We evaluated the merit of a directive issued by the Tennessee Department of Human Services (TDHS) requesting a medical evaluation for all children who were closely associated with a victim of sexual assault, even if these children denied being victims themselves. In a 6-month period, 247 girls, age 12 and under, were referred for medical evaluation. Of these, 188 were primary victims of sexual abuse, and 59 girls were secondary victims, associates of victims of abuse. All examinations were performed in an office setting. A colposcope was used to magnify the findings. Of these 59 girls, 45 girls were found to have abnormal genital findings. Nonspecific findings were present in 5 girls (8%), and findings considered specific for sexual abuse were observed in 40 girls (68%). When compared with primary victims, secondary victims were more likely to demonstrate genital abnormalities suggestive of sexual abuse. (χ2 = 13.7, p = .0011). Of the 50 secondary victims who were later interviewed by TDHS, 24 girls (48%) reported that they were also victims of assault. We strongly recommend that siblings of sexual abuse victims, as well as other children who are closely associated with them and exposed to the perpetrator, be evaluated to determine whether they have abnormalities suggestive of sexual assault. © 1991.