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Abstract
The vast majority of problems confronting the clinician who sees prepubertal children
with genital complaints involves interpretation of developmental and acquired anatomic
variations. The objective of this study is to describe the physical attributes of
a case series of 265 prepubertal hymens in terms of reason for visit, age of the child,
hymenal configuration, and other anatomic genital lesions. The patients were from
a triethnic urban population and were referred to a university-based pediatric and
adolescent gynecology clinic. All patients were seen, and their records reviewed,
by one physician (SFP). Type of hymenal configuration did not differ by age or ethnic
group. Perineal injuries did not seem to be associated with hymenal changes. Bleeding
without a history of trauma was associated with hymenal bumps or breaks suggestive
of trauma (31%) or with other hemorrhagic vulvar or genital lesions (40%). Although
the majority of cases in this series were seen for “possible sexual abuse” and/or
sexually transmitted diseases, 24% required gynecologic knowledge for diagnosis over
and above the vulvovaginitis group (20%). In conclusion, this study supports the need
to improve our skills in describing and ultimately interpreting prepubertal hymens
and their alterations.
Key Words
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References
- The microscopic anatomy of the hymen.Anat Ree. 1964; 149: 313-318
- Forensic evaluation of the sexually abused child.Pediatrics. 1986; 78: 385-398
- Gray's Anatomy of the Human Body. 27th ed. Lea & Febiger, Philadelphia1959: 1381
- Practical pediatric and adolescent gynecology. Marcel Dekker, New York1980: 4-5
- Types of hymen in the newborn infant.Eur J Obstet Gynecol Reprod Biol. 1986; 22: 225-228
- Prepubertal female genitalia: examination for evidence of sexual abuse.Pediatrics. 1987; 80: 203-208
- Configuration of the prepubertal hymen.Am J of Obstet Gynecol. 1987; 157: 950-956
- Genital findings in sexually abused, symptomatic and asymptomatic, girls.Pediatrics. 1987; 79: 778-785
- Statistical Methods for Rates and Proportions. 2nd ed. John Wiley & Sons, New York1981
Article info
Footnotes
*This paper was presented in part at the Second Annual Meeting of the North American Society for Pediatric and Adolescent Gynecology held in Cleveland, OH Sept. 1987.
Identification
Copyright
© 1988 Springer-Verlag New York Inc. Published by Elsevier Inc. All rights reserved.
