الفهرس 
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Abstract
Child abuse and neglect is a common problem in pediatrics and a major public health concern world-wide. CSA is one of the most traumatic form of maltreatment of children with well documented devastating short- and long-term health consequences manifesting as physical and mental disorders.
Research about child abuse in general and CSA specifically is very scarce in the Arab region especially Egypt. The available research shows that CSA is even more underreported and underestimated than physical child abuse and neglect in general. The first step in treatment of any problem is collection of data which helps us to know the magnitude of the problem so we can deal with it.
This study aimed to examine the incidence, risk factors and pattern of sexual assault to provide grounds for effective preventive measures and to heighten awareness of the health professionals.
The files of all cases of CSA referred to Medico-legal Office and violence against women and children clinic in the Medico-legal department of Ministry of Justice during the study period from 2012 to 2016 were investigated to fulfill the following: demographic data (age, sex, referring authority, and mental state), distribution of number of perpetrators (one or many), relation between the victims and perpetrators, general examination including evidence of general violence, local examination of genitalia and anus, time lapse between last assault and medico-legal examination.
This study included 740 cases of CSA. Females were more predominant than males. Age groups (11-18 years) represented the greatest proportion of cases of CSA while the age group (1-4 years) were the least frequent age group exposed to sexual abuse among the included cases. Female victims were the most predominant in age group (1-4 years) followed by age group (11-18 years), while male victims were more predominant in age group (5-10 years).
Majority of child sexually abused cases were of normal mentality. Friday was the most frequent day of reporting of CSA. El-Salaam was the most common authority of reporting cases of CSA. The least common authority was Bolak-Dakror.
Non-relative perpetrators were more predominant than relative perpetrators of CSA. The most frequent perpetrators were strangers followed by boyfriends but the least frequent perpetrators were grandfather and sister.
The most frequent used threat was physical violence followed by armed threat while the least frequent used force was drug facilitated. Majority of child cases were committed by one perpetrator. Physical violence was more predominant in cases of CSA that were committed by many perpetrators while verbal threat was more predominant in CSA cases that committed by one perpetrator.
Most of child sexually cases that exposed to physical and verbal threat during the sexual assault, gave history of no previous sexual abuse. In contrast to those exposed to sexual abuse without threat or drug facilitated, gave history of many previous sexual abuse.
Majority of child sexually abused cases were examined after the sexual assault by more than one week with greater percentage to age group (11-18 years). Most of child victims that were examined within first three days of the assault were age group (5-10 years). Most of child cases that were examined within first three days of the assault, gave history of no previous sexual assault but those were examined after more than one week, gave history of many previous sexual assault.
Ecchymosis was the most frequent wound in child sexually cases and was more predominant during examination in the first three days. The head and neck were the most common sites of traumatic lesions and the back of the child cases was the least common site that was affected during the assault.
The most frequently reported type of child sexual abuse in that study was anal assault that was more predominant in males than females. Vaginal penetration was the next common type of CSA in all age groups: age group (11-18 years) recorded the highest percentage of them.
Normal anogenital finding during medico-legal examination was the most frequent in all age groups of child cases, age group (1-4years) recorded the highest percentage of normal anogenital finding. Female victims that presented with recent traumatic lesion without penetration of hymen were the least among the examined cases. Injuries in hymen either old or recent and chronic sodomy sign were most predominant in age group (11-18years). Absence of anal injuries during examination was more predominant in female than male in contrast to recent penetration of anus was predominant in male than female.
Majority of female cases that were examined within first week of the assault, presented with intact hymen without traumatic lesions. In contrast to those were examined after more than one week, presented with old penetration of hymen. Most of child victims that were examined after more than one week of the assault, presented with no anal injuries. Recent penetration of hymen or anus more predominant within first three days of assault.
It is recommended to increase public awareness of child sexual abuse and its consequences on both the family and the society. Family doctors and other health professionals should be minded with suspecting signs of CSA and its short and long-term deleterious consequences to refer them to specialized authorities to overcome the delay of reporting and loss of forensic evidence.