Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1000-1011 (doi:10.1542/peds.2006-0230)
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ARTICLE

Healing of Nonhymenal Genital Injuries in Prepubertal and Adolescent Girls: A Descriptive Study

John McCann, MD, Sheridan Miyamoto, MSN, FNP, Cathy Boyle, MSN, PNP and Kristen Rogers, PhD

Children's and Adolescent's Research and Evaluation Center (CAARE) Diagnostic and Treatment Center, University of California, Davis, Children's Hospital, Sacramento, California

OBJECTIVE. The objective of this study was to identify the healing process and outcome of nonhymenal injuries in prepubertal and pubertal girls.

METHODS. This multicenter, retrospective project used photographs to document the healing process and outcome of nonhymenal genital injuries in 239 prepubertal and pubertal girls whose ages ranged from 4 months to 18 years.

RESULTS. The genital injuries sustained by the 113 prepubertal girls consisted of 21 accidental or noninflicted injuries, 73 injuries secondary to abuse, and 19 injuries of unknown cause. All 126 pubertal girls were sexual assault victims. These nonhymenal genital injuries healed at various rates depending on the type and severity. There was no statistical difference in the rate of healing between the 2 groups. Abrasions disappeared by the third day after injury. Edema was no longer present by the fifth day. Ecchymosis (bruising) resolved within 2 to 18 days depending on the severity. One prepubertal girl still had a labial hematoma at 2 weeks. Submucosal hemorrhages of the vestibule and fossa navicularis resolved between 2 days and 2 weeks. Petechiae and blood blisters proved useful for approximating the age of an injury. Petechiae were gone by 24 hours, whereas blood blisters were detected at 30 days in a prepubertal girl and 24 days in a pubertal girl. The depth of a laceration determined the time required for it to heal. Superficial vestibular lacerations seemed healed in 2 days, whereas deep perineal lacerations required up to 20 days. The appearance of new blood vessel formation was detected only in prepubertal girls, whereas scar tissue formation occurred only after a deep laceration in both groups.

CONCLUSIONS. The majority of these nonhymenal genital injuries healed with little or no evidence of previous trauma. The time required for resolution varied by type, location, and severity.

Key Words: accidental genital injuries • adolescent sexual assault • child abuse • child sexual abuse • forensic evidence • genital injuries • sexual abuse • sexual assault

Accepted May 21, 2007.


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