**1. Introduction**

Child and adolescent sexual abuse (CSA) is a widespread problem not only in the western countries but also in the eastern and middle European countries, as well. Sexual abuse in childhood and adolescence is defined as the involvement of the young individual in a sexual activity that he/she does not fully comprehend or is not developmentally prepared for, or violates the law or social taboos of the society [1,2]. The sexual activities may include all forms of oral-genital, genital, or anal contact by or to the child, or nontouching abuses, such as exhibitionism, voyeurism, or using the child in the production of pornography. Sexual abuse includes a spectrum of activities ranging from rape to physically less intrusive sexual abuse. 'Child sexual abuse is more frequent than childhood cancer, juvenile diabetes, and congenital heart disease combined...' [3].

Various studies have researched the prevalence of child sexual abuse and the international estimates show prevalence rates that are frightening high. It is estimated that 10–20% of girls and 5–10% of boys are victims of child sexual assault [4], according to data collected between 1994 and 2007 in 39 predominance studies from 28 countries. These figures are in accordance with those of previous surveys [5]. In a meta-analysis of 323 studies worldwide, featuring a total of 9.9 million abused children, the worldwide incidence was revealed to be 12.7% (18.0% for girls, 7.6% for boys) [6]. In the USA, where the reporting of child sexual assault is obligatory, 60,000 to 80,000 confirmed cases are reported per year, showing a general decrease [7]. The incidence of child sexual assault is 20% in the UK and Switzerland [8,9], while it is to a certain degree higher in Germany, with 20.1%, and in Spain, with 22% [10,11]. In north European countries, the incidence appeared to be significantly lower: 17% in Norway and 13% in Sweden [12,13].

The literature reports a lifelong association between sexual victimization in childhood and adolescence and chronic mental and physical illness in adulthood [14]. CSA has been related to several negative health problems, including both physical and mental conditions [15–17]. Victims with child maltreatment histories are more likely to manifest greater risk for violent crimes [18], substance use disorders [19], more school discipline problems and suspensions [20], poor long-term intellectual and academic achievement [21], and greater likelihood of becoming a teenage parent [22,23]. There are also significant economic and societal consequences [24]. Women with a history of CSA account for a significantly higher proportion of primary care and outpatient costs than women without any such history [25].

There are limited studies that focus on childhood abuse in middle and eastern European countries. The available data from Hungary are inadequate and in many cases unreported; trustworthy data on the frequency of subtypes of sexual abuse do not exist.

There are no Hungarian National or Country statistics obtainable. The incidence and nature of child sexual abuse in Hungary have not been researched, apart from a recent study that investigated sexual abuse in only female children [26] and some unscientific evidence from split sources.

In Hungary, when a disclosure occurs, the emergency, gynecology and pediatric departments are commonly the portal for entry, and gynecologists (for female victims), pediatricians, and traumatologists (for male victims) are generally the 'first reporters' when sexual abuse is suspected. This is followed by reporting and the involvement of social services and law enforcement. Although reporting of child abuse is not mandatory, in the case of a victim under 18 years of age, legal proceedings can be initiated by the victim's parent, carer or guardian, but not by the doctor.

The aim of this population-based study was to collect data from a Hungarian county with regard to the characteristic features of both male and female child abuse cases in an effort to further understand the extent of the problem, to progress towards reporting, and to approach the services and sugges<sup>t</sup> educational and prevention strategies.
