Foreword In preparation for crafting the foreword to the fourth edition of Finkel & Giardino’s Medical Evaluation of Child Sexual Abuse: A Practical Guide, I reviewed what I had written for its predecessor. I recalled the 1980s and the explosion of cases of child sexual abuse, some involving multiple victims and many cases sensationalized by headlines in the media or lead stories on the eve- ning news. Many of us became involved in assessing those children, admittedly in the face of an emerging research agenda and a paucity of studies. We did not even have data on normal prepubescent female anatomy and common variants. I mentioned the skepticism that surrounded the abuse disclosed by young chil- dren and that the average time interval between abuse and disclosure had been 8 years. Some of the more notorious cases were very polarizing. Bumper stickers appeared, declaring, “We believe the children.” But neither we physicians nor the children were uniformly believed, and many alleged perpetrators were found not guilty. I can still remember the gasp that that filled the ballroom in San Diego at the child maltreatment meetings in 1990 when David Chadwick announced the startling “not guilty” verdict in the McMartin Preschool case. No doubt, science and forensic assessment of cases of child abuse has pro- gressed significantly since then. The 18 chapters that follow this foreword are a testimony to ongoing scholarly work to help the children as well as the commu- nity. And though we have made significant progress in some domains of child sexual abuse, we are still confronted with victim shame and secrecy and a public that all too often fails to believe those who experienced sexual abuse and assault, be it by a friend, family member, or stranger. It is hard as a child abuse pediatrician not to feel disappointed and discour- aged by high-profile stories in which alleged perpetrators of sexual assault have escaped justice and even attained high levels of power and prestige, while the victims have been disbelieved and pushed aside. Many of us deal daily with young people who have experienced violent assaults. The feelings of many clini- cians caring for these patients was eloquently articulated in an article in STAT by child abuse pediatrician Nina Agrawal, MD. She wrote: I see teenage girls every day who have been sexually assaulted, often by older teenage boys. Sadly, very few of the perpetrators are ever held accountable for the crimes they have committed. Why? The victims have everything to lose by coming forward. A quote commonly attributed to Yogi Berra sums it up: “It’s déjà vu all over again.” Unfortunately, not that much has changed about the credibility afforded to victims of sexual abuse. But now, the good news. We as professionals continue to learn, grow, and improve the care we give our patients. Our successes have been significant.
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