of adults who organized sex rings of several children or adolescents shows that the rings were run by a male, with occasional female partner, and that many of the offenders held jobs affording extensive contact with children or utilized child recruiters. Another type of sex ring involved a friendly neighbor who spent years insinuating himself into familes' good graces. The syndicated rings identified recruited children, produced pornography, provided sexual services, and established a network of customers. Findings indicate that pedophiles do not rape their victims, but rather pressure the children into cooperation. They form transition rings, in which the exchange of experience and photographs is extensive; these transition rings lead to prostitution and pornography roles for the children. When apprehended, the offender gives ingenious alibis, claiming he is sick rather than criminal. The devastation caused by this victimization is extremely psychologically violent and the children involved suffer post-traumatic stress responses. During treatment, psychiatrists must be willing to dig for this cause, since victims rarely volunteer the information. Police officers and prosecutors must also be aware of the nature of child sexual abuse. Notes are provided.