Epidemiologic research in nearly two dozen countries shows that sexual abuse is a real danger for 5-20% of all children, girls being 2-3 times more at risk than boys. Sexual abuse has proved an important risk factor in many behavioral or even somatic disorders, including posttraumatic symptoms such as nightmares, phobias, nutritional problems, aggressivity and school problems. Unfortunately the problem is surrounded by shame, denials and numerous misleading prejudices which make it hard to diagnose. Diagnosis is also complicated by the frequent absence of reliable physical evidence, the lack of serious research into the child's normal sexual behavior and development, the fact that many small children express themselves awkwardly, and finally the existence of reasons for making untruthful statements, e.g. in child custody disputes. In North America experience has shown the importance of certain arrangements when public health authorities need to respond effectively to the problem of sexual abuse: these arrangements are: (1) Education of the pediatric and medical communities to ensure that the majority of personnel are thoroughly aware of the symptoms and are willing to accept the diagnosis. (2.) Training of specialists capable of interpreting the physical signs, where these are present. (3.) Interdisciplinary cooperation, in practice, of the police and social and psycho-medical institutions with medical personnel when investigating individual cases. (4.) Serious efforts must be made to ensure that children do not suffer the negative iatrogenic effects of investigations into sexual abuse: that is, by minimising the number of interviews and examinations, respecting the child's privacy, and doing everything possible to ensure positive follow-up of the child by the primary social network surrounding him/her.
