Medical forensic exams for victims of childhood sexual abuse (CSA) can be a helpful resource for addressing patients’ complex medical, psychological, and legal needs. These exams can be performed by physicians or forensic nurses to identify and treat injuries, evaluate the risk for sexually transmitted infections and pregnancy, and collect evidence. In this study, we examined CSA cases treated in a midwestern, community‐based forensic nurse examiner (FNE) program to document rates of anogenital injury and identify what factors predict the presence of such injuries (N= 203). Overall, 39% of the cases had anogenital injury. Victims who were examined for suspected vaginal and/or anal assault were significantly more likely to have anogenital injuries, and patients examined within 24 hours of an assault were also significantly more likely to have documented injuries. Patients who were seen for vaginal and/or anal assaults and who had bathed since the assault were significantly less likely to have injury. Nurses who had less experience with pediatric medical forensic exams were somewhat more likely to document anogenital injuries. Findings suggest that clinical pediatric practice would benefit from additional practitioner training in injury detection to avoid false positives.