A complete cleft was defined as a defect that extended through the entire rim of hymen, all the way to the fossa or vestibular wall. A deep notch was defined as a V-shaped defect extending through more than 50% of the width of the hymen. In a case-control study 8 of prepubertal girls aged 3 to 8 years, only girls who described digital-vaginal or penile-vaginal penetration were found to have deep notches or complete clefts in the posterior rim of the hymen or measurements of the posterior rim of the hymen at the midline less than 1 mm wide. 7 Detailed, magnified, and objective photodocumentation is therefore necessary to adequately compare the appearance of the hymen in girls who have never experienced vaginal penetration (abuse or consensual) with those who admit having had vaginal intercourse. In many centers where children and adolescents are evaluated for possible sexual abuse, photographs are taken with a camera attached to a colposcope to document any abnormal findings. The lack of photographs precludes peer review by blinded experts. While there have been studies to obtain normative data on the appearance of the hymen and other genital tissues in newborn infants and prepubertal girls selected for nonabuse, 3 - 5 the only published study comparing adolescent girls who were consensually sexually active with those who were not 6 did not use magnification, such as a colposcope, and did not use photographs to document the appearance of the hymen. There is a paucity of data available to assist in that determination. The physician performing the examination is then expected to determine whether there has been vaginal penetration. 1 In practice, however, asymptomatic adolescent girls may not undergo a genital examination unless there is suspicion of sexual abuse or previous consensual sexual activity. THE AMERICAN ACADEMY OF Pediatrics, Elk Grove, Ill, recommended in 1989 that all adolescent girls have an external genital examination as part of their physical examination to look for abnormalities of the hymen and other genital tissues. Subjects who admitted past intercourse still had nondisrupted, intact hymens in 52% of cases. Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion.Ĭonclusions Deep notches or complete clefts in the posterior rim of the hymen were rare in girls who denied intercourse. 001), but the mean width of the posterior hymenal rim was not significantly different between the 2 groups (2.5 mm vs 3.0 mm P =. Results Posterior hymenal notches and clefts were more common among girls admitting past intercourse (13/27 ) than in girls who denied intercourse (2/58 P =. The presence of notches or clefts was recorded during the examination, and photographs taken at ×10 magnification were used to take measurements of the width of the posterior hymenal rim. External genital inspections were performed using a colposcope with an attached 35-mm camera to document the appearance of the hymen. Methods Subjects were interviewed in private after completing detailed questionnaires and then underwent a physical examination. Subjects Female patients aged 13 to 19 years, recruited from an urban adolescent medicine practice. Objective To compare the morphology of the hymen in adolescent girls who have and have not had sexual intercourse involving penile-vaginal penetration.
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