Sir.—Drs Dershewitz and colleagues1 have shared some very impressive pictures of herpetic vulvovaginitis in an 8-year-old girl. As stated, "Child abuse should be considered in these patients." More importantly, child sexual abuse must be considered in these patients. Although difficult to determine accurately from the illustrations, there appears to have been significant trauma to the posterior forchette, the hymen, and the anus. These findings would support child sexual abuse as the underlying problem in this patient.
Kaplan et al,2 in the same issue, described genital herpes simplex in children and made the point that herpes simplex virus infection in children is "frequently sexually transmitted and should always be considered a possible indicator of child abuse." The diagnosis of sexual abuse must be considered; if not, the diagnosis will never be made. While it may be reassuring to the physician to see resolution of the herpetic lesions and the