During a routine follow-up visit, 428 victims of sexual abuse and their caretakers were asked about genitourinary complaints. Symptoms elicited included vaginal pain, increased urinary frequency, dysuria, and enuresis. A urinalysis was performed for all victims with symptoms, and those with positive or equivocal urinalysis results had a urine culture done. Urinalysis and urine culture were performed on a control group of 53 consecutive asymptomatic victims. Twenty percent (85/428) of the victims complained of one or more genitourinary symptoms. The most common symptom was vaginal pain (51%). Of the symptomatic victims, only 2 had a urinary tract infection. None of the 53 asymptomatic control victims had a urinary tract infection. There was no significant relationship between the presence of genitourinary symptoms and repetitive abuse, genital trauma, vaginal contact, or gender of the victim. However, patients younger than 6 years of age were more likely to have genitourinary symptoms than older patients. These findings indicate that urinary tract symptoms following sexual abuse are common but that urinary tract infection is quite uncommon. Our study does not support routine screening of children for urinary tract infection solely because they have been sexually abused. © 1990, American Medical Association. All rights reserved.