Physical signs of child sexual abuse

Also known as the ‘purple book’, this guidance includes good practice in relation to the paediatric forensic examination where there are concerns about child sexual abuse. It also provides an evidenced-based review of the interpretation of physical signs.


In 2015 the RCPCH, in collaboration with the American Academy of Pediatrics (AAP), the Royal College of Physicians of London (RCP) and The Faculty of Forensic and Legal Medicine (FFLM), updated the 2008 RCPCH publication entitled ‘The Physical Signs of Child Sexual Abuse’ based on the best available evidence.

The publication updated previous evidence and included new reviews such as:

  • anogenital signs of accidental injuries in girls and boys
  • genital bleeding in prepubertal girls
  • healing in anogenital injuries.

This publication is to be used by clinicians with specialist child protection skills with specific training and competences in the forensic assessment of children and young people where there are concerns about child physical abuse.

The review is provided free of charge if you are:

  • an RCPCH member and
  • a named or designated doctor for safeguarding children and
  • involved in the forensic medical examination of children for suspected CSA.

Others may purchase a copy through our stockists, Lavenham Press:

  • If you are a member of the RCPCH, Faculty of Foresnic & Legal Medicine (FFLM), Royal College of Physicians (RCP), British Association of Paediatric Surgeons (BAPS), or American Academy of Pediatrics the cost is £35 plus delivery – please contact to request your coupon code which you can use when placing your order
  • For all non-members the cost is £49 plus delivery

You can also pay by cheque; contact / 01787 249 290. You’ll need to make the cheque payable to ‘Lavenham Press Ltd’ and post to Lavenham Press Ltd, Arbons House, 47 Water Street, Lavenham, Suffolk CO10 9RN.

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