In Reply.—We wish to thank Drs Jason and Kramer for their letter and appreciate the opportunity to respond to their general comments, as well as their specific concerns, about our study.
Most childhood sexual abuse incidents are not reported,1 and most studies of sexual abuse reflect the nature of the population served by individual sexual assault centers.2 As a referral center, more than half of our patients were referred by the police, private physicians, local emergency rooms, social service agencies, or counseling services. We acknowledged the risks of reporting bias and comparison with dissimilar populations within the discussion of our findings.
The first specific concern is how many of the "alleged sexual assaults" were actually sexual assaults. Although it is often difficult to substantiate medically and legally prove complaints, we believe that the history given by the child and/or the physical findings indicated that more than 95%