Genital Anatomy in Pregnant Adolescents: “Normal” Does Not Mean “Nothing Happened”

Abstract

ABSTRACT. Many clinicians expect that a history of penile-vaginal penetration will be associated with examination findings of penetrating trauma. A retrospective case review of 36 pregnant adolescent girls who presented for sexual abuse evaluations was performed to determine the presence or absence of genital findings that indicate penetrating trauma. Historical information and photograph documentation were reviewed. Only 2 of the 36 subjects had definitive findings of penetration. This study may be helpful in assisting clinicians and juries to understand that vaginal penetration generally does not result in observable evidence of healed injury to perihymenal tissues. Pediatrics 2004;113:e67-e69. URL: http://www.pediatrics.org/cgi/content/full/113/1/e67; child sexual abuse, genital anatomy, pregnancy, adolescent.A review of the medical literature over the past 15 years regarding genital findings in female children and adolescents evaluated for sexual abuse reveals a number of trends: identification and recognition of congenital anatomic variants has increased 1-3 ; identification and recognition of acute and healed findings of penetrating trauma to the hymen and vagina has decreased 4 ; and the emphasis on recoverable evidence in cases of child sexual abuse has waned. 5,6 For example, in an earlier study of sexually active adolescents, 74% had complete clefts in the posterior half of the hymen, a finding attributed to penile-vaginal penetration. 7 However, a more recent study of 2384 children and adolescents receiving medical examinations for sexual abuse indicated that 96% of the subjects had normal or nonspecific examination findings. 4 Similarly, findings that formerly were attributed to penetrating trauma (eg, partial clefts in the posterior half of the hymen) have now been documented in girls selected and screened for nonabuse. 8 These recent research findings have created questions and controversies not only concerning the interpretation of medical findings but also the potential for misperceptions to occur when presenting a case of child sexual abuse in court. Individuals without medical knowledge and physicians without expertise expect physical evidence to support a history of penile-vaginal penetration and believe that a doctor can determine from a vaginal examination whether a woman-or a child-is a virgin. 9 Although some researchers have suggested that "It's normal to be normal," 10 normal or nonspecific findings on examination can be misinterpreted as meaning "nothing happened." METHODSThe purpose of this study was to summarize the medical history and genital examination findings in 36 adolescents who were pregnant at the time of, or shortly before, their sexual abuse examination. The medical history and photocolposcopic slides were reviewed; patient age, history of consensual sexual contact, gestational age of the fetus, and written documentation of the examination findings were analyzed. All the authors reviewed all the images jointly and were blinded to medical history other than pregnancy status;...

The Evaluation of Sexual Abuse in Children

“…[34][35][36][37][38] In a recent study of pregnant adolescents, only 2 of 36 had evidence of penetration. 39 Occasionally, a child presents with clear evidence of anogenital trauma without an adequate history. Abused children may deny abuse.…”

Assessment of the Relationship Between Sexual Intercourse Route (Oral, Vaginal, Anal) and Medical Examination Findings in Child Sexual Abuse

“…Bunlar; penetre edici genital travma bulguları, saldırga-nın sperm veya semeninin mağdurun vücudundan elde edilmesi, mağdurda cinsel yolla bulaşan hastalıkların tespit edilmesi, cinsel aktivitenin video kayda alınması ve saldırganın itirafıdır. 16 Fizik muayene bulgularının kaybolduğu, iyileştiği veya saptanamadığı durumlarda, ruhsal muayene bulguları cinsel istismarı kanıtlayabilecek tek araç olarak karşımıza çıkmaktadır. Bu nedenle tüm cinsel suç olgularında ruhsal değerlendirmenin muayenenin bir parçası olması ve ruhsal değerlendirmenin sadece suçun niteliği ve cezayı artırıcı yasa maddeleri açı-sından değil, kişinin cinsel dokunulmazlığının ihlal edilip edilmediği açısından tanı koymaya da yardımcı olarak kullanılması gerekmektedir.…”

The emergency management of a rape case in a nutshell: adolescent and adult cases

“…During adolescence, the hymen changes from a sensitive, inelastic structure to being elastic and redundant, forming a structure that has a high probability not to be torn by penetration. [22][23][24] Complete…”