PEDIATRICS Vol. 90 No. 2 August 1992, pp. 265-272
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kerns, D. L.
Right arrow Articles by Thomas, R. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kerns, D. L.
Right arrow Articles by Thomas, R. G.

Concave Hymenal Variations in Suspected Child Sexual Abuse Victims

David L. Kerns MD1, Mary L. Ritter CHA, PA-C1, and Ronald G. Thomas PhD2

1 From the Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA
2 From the Division of Biostatistics, Stanford University School of Medicine, Stanford, CA

The purpose of this study was to describe and analyze the characteristics of, and the clinical correlates to, concave hymenal variations in a large number of suspected child sexual abuse victims. Thirteen hundred eighty-three female child and adolescent suspected sexual abuse victims were comprehensively evaluated. Photocolposcopy was used for the anogenital examinations. Concave hymenal variations were found in 174 patients (12.6%). Sixty-one (35.1%) were anterior. Of these, 40 (65.6%) were curved and smooth, and 21 (34.4%) were angular and/or irregular. One hundred (57.5%) were posterior/lateral. Of these, 33 (33%) were curved and smooth, and 67 (67%) were angular and/or irregular. Thirteen patients (7.5%) had multiple hymenal concavities. Posterior/lateral location was associated with penile-vaginal contact (P = .004), penetration (P = .006), stranger perpetrator (P = .032), hymenal rim narrowing (P < .001), and posterior fourchette abnormality (P = .049). Angular and/or irregular features were associated with penile contact (P = .005), vaginal contact (P = .035), penile-vaginal contact specifically (P < .001), penetration (P = .046), abnormal general physical examination (P = .018), and hymenal rim narrowing (P < .001). Logistic regression analysis demonstrated that age-specific prevalence trends for posterior/lateral (P < .001) and angular and/or irregular (P = .011) concavities were consistent with acquired anatomic findings. An interobserver exercise with five "blinded" raters evaluating photographs of 49 patients showed significant agreement among observers in sorting posterior/lateral and angular concavities into the diagnostic categories "suggestive of trauma" and "trauma." Multiple lines of evidence support the hypotheses that concavity characteristics of posterior/lateral location, angular contour, and rim irregularity are associated with prior hymenal trauma.

Key Words: sexual abuse • concave hymenal variations • hymenal trauma

Submitted on November 19, 1991
Accepted on January 29, 1992




This article has been cited by other articles:


Home page
 PediatricsHome page
J. McCann, S. Miyamoto, C. Boyle, and K. Rogers
Healing of Hymenal Injuries in Prepubertal and Adolescent Girls: A Descriptive Study
Pediatrics, May 1, 2007; 119(5): e1094 - e1106.
[Abstract] [Full Text] [PDF]

Home page
 Child MaltreatHome page
J. A. Adams
Evolution of a Classification Scale: Medical Evaluation of Suspected Child Sexual Abuse
Child Maltreat, February 1, 2001; 6(1): 31 - 36.
[Abstract] [PDF]