Preface We are very pleased to offer a revised and expanded fourth edition of Medical Evaluation of Child Sexual Abuse: A Practical Guide. This edition reflects almost 30 years of collaboration of the coeditors of this book. We have been very fortunate to see our baby grow from a small manual to a comprehensive and yet practical clinical resource. Our book has stood the test of time and matured into what we believe to be one of the few books that could be said to be a standard reference text for the field. Its strength is rooted in the exceptional contributors who all are experts in the field of child maltreatment and bring great academic and clinical expertise to their chapters. As coeditors, we made a decision that the fourth edition will set the stage for the next generation of child abuse pediatricians (CAPs) to share their expertise. Readers will see new names paired with the familiar as this book transitions to the next generation of leaders in our field. There have been significant changes in the format of this edition with major revisions throughout. We are honored to have this book published by the American Academy of Pediatrics (AAP). In 1991, our first guide and precursor to this textbook on the medical evaluation of children who have been sexually abused was published. At that time, our understanding of the sexual victimiza- tion of children was still in its infancy. And although we have made great strides in public awareness of child sexual abuse (CSA), the problem is still of epidemic proportions. The provision of anticipatory guidance by primary care physicians is still not routine. Communities are much more resourced around the country to respond to allegations of sexual abuse, but those resources are limited and need to be bolstered. There is now the recognition that CSA is an adverse childhood experience and that there is clearly not just a cost to the child but also an economic cost to society when we fail to provide the diagnos- tic and treatment services that children who have been victimized need and deserve. We hope that this edition will provide new insights into how best to meet the needs of children when CSA is suspected and respond in a way that meets the diagnostic and treatment needs of child victims. Since the time of the last edition, child abuse pediatrics has been established as a recognized subspecialty of pediatrics. Child abuse pediatricians have become integral to the work of child protection, but many communities lack access to this level of expertise. We have enhanced our collective understanding of the sexual victimization of children and our response when these concerns arise. The impact of our increasing evidence base and professional skill devel- opment has dramatically improved our diagnostic acumen, improved the pro- tection and prevention of CSA, and refined our therapeutic intervention. It is truly heartening to see the systems designed to recognize sexual abuse and then investigate allegations in a manner that is informed and sensitive to vic- tims’ special needs becoming steadily more accessible throughout the United
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