Incident estimates of sexual abuse in children and adults in the United States range from 6% to 74%, depending on case findings and documentation methods. A past history of abuse can put the patient at risk of developing physical and psychological sequelae including fear of medical procedures. Invasive procedures such as endoscopy and colonoscopy may further exacerbate fears and provoke stress reactions in patients with a past history of abuse. Although patients may not disclose a past history of abuse, their reactions during the procedure may provide cues for the healthcare team. This article reviews the need for a careful assessment and intervention during endoscopy procedures for patients with a past history of abuse. Guidelines for compassionate care and follow-up are discussed.