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Post-publication Peer Reviews to:

ARTICLES: John McCann, Sheridan Miyamoto, Cathy Boyle, and Kristen Rogers Healing of Hymenal Injuries in Prepubertal and Adolescent Girls: A Descriptive Study Pediatrics 2007; 119: e1094-e1106 [Abstract] [Full text] [PDF]

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Clarification?

James K. Ribe, M.D.   (29 May 2007)

Re: Clarification?

John J McCann, Sheridan Miyamoto, Cathy Boyle, and Kristen Rogers   (1 October 2007)

Clarification? 29 May 2007
James K. Ribe, M.D., Coroner Los Angeles County Send letter to journal: Re: Clarification? jribe{at}coroner.co.la.ca.us James K. Ribe, M.D.	How do we square the authors' "conclusions" on the first page ("left no evidence of a previous injury") with the last sentence of their "conclusions" on the last page, which cautions against interpreting the residual findings as normal? Would it be correct to divide the interpretation of such residual findings into two different situations -- the situation where there has been a documented previous laceration at the site of the residual finding, and the situation where there has not? The authors' final sentence seems to mean that in the former situation, the residual findings can be interpreted as being consistent with a previous injury, while in the latter situation, they can be interpreted as normal. Conflict of Interest: None declared
Re: Clarification? 1 October 2007
John J McCann, Retired University of California, Davis, Sheridan Miyamoto, Cathy Boyle, and Kristen Rogers Send letter to journal: Re: Re: Clarification? drjohnmccann{at}aol.com John J McCann, et al.	The interpretation of the findings in the case of a healed injury is the key issue that is being addressed in this article. In the introduction the authors state that "...,if an assault had taken place sometime in the past, the signs of trauma may have faded as the injuries healed." In this article's conclusion, the authors state: "These data heighten the examiner's need to exercise caution before calling a finding "normal, without evidence of a previous injury." The latter part of this statement "without evidence of a previous injury" is the operative portion of this sentence. During this study, it became clear that, except for the severist injuries that included transections of the hymenal membrane, once an injury had healed the findings were frequently similar to those interpreted as being "normal fndings" in the studies of children selected for "non-abuse." Due to this remarkable healing of female genital injuries the examiner must be very circumspect in declaring that there is no evidence of previous injury when in fact one would expect a normal examination except in a case where the injury was very extensive. Conflict of Interest: None declared

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