Abstract
Introduction
Interpretation of genital findings is a key component of the medical examination for
suspected child sexual abuse. This study seeks to review the extent of evidence-based
research on genital findings in prepubertal girls.
Methods
Literature review on normal genital anatomy in non-abused girls, case control studies
comparing abused and non-abused girls, and observations of healing where the mechanism
of injury is documented.
Results
A prolific literature exists on children examined for suspected abuse. By comparison
there is a very little literature on children screened for non-abuse. Primary data
on normal genital anatomy in girls after the neonatal period was found in 10 papers
of non-abused girls and 6 case-control studies. The screening methods used to ensure
that only non-abused children were assigned to non-abused groups were of variable
standards. The evidence base on prepubertal girls selected for non-abuse using robust
methodology is very small. The evidence base on healing of documented genital injury
is contained in two case series, and a small number of case reports. Almost the entire
evidence base on prepubertal genital anatomy in girls is derived from the USA.
Conclusions
Knowledge of the American studies and the limited extent of the total evidence base
are essential to interpretation. A posterior rim of hymen measuring at least 1 mm is always present unless there has been trauma. There is such a wide range of normal
hymen orifice size, that measurements are generally unhelpful. Genital injuries generally
heal rapidly and most heal without residua. Hymen healing does not leave scarring,
but scarring or vascular changes may occur to surrounding tissues. Except for deep
lacerations hymen injury leaves no evidence of trauma. A full thickness transection
through the posterior hymen is reliable evidence of trauma and does not heal without
surgical repair.
Key Words
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© 2008 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
