Objective: To explore the status and associated factors of the knowledge and health education needs about child sexual abuse of middle school students by sex, so as to provide a basis for targeted safety education of preventing child sexual abuse. Methods: From June to July 2023, 1 256 junior high school students from 2 middle schools in southern area of Shaanxi Province were selected by a convenience sampling method. A selfdesigned general information questionnaire, Childrens Sexual Assault Cognition Questionnaire, and Health Education Needs Questionnaire were used for questionnaire survey. Group comparisons were conducted using ttests, analysis of variance, and Chisquare tests. Multiple linear regression analysis was used to explore the factors related to cognitive scores of sexual assault, and binary Logistic regression analysis was used to explore the factors related to the willingness of middle school students to receive sexual assault safety education. Results: The correct response rate of the participants for knowledge of sexual assault cognition (CSA) was (80.97±12.09)%. For each item, the correct response rate ranged 46.7%-97.2%. The correct rate (78.98±12.23)% of male students knowledge of CSA was lower than female students (83.17±11.55)% statistically (t=-6.23, P<0.01). The factors influencing the participants knowledge of CSA included gender (β=0.16), mothers occupation (β=0.07) and experience of CSA safety education (β=0.10) (P<0.05). Most students (92.7%) were willing to receive CSA education. Girls (OR=1.72, 95%CI=1.06-2.77) and students who previously received CSA education (OR=6.98, 95%CI=4.44-10.96) had more willingness to receive CSA education (P<0.05). A total of 71.8% of middle school students preferred their parents as educators, while 43.4% of students chose onsite instruction as the preferred method of CSA education. Conclusions Middle school students have a strong willingness to accept CSA safety education. Knowledge of CSA and willingness to receive CSA safety education are related to gender and previous educational experience.