Background: Sexual abuse toward children and adolescents has a much too common occurrence that results in harm to millions of children, boys and girls alike, in large and small communities, and across a range of cultures and socioeconomic backgrounds. Objective: To recognize the number of alleged child sexual abuse cases in Al-Sharqia Governorate in Arab republic of Egypt during a period of time of one year extending from the beginning January to the end of December, 2020. Patients and Methods: The present work was a prospective study that included 90 alleged child sexual abuse cases referred to the Forensic Medicine Authority, Al-Sharqia Governorate in Egypt for one year. Children were interviewed regarding the circumstances of the assault. General and local examination (examination of the genitalia and anal region with legal documentation) were done and documented. Results: Our study showed that female victims were more than males (56 cases: 62.3% versus 34 cases: 37.7%) with predominance of adolescents female (34.3%, 31 cases), higher in rural than urban areas.  Interfamilial perpetrators represented only 12.2 %, while extra familial perpetrators were the main perpetrators neighbors (37.8 %), strangers (30%) and adult friends (20%). Vaginal penetration was the highest sexual assault, especially among adolescent group (>12y), while anal penetration was significant among school age (6-12 y). Conclusion: Sexual abuse of young children was extremely under-reported in Al-Sharqia Governorate.    Abuse was often committed by close persons that exposed the child to endless cycles of violence. The assessment of sexual abuse among young children was a challenging, and cautious interpretation of findings was mandatory. It is important to teach and encourage children to tell their caregivers about any person who tried to sexually abuse them. It is essential to increase public awareness of child abuse in addition; physicians in primary health care facilities and hospital centers should be educated regarding suspected signs of child abuse.