Cases of suspected child sexual abuse are notoriously difficult in respect of investigation, management, diagnosis and aftercare. This specialised area of forensic medicine is what might be regarded as a "dynamic science" in that our understanding and knowledge of the subject is incomplete. Recent research continues apace and while this undoubtedly assists in our understanding of the complexities involved, we may be obliged to re-examine our medical opinion on the basis of emerging validated scientific research. Particularly difficult is the problem of educating non-medical professionals that the majority of children who have been the victims of child sexual abuse show no clinical evidence that abuse has occurred. These highly emotive cases may be made yet more difficult by any variation in medical opinion, not specifically limited to that between prosecution and defence "experts". Consequently it behoves us to follow clearly defined guidelines and practices in our investigation and management of these cases such that we might provide the children involved with the best care for their immediate and future health and safety.