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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.
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*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.
© 1988 Springer-Verlag New York Inc. Published by Elsevier Inc. All rights reserved.