The physical signs of child sexual abuse. An evidence-based review and guidance for best practice Royal College of Paediatrics and Child Health and The Royal College of Physicians of London and its Faculty of Forensic and Legal Medicine UK: Lavenham Press (see http://www.rcpch.ac.uk to order) ISBN 9781906579005

This is the first edition of this textbook. It is the culmination of five years of input by a working group of clinical experts and specialists in evidence-based medicine. The book provides clinicians with an up-to-date background on this disturbing subject, and is also a foundation upon which to base their clinical decision making. It addresses the strengths and limitations of currently available evidence, and highlights the significant shortcomings of certain key areas of research.

It is divided into nine main sections: Introduction, Responding to concerns, Methodology, Genital signs of sexual abuse in girls, Anal signs of child sexual abuse, Genital signs of sexual abuse in boys, Sexually transmitted infections, The extent of anogenital signs at examination and Good practice guidelines.

The introduction provides the reader with a broad perspective on the definition and prevalence of child sexual abuse; it outlines the objectives of the working group and contains a brief summary of the book's layout and recommended method of use. Following on, the second chapter provides a practical and concise general introduction on the initial management of a disclosure of child sexual abuse. The methodology chapter highlights how evidence was collated and appraised, and any limitations encountered. Chapters four to eight are sub-sectioned to follow a specific format: a short non-evidence based introduction including anatomical description and illustrations, an evidence-based section related to the specific topic, helpful lists and summaries of key messages collated from the literature, 'issues for clinical practice' identified by the project group, and a summary and conclusion. Chapter Nine outlines 'non-evidence based good practice guidelines' and is perhaps the most clinically useful section, covering all practical aspects of performing a child assessment. It is helpfully laid out in bullet point lists, with flow diagram summaries to aid visualisation.

In keeping with its evidence-based theme, the book outlines key areas in need of good quality research in the future. It contains a glossary of words used and a helpful quick-reference section with frequently asked questions and the relevant sections of the book which address these. It concludes with a full list of references used.

Whilst the content is entirely in keeping with the title, the book is very focused on the physical signs of child sexual abuse seen in the genital and anal areas. A brief mention of the emotional and behavioural signs of sexual abuse and the general signs of physical abuse would complement this book well. These features are usually more obvious to health care professionals, and in the absence of a disclosure of child sexual abuse by the victim or someone known to them, are likely to be the first warning signs which would cause a clinician concern. Intra-oral signs of sexually-transmitted diseases are rare, but have been documented; the lack of good evidence relating to these features is reflected in the extent of their mention in the text.

In summary, this book provides a much-needed wealth of information for clinicians who treat children. Its practical format allows health care workers, who may encounter victims of child sexual abuse, to manage such encounters appropriately; this would include dentists working in multi-disciplinary teams caring for large numbers of children. More importantly this book is based on evidence, and highlights specific areas which are still in need of research.