Changes in hymenal anatomy during examination of prepubertal girls for possible sexual abuse

The assessment of child sexual abuse allegations: using research to guide clinical decision making

“…Examples include when a child becomes pregnant or tests positive for certain sexually transmitted diseases (e.g., syphilis or gonorrhea) that were not acquired perinatally. Similarly, the presence of semen, sperm, or acid phosphatase also provide decisive evidence of abuse (Bays & Chadwick, 1993;Horowitz et al, 1995). This type of evidence, however, is present in only a minority of cases, and therefore the lack of such evidence does little to rule out the possibility that abuse occurred.…”

“…Beyond obvious medical indicators of CSA, there are additional sources of evidence that provide strong evidence of abuse, including certain types of tissue damage, such as tears or deformations of the hymenal rim of prepubescent girls. Many experts (Bays & Chadwick, 1993;Horowitz et al, 1995;Lamb, 1994) argue this type of tissue damage should be viewed as conclusive evidence of sexual trauma. The rationale is that certain types of internal tissue damage are unlikely to be caused by other forms of trauma, including straddle injuries (Lamb, 1994).…”

“…It has been found that, even among experienced medical examiners using colposcopic photographs, not all examiners agree regarding what constitutes an abnormal anogenital exam (Adams & Wells, 1993). Furthermore, dierent examination positions and techniques can create apparent changes in both the appearance of the hymen and the size of the hymenal opening (Bays et al, 1990;McCann, Wells, Simon, & Voris, 1990). These factors make it dicult to argue that tissue damage is as de®nitive of abuse as are pregnancy, syphilis, gonorrhea, or the presence of sperm.…”

Assessments of Girls' Genital Findings and the Likelihood of Sexual Abuse

“…A glo¬ bal characterization of each of the 7 photographs as nor¬ mal, intermediate, or abnormal was generated from the expert panel's ratings of the photographs using a visual ana¬ log scale from 1 (normal) to 5 (abnormal). One photograph with an average rating of 4.8 (range, [4][5] was categorized as abnormal ( Figure 3). Four photographs with average ratings of 2.2 (range, 2-3), 2.2 (range, 1-3), 2.8 (range, [2][3][4], and 3.4 (range, [2][3][4][5], respec¬ tively, were categorized as intermediate ( Figure 2).…”