PEDIATRICS Vol. 85 No. 2 February 1990, pp. 182-187
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Comparison of Genital Examination Techniques in Prepubertal Girls

John McCann MD1, Joan Voris MD1, Mary Simon MD1, and Robert Wells PhD1

1 From the Department of Pediatrics, Valley Medical Center, Fresno, California

The results of three separate methods used to examine prepubertal girls are compared and a technique for measuring hymenal orifice diameters from colposcopic photographs is presented. A total of 172 girls who were examined by three techniques during their evaluation in a clinic for suspected child sexual abuse victims were studied. Their ages ranged from 10 months to 11 years with a mean of 5 years, 8 months. The examination techniques used were the supine position with labial separation, the supine position with labial traction, and the knee-chest position. The knee-chest position (98%) and the supine traction method (96%) proved to be superior to the supine separation technique (86%) in opening the vaginal introitus. The largest vertical transhymenal diameters were produced in the knee-chest position, whereas the greatest transverse horizontal spans were generated by the supine traction procedure. Other soft tissue changes were noted but not quantified. A multimethod approach to the examination of the sexually abused child is recommended to take advantage of the strengths of each technique.

Key Words: sexual molestation • sexual abuse • prepubertal genital examination • hymen • colposcope

Submitted on June 27, 1988
Accepted on March 27, 1989




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