There is a paucity of studies on child sexual abuse in Asia. This study reviews the trends of child sexual abuse in Singapore and discusses the medico-legal considerations in the identification, assessment and management (including forensic implications) of such cases. It is a retrospective case review of 38 consecutive cases of child sexual abuse seen at a child guidance clinic in Singapore. Our study showed that most of the children were young (74% below age 9) and female (78.9%) with perpetrators who are males and usually known to the victims. There is a need to have integrated protocols to streamline assessment and reduce the need for repeated questioning. Adequate support of the victims in the form of specialised handling during the Court proceedings and in the use of new technology (such as video conferencing) for obtaining the child's testimony may be necessary. A child's fitness to testify is determined by the credibility and competence of the child. Repressed memories are of questionable validity.