Objectives: To describe the legal outcomes and factors associated with case reaching court and conviction for sexual abuse of children seen at the Philippine General Hospital Child Protection Unit (PGH-CPU) from 1997 to 2000. Methods: Mixed transdisciplinary research design combined longitudinal cohort with qualitative methods. Data were obtained by chart review, in-depth interviews of key informants, and analysis of legal documents. Quantitative data were analyzed with descriptive statistics, bivariate analysis and regression analysis. Qualitative data were inductively coded and classified. Results: Among 486 cases of child sexual abuse included in the study, 61.3% were referred by mandated child abuse report receivers and 15% went to trial. Factors associated with a case reaching the court included: referral source (p less than 0.0001), acute evaluation (p less than 0.001), disclosure involving penetration (p = 0.005), and abnormal anogenital findings (p = 0.00003). The odds of a case reaching court were increased 4.8 times for self-referred patients, 4 times for patients examined acutely, and 2 times more for patients with anogenital injuries. The legal outcomes were: 46.5% unresolved, 30% convicted, 21.8% acquitted, and 1.7% other outcome. The average duration of case resolution was 534 days. In the quantitative study, the doctor's testimony was significantly associated with legal outcome (p = 0.001). In the qualitative study, the child's clear, credible disclosure was the most important determinant of the legal outcome. Conclusions: This study showed a conviction rate in CSA cases that is similar to those of Western countries, and court rulings that primarily relied on children's disclosures. However, the value of having physical findings for cases to reach court was also demonstrated. The experience of the PGH-CPU, where a request for medical evaluation is often the entry point into the child protection system, highlights the role of the medical assessment in "initiating the community response to child abuse" and in delivering justice and protection for abused children. Practice implications: In the Philippine legal system, measures to preserve children's verbal evidence and to prevent the systematic exclusion of sexually abused patients without anogenital injuries from reaching court are needed. The strong association of physician testimony with perpetrator conviction calls for the standardization of the practice of medico-legal evaluation in the country. (Contains 1 figure and 5 tables.)