**2. Methods**

Our population-based study took place in 1 out of 19 Hungarian counties (Szabolcs-Szatmár-Bereg County, inhabitans: 585,000). In this county, there are only four cities, with four hospitals where these cases can be seen. The case notes of sexually abused girls and boys under 18 years, seen at the four hospitals of this county (University Teaching Hospital of Nyíregyháza, University Teaching Hospital of Fehérgyarmat, City Hospital of Mátészalka and the City Hospital of Kisvárda) between 1 January 2000 and 31 December 2015, were reviewed. These are the departments in Szabolcs-Szatmár-Bereg County to which adolescent cases with a suspicion of sexual abuse are referred. The female cases are exclusively referred to the gynecological department of the above listed hospitals; the boys are seen at the pediatric, urological and traumatological departments of these hospitals. Data were collected, recorded and extracted from the files of children who had allegedly experienced CSA and received care and follow-up services. Guidelines for standard management, including the definition of CSA and the purpose and procedure for the examination, were elaborated in detail at these departments.

In our population-based study, sexual abuse includes non-contact sexual abuse, sexual touch, oral sex, sexual penetration, anal sex and sexual exploitation.

The data collected included the age and education of the victim, family relationship between victim and perpetrator, frequency of abuse, type and place of abuse, season of the year and time of day when the abuse occurred, family relationship between victim and person accompanying her/him on presentation at the hospital, the time interval between alleged sexual contact and clinical examination and the findings on the medical examination.

An adolescent gynecologist for females, or a pediatrician, urologist or a traumatologist for males, performed the examination. All cases were managed according to the standard guidelines [27]. We obtained full medical and social histories and conducted physical examinations following a standard protocol. The clinical investigation included a 'head-to-toe' physical examination, assessment of sexual development, identification of any injury with specific reference to colposcopic appearances of the hymenal membrane and surrounding surfaces (girls), identification of any injury on the penis, scrotum and anus (boys), signs of abuse. Diagnosis of a possible pregnancy was ruled out by a urine test or ultrasound examination, collection of forensic evidence (sperm, saliva, other trace evidence) and evaluation for sexually transmitted infections were also part of our examination. Appropriate medical or surgical treatment was provided based on clinical findings. All relevant findings were documented and incorporated into a report and distributed in response to official requests. We analyzed the difference between CSA and rape, emphasizing the diagnostic challenges. The results of the legal proceedings were also recorded. The criminal, judicial and medical records were continuously monitored and compared.

Descriptive analyses were conducted using SPSS (Statistical Package for Social Science, SPSS Inc., Chicago, IL, USA). Estimates of mean value, standard deviation, frequency, *t*-test, Mann-Whitney test, confidence interval and correlation were assessed. Prevalence rates were tested using Pearson's *X*<sup>2</sup> tests. The significance level was kept at 0.05 level.
