PEDIATRICS Vol. 79 No. 5 May 1987, pp. 778-785
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Genital Findings in Sexually Abused, Symptomatic and Asymptomatic, Girls

S. Jean Emans MD1, Elizabeth R. Woods MD, MPH1, Nancy T. Flagg MD1, and Amanda Freeman MD1

1 From the Divisions of Adolescent/Young Adult Medicine and Gynecology, Departments of Pediatrics and Surgery, Harvard Medical School and The Children's Hospital, Boston

Although evaluation of the vulva of sexually abused girls using magnification with a colposcope or pediatric otoscope has become increasingly popular, the incidence of various genital findings in sexually abused and asymptomatic children has not been reported. A prospective study was carried out in which 20 genital findings from three groups of girls (mean age 4.8 ± 2.6 years) were analyzed. The three groups were (1) sexually abused girls (n = 119), (2) normal girls with no genital complaints (n = 127), and (3) girls with other genital complaints (n = 59). Group 1 was more likely than group 2 to have scars on the hymen or posterior forchette (9% v 1%, P = .002), increased friability of the posterior forchette (10% v 1%, P = .001), attenuated hymen (18% v 4%, P = .0003), and synechiae from the hymenal ring to the vagina (8% v 0%, P = .0009). Groups 1 and 3 were remarkably similar with the exception of erythema which was more common in group 3 (34% v 68%, P = .0001). Hymenal diameter was slightly greater in group 1 than 2 but not 3. Although genital findings distinguish some sexually abused girls from asymptomatic girls, many findings also occur in girls with other genital complaints, which suggests that many of these girls have also been molested or that vulvar inflammation may lead to some of these findings.

Key Words: sexual abuse • hymen • genital examination

Submitted on April 14, 1986
Accepted on June 27, 1986




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