Objectives: To determine in a population of children who underwent a medical e xamination after alleged sexual assault the proportion who had unmet medical or psychiatric needs. Design: Retrospective medical record review. Setting: A refer ral center for alleged child victims of sexual assault in Houston, Tex, from Dec ember 1, 2003, through April 30, 2004. Participants: Four hundred seventy-three children (81%girls). Nine children refused all or part of the medical evaluati on. Main Outcome Measure: Diagnoses that warranted intervention at the time of t he medical evaluation. Results: A medical or psychological diagnosis that requir ed intervention as judged by the examiner was made in 123 children (26%) (95%confidence interval, 22%-30%). In 39 children (8%of the total study populatio n) (95%confidence interval, 6%-11%), the diagnosis had the potential to resu lt in significant patient morbidity if not immediately addressed. In contrast, 4 4 children (9%)-(95%confidence interval, 7%-12%) had probable or definite physical or laboratory evidence that supported the allegation of sexual assault. Conclusion: Among children undergoing a medical evaluation after an alleged sex ual assault, important unmet health care needs are at least as common as forensi c findings. Objectives: To determine in a population of children who underwent a medical e xamination after alleged sexual assault the proportion who had unmet medical or psychiatric needs. Design: Retrospective medical record review. Houston, Tex, from Dec ember 1, 2003, through April 30, 2004. Participants: Four hundred seventy-three children (81% girls). Nine children refused all or part of the medical evaluati on. Main Outcome Measure: Diagnoses that warranted Results: A medical or psychological diagnosis that requir ed intervention as judged by the examiner was made in 123 children (26%) (95% confidence interval, 22% -30%). In 39 children (8% of the total study populatio n) (95% confidence interval, 6% -11%), the diagnosis had the potential to resu lt in significant patient morbidity if not immediately addressed. In contrast, 4 4 children (9% ) - (95% confidence interval, 7% -1 2%) had probable or definite physical or laboratory evidence that supported the allegation of sexual assault. Conclusion: Among children undergoing a medical evaluation after an alleged sex assault, important unmet health care needs are at least as common as forensic findings.