Introduction Child sexual abuse (CSA) is a serious violation of human well-being and of the law. It is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races and socioeconomic classes. CSA is outlawed nearly everywhere in the world, generally with severe criminal penalties, including, in some jurisdictions, life imprisonment or capital punishment 
Aim of the study to examine the incidence, risk factors and pattern of sexual assault in children to provide grounds for effective preventive measures and to heighten awareness of the health professionals. 
Methods This is both retrospective and prospective study evaluating sexual assault against children that were referred to Medico-legal Office and violence against women and children clinic in the Medico-legal department of Ministry of Justice, Cairo, Egypt from 2012 to 2016. 
Results The total number of CSA cases was 740 in the age range from 1 to18 years, females 391 (52.8%) were more predominant than males 349 (47.2%). The age group from 11 to 18 years accounted for the highest rate (56%), mostly in females (62.6%). El-Salaam was the most common district of reporting cases of child sexual abuse (9.7%). Most CSA cases were committed by single perpetrator (87 %) and most perpetrators were non-relative (89.1%).The most frequently reported type of child sexual abuse was anal assault (55%). Physical violence (27.7%) was the most common threat used against child cases. Majority of cases were examined after the sexual assault by more than one week (40.4%). Ecchymosis (6.1%) was the most frequent wound seen upon examination of CSA cases. Head and neck were the most common site of traumatic lesions (5.1%). 
Conclusions 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