Journal of Pediatric and Adolescent Gynecology
Volume 21, Issue 4 , Pages 177-185 , August 2008

Genital Findings in Prepubertal Girls: What Can Be Concluded from an Examination?

  • Mary Pillai, MB, ChB, FRCOG, MRCPCH, MRCP(UK), MD

      Affiliations

    • Corresponding Author InformationAddress correspondence to: Mary Pillai, Cheltenham, Cheltenham General Hospital, UK GL53 7AN

References 

  1. Cantwell HB. Vaginal inspection as it relates to child sexual abuse in girls under thirteen. Child Abuse Negl. 1983;7:171
  2. Hobbs CJ, Wynne J. Child sexual abuse—an increasing rate of diagnosis. Lancet. 1987;ii (8563):837
  3. Hobbs CJ, Wynne JM. Sexual abuse of English boys and girls: The importance of anal examination. Child Abuse Negl. 1989;13:195
  4. Hobbs CJ, Wynne JM, Thomas AJ. Colposcopic genital findings in prepubertal girls assessed for sexual abuse. Arch Dis Child. 1995;73:465
  5. Adams JA. Approach to the Interpretation of Medical and Laboratory Findings in Suspected Child Sexual Abuse: A 2005 Revision. The APSAC Advisor Summer. 2005;7:
  6. Herman-Giddens ME, Frothingham TE. Prepubertal female genitalia: examination for evidence of sexual abuse. Pediatrics. 1987;80:203
  7. Adams JA, Harper K, Knudson S, et al. Examination findings in legally confirmed child sexual abuse: it's normal to be normal. Pediatrics. 1994;94:310
  8. Heger A, Ticson L, Velasquez O, et al. Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Negl. 2002;26:645
  9. Pillai M, Paul S. Facilities for complainants of sexual assault throughout the United Kingdom. J Clin Forensic Med. 2006;13:164
  10. Pillai M. An evaluation of ‘confirmatory’ medical opinion given to English courts in 14 cases of alleged child sexual abuse. J Forensic Legal Med. 2007;14:503
  11. Jenny C, Kuhns MLD, Arakawa F. Hymens in newborn female infants. Pediatrics. 1987;80:399
  12. Berenson AB, Heger A, Andrews S. Appearance of the hymen in newborns. Pediatrics. 1991;87:458
  13. Al Herbish AS: The hymen morphology in normal newborn Saudi girls. Ann Saudi Med. 2001;21:188
  14. Mor N, Merlob P. Congenital absence of the hymen only a rumor?. Pediatrics. 1988;82:679
  15. Berenson AB. Appearance of the hymen at birth and at one year of age: a longitudinal study. Pediatrics. 1993;91:820
  16. Berenson AB. A longitudinal study of hymenal morphology in the first 3 years of life. Pediatrics. 1995;95:490
  17. Berenson AB, Grady JJ. A longitudinal study of hymenal development from 3 to 9 years of age. J Pediatr. 2002;140:600
  18. Pokorny SF. Configuration of the prepubertal hymen. Am J Obstet Gynecol. 1987;157:950
  19. Goff CW, Burke KR, Rickenback C, et al. Vaginal opening measurement in prepubertal girls. Am J Dis Child. 1989;143:1366
  20. McCann J, Wells R, Simon M, et al. Genital findings in prepubertal girls selected for nonabuse: a descriptive study. Pediatrics. 1990;86:428
  21. Gardner JJ. Descriptive study of genital variation in healthy, nonabused premenarchal girls. J Pediatr. 1992;120:251
  22. Berenson AB, Heger AH, Hayes JM, et al. Appearance of the hymen in prepubertal girls. Pediatrics. 1992;89:387
  23. Heger A, Ticson L, Guerra L, et al. Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and non-specific findings. J Pediatr Adolesc Gynecol. 2002;15:27
  24. Myhre AK, Berntzen K, Bratlid D. Genital anatomy in non-abused preschool girls. Acta Paediatr. 2003;92:1453
  25. Emans SJ, Wood BR, Flagg NT, et al. Genital findings in sexually abused, symptomatic and asymptomatic girls. Pediatrics. 1987;79:778
  26. White ST, Ingram DL, Lyna PR. Vaginal introital diameter in the evaluation of sexual abuse. Child Abuse Negl. 1989;13:217
  27. Lillibridge C, Kappes B. Quantitative observations of hymens in prepubescent females selected for non-abuse. Alaska Med. 1993;35:160
  28. Ingram DM, Everett VD, Ingram DL. The relationship between the transverse hymenal orifice diameter by the separation technique and other possible markers of sexual abuse. Child Abuse Negl. 2001;25:1109
  29. Berenson AB, Chacko MR, Wiemann CM, et al. A case control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol. 2000;182:820
  30. Berenson AB, Chacko MR, Wiemann CM, et al. Use of hymen measurements in the diagnosis of previous penetration. Pediatrics. 2002;109:228
  31. Paradise JE. Predictive accuracy and the diagnosis of sexual abuse: a big issue about a little tissue. Child Abuse Negl. 1989;13:169
  32. Bays J, Chadwick D. Medical diagnosis of the sexually abused child. Child Abuse Negl. 1993;17:91
  33. Cantwell H. Update on vaginal inspection as it relates to child sexual abuse in girls under thirteen. Child Abuse Negl. 1987;11:545
  34. McCann J, Voris J, Simon M, et al. Comparison of genital examination techniques in prepubertal girls. Pediatrics. 1990;85:182
  35. Berkowitz CD, Elvik SL, Logan M. A simulated “acquired” imperforate hymen following the genital trauma of sexual abuse. Clin Pediatr (Phila). 1987;26:307
  36. Finkel M. Anogenital trauma in sexually abused children. Pediatrics. 1989;84:317
  37. McCann J, Voris J, Simon M. Genital injuries resulting from sexual abuse: A longitudinal study. Pediatrics. 1992;89:307
  38. Boos S. Accidental hymenal injury mimicking sexual trauma. Pediatrics. 1999;103:1287
  39. Heppenstall-Heger A, McConnell G, Ticson L, et al. Healing patterns in anogenital injuries: a longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics. 2003;112:829
  40. McCann J, Miyamoto S, Boyle C, et al. Healing of hymenal injuries in prepubertal and adolescent girls: a descriptive study. Pediatrics. 2007;119:e1094
  41. Boos SC, Rosas AJ, Boyle C, et al. Anogenital injuries in child pedestrians run over by low-speed motor vehicles: four cases with findings that mimic child sexual abuse. Pediatrics. 2003;112:77
  42. Paul DM. The medical examination in sexual offences against children. Med Sci Law. 1977;17:251

PII: S1083-3188(07)00266-5

doi: 10.1016/j.jpag.2007.08.005

Journal of Pediatric and Adolescent Gynecology
Volume 21, Issue 4 , Pages 177-185 , August 2008

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