Appearance of the Genitalia in Girls Selected for Nonabuse

Heger, Astrid; Ticson, Lynne; Guerra, Lisa; Lister, Julie; Zaragoza, Toni; McConnell, G.; Morahan, Mary

doi:10.1016/s1083-3188(01)00136-x

Cited by 83 publications

(11 citation statements)

References 8 publications

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“…The vaginal canal extends internally from the hymen to the cervix. It is rare that the hymen covers the vaginal orifice completely (“imperforate hymen”) [12, 13], and the reported prevalence of this condition varies from approximately 1 case per 1000 population to 1 case per 10,000 population [13].…”

Section: Commonly Encountered Myths Involving the Hymenmentioning

confidence: 99%

“…The hymen’s appearance can also be distinguished by the presence of polyps, tags, ridges, bands, and notches, and there is no standardized hymeneal appearance for young girls, adolescents, or adult women. Different configurations of the hymen exist, and include, most commonly: annular (also known as circumferential), crescentic, and fimbriated (with finger-like projections) [12, 14, 15].…”

Section: Commonly Encountered Myths Involving the Hymenmentioning

confidence: 99%

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The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault

et al. 2019

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Conclusions about women’s and girls’ sexual history are made in some settings based on assumptions about the hymen, a small membranous tissue with no known biological function, which typically occupies a portion of the external vaginal opening in females. Clinicians, however, continue to refer to changes in the hymen to assess for a history of consensual or nonconsensual sexual intercourse. We reviewed published evidence to dispel commonly held myths about the hymen and its morphology, function, and use as evidence in cases of sexual violence. An examination of the hymen is not an accurate or reliable test of a previous history of sexual activity, including sexual assault. Clinicians tasked with performing forensic sexual assault examinations should avoid descriptions such as “intact hymen” or “broken hymen” in all cases, and describe specific findings using international standards and terminology of morphological features. We call on clinicians to consider the low predictive value of a hymen examination and to: 1) avoid relying solely on the status of the hymen in sexual assault examinations and reporting; 2) help raise awareness of this issue among their peers and counterparts in law enforcement and the judicial system; and 3) promote fact-based discussions about the limitations of hymenal examinations as part of clinical education for all specialties that address the sexual or reproductive health of women and girls. Electronic supplementary material The online version of this article (10.1186/s12978-019-0731-8) contains supplementary material, which is available to authorized users.

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Section: Commonly Encountered Myths Involving the Hymenmentioning

confidence: 99%

Section: Commonly Encountered Myths Involving the Hymenmentioning

confidence: 99%

The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault

et al. 2019

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“…We need to emphasize that CSA-specific findings are only found in a minority of CSA victims (4–5%) when examined over 72 h after the last abuse [1, 2, 21, 22, 38, 49], due to the rapid healing of mucous tissue. Accordingly, in 95%, there are no physical findings at anogenital examination in children examined 48 h or more after the abuse [1, 2].…”

Section: What Makes It So Difficult To Recognize Csa In Children?mentioning

confidence: 99%

“…As stated above, only few physical findings are highly suggestive of sexual abuse [ 3 ]. The absence of physical findings never excludes CSA [ 1 , 2 , 21 , 22 , 38 , 49 ]. In any case of alleged CSA, a thorough anogenital examination should be performed, especially if the child reports anogenital complaints [ 26 ].…”

Section: What Makes It So Difficult To Recognize Csa In Children?mentioning

confidence: 99%

Clinical practice: recognizing child sexual abuse—what makes it so difficult?

et al. 2018

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Recognizing child sexual abuse (CSA) in children is difficult, as there can be many hurdles in the assessment of alleged CSA. With this paper, we try to improve the recognition of CSA by discussing: (1) the difficulties regarding this matter and (2) the diagnostic evaluation of alleged CSA, combining both practical clinical recommendations based on recent research. Children are restrained to disclose CSA due to various reasons, such as fears, shame, and linguistic or verbal limitations. Associations between CSA and urogenital or gastrointestinal symptoms, internalizing and externalizing behavioral problems, post-traumatic stress symptoms, and atypical sexual behavior in children have been reported. However, these symptoms are non-specific for CSA. The majority of sexually abused children do not display signs of penetrative trauma at anogenital examination. Diagnosing a STI in a child can indicate CSA. However, other transmission routes (e.g., vertical transmission, auto-inoculation) need to be considered as well.Conclusion: The assessment consists of medical interview and child interview (parents and child separate and together) with special attention to the child’s development and behavior (problems), psychosocial situation and physical complaints, the child’s mental health, and the child’s trauma history; anogenital examination should be done in all cases of alleged CSA. The examination should be documented by photo or video graphically. Recent research suggests that videography may be the preferred method, and testing on STIs. The assessment should be done multidisciplinary by experienced professionals. Health-care professionals who care for children need to know how child protective agencies and law enforcement are organized. In case there are concerns about a child’s safety, the appropriate authorities should be alarmed.What is Known:• Sexual abuse in children often remains unrecognized in the majority of cases.What is New:• Research suggests that videographic documentation is preferred above photographic documentation for anogenital examination; observations of children’s behavioral reactions during examinations might be valuable in the evaluation of suspected sexual abuse; nucleic acid amplification testing can be used on vaginal swabs or urine samples for chlamydia and gonorrhea; the CRIES-13 and the CAPS-CA can be used to assess trauma-symptoms in children after sexual abuse.

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“…Among these anomalies, imperforate hymen is the most common anomaly with an incidence of 1/1,000 to 1/10,000 [2]. Transverse vaginal septum (TVS) with a prevalence of 1 in 30,000 to 1 in 80,000 women is more rare than imperforate hymen [3].…”

Section: Introductionmentioning

confidence: 99%

Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

Dilbaz

Altınbaş

Altınbaş³

et al. 2014

Case Reports in Obstetrics and Gynecology

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A 13-year-old patient with a complaint of worsening lower abdominal pain during the past 4 months was admitted to the emergency department. An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos. Imperforate hymen was observed on examination of the external genitalia. MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina. Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected. Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to proceed to laparotomy. Pus with peritoneal microabscess formations was observed at laparotomy. The imperforate hymen and TVS were excised vaginally. A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach.

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Appearance of the Genitalia in Girls Selected for Nonabuse

Cited by 83 publications

References 8 publications

The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault

The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault

Clinical practice: recognizing child sexual abuse—what makes it so difficult?

Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

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