Sexual abuse is a significant issue in child and youth health, often imposing an immediate and serious effect on child health and serious long term consequences on adulthood. The extreme variability of observable signs of possible child sexual abuse can range from the vague to the clear cut and this has led to the fact that allegations of sexual abuse are frequently contested. The great number of variables to be taken into consideration in the procedure of decision making renders the substantiation process very complicated for the cases of suspected child sexual abuse. This book explores all the aspects related to the problem of false allegations and misdiagnoses of CSA. Starting from a bibliometric research exploring the main trends and characteristics of the international literature on CSA, a synthesis of current updated evidences and a review of all available case reports published, the issue is tackled considering all possible factors that may influence the professionals in arriving to a decision as to whether or not a child has been sexually abused and in integrating empirical research to help guide their decision-making process.