Several methodological issues, however, existed with this investigation. Methods The sexual abuse evaluation clinic staffed by pediatricians from the University of Arizona, Tucson, serves as the only specialty clinic in the region of about population, providing nonemergency medical evaluations for suspected child victims of sexual abuse. One study had lack of control over the examination and little detail on injury classification procedures and therefore was not included in this review Crane, In general, most children are referred to a sexual abuse clinic because they have made a disclosure of abuse. No investigators using state-of-the-art examination techniques and a rigorous classification system for genital injury severity have studied the criminal justice outcomes following sexual assault. This determination is critical in addressing the safety needs of a child and providing appropriate treatment. LOCATION OF GENITAL INJURY The most common locations for genital injury in female teenagers and women are the posterior fourchette tense band of tissue that connects the two labia minora , labia minora two thin inner folds of skin within the vestibule of the vulva , hymen thin membrane composed of connective tissue that overlies the vaginal opening , and fossa navicularis shallow depression located on the lower portion of the vestibule and inferior to the vaginal opening Grossin et al. For the missing item, see the original print version of this publication. Behavior changes and sexualized play have been described as early warnings of child sexual abuse, 2 and physicians and others have been urged to consider the possibility of sexual abuse as a cause. This may mean that these agencies were not notified until later in the disclosure process after other warning signs were evident. Only one third of children with significant findings unrelated to abuse were referred because of a physical finding. Alternatively, the presenting symptoms may have persisted, and the assessment in the sexual abuse clinic differed from that of the referral source. Several of the cited studies indicate that new avenues of investigation, such as refined measurement strategies for injury severity and skin color, may lead to advancements in health care, forensic, and criminal justice science.