Prepubertal Vagina Examination

Prepubertal Vagina Examination

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Pediatrics .

1987 Aug .

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Experience with more than 375 cases of possible sexual abuse has taught us that much work still needs to be done in understanding normal prepubertal female anatomy and interpreting findings in sexual abuse cases. Because pediatric clinicians are often called upon to assess possible sexual abuse victims, knowledge of what is known and how best to examine the genitalia of a young girl is essential. Two cases are discussed that involve normal and abnormal anatomy. Examination techniques for adequate visualization include proper tension and timing with the spreading of the labia in the supine position, the knee-chest position, and lateral traction on the buttocks while lying flat on the abdomen to look for anal relaxation. The hymen, contrary to common notion, is often a slack, thick, folded, stretchable tissue which may persist after digital or penile penetration. Findings secondary to sexual abuse are often subtle. Acute tears or bruising are rare because force is seldom a part of the sexual acts committed against a child. A vaginal opening of greater than 5 mm is not common and may indicate vaginal penetration with a finger, object, or penis. An "intact" hymen does not necessarily preclude vaginal penetration. Lack of physical evidence never rules out abuse because many sexual acts leave no physical findings.

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Frequency:

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Thursday
Friday
Saturday

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Affiliation

1 Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston.

A B Berenson .

Curr Opin Obstet Gynecol .

1994 Dec .

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1 Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston.

Hornor G.
Hornor G.
J Pediatr Health Care. 2010 May-Jun;24(3):145-51. doi: 10.1016/j.pedhc.2008.10.007. Epub 2008 Dec 18.
J Pediatr Health Care. 2010.

PMID: 20417886

Pillai M.
Pillai M.
J Pediatr Adolesc Gynecol. 2008 Aug;21(4):177-85. doi: 10.1016/j.jpag.2007.08.005.
J Pediatr Adolesc Gynecol. 2008.

PMID: 18656071

Review.

Berkowitz CD.
Berkowitz CD.
J Child Sex Abus. 2011 Sep;20(5):537-47. doi: 10.1080/10538712.2011.607752.
J Child Sex Abus. 2011.

PMID: 21970645

Review.

Price J.
Price J.
Best Pract Res Clin Obstet Gynaecol. 2013 Feb;27(1):131-9. doi: 10.1016/j.bpobgyn.2012.08.008. Epub 2012 Nov 10.
Best Pract Res Clin Obstet Gynaecol. 2013.

PMID: 23146342

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McCann J, Miyamoto S, Boyle C, Rogers K.
McCann J, et al.
Pediatrics. 2007 Nov;120(5):1000-11. doi: 10.1542/peds.2006-0230.
Pediatrics. 2007.

PMID: 17974737

Krajewski W, Wojciechowska J, Krefft M, Hirnle L, Kołodziej A.
Krajewski W, et al.
Cent European J Urol. 2016;69(1):112-7. doi: 10.5173/ceju.2016.673. Epub 2016 Mar 21.
Cent European J Urol. 2016.

PMID: 27123337
Free PMC article.

Review.

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For many reasons including the recent increase in the reporting of sexual abuse, more physicians are being asked to perform genital examinations on prepubertal girls. Recent studies have clarified the appearance of structures in this area in nonabused children and demonstrated both acute and chronic changes that may result from trauma.

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Prepubertal Vagina Examination

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